Diastasis recti repair. General surgery othroscopically with robot or standard abdominoplasty? (photos)

Question

I'm a 63 year old male 5'10" 205lbs. I have a diastasis recti from my sternum to my belly button that has an umbilical hernia. I had liposuction to my abdominal 7 years ago so don't have much fat or loose skin there. A highly recommended general surgeon recommends an othroscopic repair with the robot using mesh and the head of plastics at a major medical school recommends a abdominoplasty. My insurance will cover the general surgeon as a ventral and umbilical repair. I'm worried the mesh.

J. Timothy Katzen, MD, FACS · Answer

Hello JTOWN 54 in Denver.  Thank you for your question regarding rectus diastasis repair and whether you should undergo arthroscopic mesh repair with a robot and a general surgeon or undergo a standard abdominoplasty with a plastic surgeon.  
Thank you for your history and your pictures.  I suggest you undergo functional correction before you undergo cosmetic correction.  I mean that hernias should be fixed before cosmetic or elective procedures.  If your rectus diastasis and ventral and umbilical hernia repairs are covered by insurance, I suggest you undergo arthroscopic rectus abdominis diastasis repair with your general surgeon and robot.  During the arthroscopic mesh repair, your abdomen is inflated with air.  This exposes the rectus abdominis muscle.  Then, a piece of mesh is inserted into the peritoneal cavity, and the rectus diastasis is repaired.
The ventral umbilical and hernia will also be repaired from the inside.  After your rectus diastasis repair, you can reevaluate the abdomen.  If you do not like the appearance, you could undergo an abdominoplasty or tummy tuck.  You may be satisfied with the results after the mesh repair and not need to pay for a cosmetic abdominoplasty.
Regarding the mesh during the arthroscopic procedure, the mesh is placed behind the rectus abdominis muscle.  This is one way to repair the rectus diastasis.  If the rectus diastasis were to be repaired by a plastic surgeon during your abdominoplasty, the rectus abdominis muscles would be implicated or brought together and possibly mesh placed on top.  Therefore, with the arthroscopic procedure, the mesh is placed behind the rectus abdominis muscle, and with the abdominoplasty, the mesh would be placed on top of the muscle.  Nothing is wrong with either procedure.  It is just different approaches to repair the same defect.  In conclusion, I suggest you go with the insurance-covered rectus abdominis diastasis repair with your general surgeon and robot.  I hope this helps to answer your question about whether you should undergo a rectus abdominis repair with a general surgeon and a robot or undergo a standard abdominoplasty.  Good luck.
Since tummy tuck surgery can be a big procedure, please seek an experienced, board-certified plastic surgeon with significant experience performing tummy tucks.  Do your research.   If you cannot find an experienced tummy tuck plastic surgeon in your neighborhood, consider traveling out of state.  Sincerely, Dr. Katzen, MD, MBA, FACS, FICS. ( Plastic Surgeon, President of the American Society of Bariatric Surgeons, certified by the American Board of Plastic Surgery, Fellow of the International Society of Aesthetic Plastic Surgery, American College of Surgery, and International College of Surgery, and member of the American Society of Plastic Surgery, American Academy of Cosmetic Surgery, RealSelf Hall of Fame, and RealSelf Doctor Advisory Board for Medical Review and Consumer Panel.)

Steven J. Rottman, MD, FACS · Answer

Thank you for your question and photos. You appear to only need muscle repair, not a formal tummy tuck. A laparoscopic approach should be all you need. Please meet with a board certified surgeon who frequently performs this procedure. Hope this helps and good luck with your procedure.

Gregory A. Buford, MD, FACS · Answer

From the pictures your provided, it is evident that you have a fair amount of excess skin which will only increase following repair of the diastasis.  My suggestion would be to do a Tummy Tuck.  A repair alone will do just that and not address the excess skin.  The only downside is the scar but the big upside is the fact that you will have a much nicer shape to your abdominal wall overall.I hope that helps!

Lee E. Corbett, MD · Answer

Either approach will correct your problem. You have to weigh the pros and cons of each approach. The abdominoplasty will leave more of a scar though.

Jon A. Perlman, MD (retired) · Answer

Your situation is somewhat unusual since you don't really need a tummy tuck just a DR repair.  Laparoscopic surgery in the hands of an experienced surgeon would seem appropriate but please inquire how many similar cases he/she has done and what the success rate has been.  Ask to see photos to view skin quality after muscle wall tightening.  ATB,Jon A Perlman MD FACS 
  
Certified, Am Board of Plastic Surgery 
  
Member, Am. Society for Aesthetic Plastic Surgery (ASAPS)     
  
Member, Am. Society of Plastic Surgeons (ASPS)
  
Beverly Hills, Ca

Diastasis recti repair. General surgery othroscopically with robot or standard abdominoplasty? (photos)

Answers (5)