How Can You Determine the Need for Muscle Repair During a TT Evaluation? (photo)

I am wondering how it is determined that you need muscle repair or not. Full or mini tuck just by observation. My first consult did not even look at me without cloths before he decided full. The second looked without cloths and said mini and lipo. How do you know repair is necessary? When it is repaired what actually happens??? Thanks for all your help. Also are you insulted when a patient tells you exactly what you expect and what they want?

Doctor Answers 10

Tummy tuck and muscle repair

An evaluation for tummy tuck includes examining the abdomen while the patient is relaxed and leaning slightly forward on exhalation.  If the abdomen protrudes, then muscle repair wound be beneficial.

When a tummy tuck is indicated, it is rare not to perform muscle repair at the same time.

 I hope this helps.

Nashville Plastic Surgeon
5.0 out of 5 stars 182 reviews

Muscle repair in tummy tuck

One helpful way to see if a muscle procedure will improve things is to let your stomach hang out, and compare that to sucking your tummy in some. If you look flatter and like that, then muscle plication usually helps the way your results will look. In my practice, almost all tummy tuck patients choose to have their muscle tightened. Some need muscle repair, but due to their desire to avoid pain, or due to concern about downtime, they choose to not have muscle tightening.

A mini-tuck usually is used only where there is a little looseness in the lower abdomen. If there is any looseness around the belly button or upper abdomen, then a full tummy tuck is needed. Again, almost all of my patients choose a full tummy tuck.

Victor Au, MD (retired)
Chapel Hill Plastic Surgeon
4.5 out of 5 stars 7 reviews

Diagnosis for Tummy Tuck

Hi there-

Generally speaking, if a surgeon doesn't examine you completely, you should not let them operate on you... Similarly, anyone who offers to operate on you should be able to explain why the operation would benefit you, the alternatives available, and why the recommended option is best for you...

Unfortunately, it sounds like your two visits achieved very few of these goals...

The best advice I could give you would be to keep looking until you find a surgeon Certified by The American Board of Plastic Surgery who you like and feel you can trust. I hope that you have not been having bad experiences because you are searching for all the wrong things... In other words, if you are looking for the lowest price, you are also likely to find the lowest quality.

It would be difficult, if not irresponsible for me to make a surgical recommendation for you without examining you myself, but I would say that in general I believe "mini" tummy tucks end up being a source of regret for surgeon and patient alike.

Armando Soto, MD, FACS
Orlando Plastic Surgeon
4.8 out of 5 stars 157 reviews

Plastysma plication in abdominoplasty

Any consultation for surgery requires a full examination.  If you saw a surgeon who skipped the examination, then you should skip out on that surgeon and find someone who performs a complete evaluation before making a recommendation for  surgery.  Tightening of the muscle is required when there is laxity.  Under such circumstances, the tummy tuck would remove excess skin but there would still be a bulge in the abdomen.  Photographs alone cannot disclose whether there is muscle laxity as posture can be part of the equation.  If the abdominal muscles are spread, creating what is called a diastasis or gap, then performing a tummy tuck without muscle tightening will not produce a fine result.

Robert L. Kraft, MD, FACS
New York Plastic Surgeon
5.0 out of 5 stars 40 reviews

Testing for a muscle repair for tummy tuck

There is a simple process to find a diastasis or muscle separation before a tummy tuck. If you lay on your back and press your finger into the midline of your abdomen near the belly button, and pick your head fully up as in doing a sit-up, you may feel the separation between the muscles as they tighten. What is actually repaired during tummy tuck is the outter layer of tissue (fascia) over the muscle closing the gap and tightening the abdomen. You must tell your surgeon what you expect and what you want, and if they are not listening there may be a red flag.

Best of luck,

Peter E. Johnson, MD
Chicago Plastic Surgeon
4.0 out of 5 stars 42 reviews

How you determine if muscle repair is needed with a tummy tuck?

This is determined on the physical examination during the consultation. I have my patients lie supine in the exam chair and have them lift their heads up from the head rest. This way I can palpate the muscle edges and determine the degree of distance of muscle separation. Also tells me if the person has a midline hernia as well.

George Marosan, MD
Bellevue Plastic Surgeon
4.8 out of 5 stars 38 reviews

Abdominal evaluation

I would avoid a surgeon who doesn't do a complete examination. I would also be suspect of a surgeon who won't listen to what you want, even if listening to you means disagreeing with you. Regarding muscle plication, I think this is an overdone part of an abdominoplasty. This is especially true for someone who has significant fat layers since muscle tightening may not change the external appearance of the abdomen and increases risk of pulmonary and deep vein thrombosis complications. I always ask patients to stand erect and contract their abdominal muscle with and without "sucking in" their abdomen. Very little external change when a patient contracts the muscle may indicate that muscle tightening is not very necessary.

Robin T.W. Yuan, M.D.

Robin T.W. Yuan, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 11 reviews

Tummy Tuck and Muscle Repair?

Thank you for the question and pictures.

The need for “muscle repair” is based on obtaining a good history and physical examination. The status of the abdominal wall muscles  can be determined by visual examination and palpation in the upright and bent over (diving) positions.

The reapproximation (plication)  of the rectus muscles is an  important part of all tummy tuck procedures I do.  These muscles have spread apart during pregnancy and/or weight gain. Bringing them together again in the midline helps to “tighten” the abdominal wall as well as to narrow the waistline.

In my opinion, the mini tummy talk is an  operation that  produces very limited results and is very rarely indicated. It involves a shorter incision but does not address the majority of the abdominal wall issues present for most patients who present consultation. For example, the area of skin excised is quite small. The abdominal wall musculature is addressed below the umbilicus leaving the upper number wall potentially lax. The appearance of the umbilicus is not necessarily addressed sufficiently.

For most patients who have had pregnancies and/or weight loss a full abdominoplasty is necessary to achieve the desired results. Of course, there are downsides (including a longer scar and probably a longer recovery time) but for most patients the benefits outweigh the downsides. It is not unusual to see patients who've had mini tummy tuck  surgery present for  revisionary surgery.
It is important  for patients seeking abdominal contouring surgery to work with a well experienced board-certified plastic surgeon to obtain advice (based on good ethics and judgment) to  improve  their chances of a successful outcome and minimize the need for further surgery.

I hope this helps.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 1,487 reviews

Muscle Repair with Tummy Tuck is needed when Physical Exam reveals a split between the Rectus Muscles called a Diastasis Recti

Muscle repair during a Tummy Tuck is done to repair a split between the two Rectus Abdominus Muscles of the abdomen. This split is usually occurs after pregnancy.

Diagnosis is made during Physical Exam. With you lying on the exam table the Physician will ask you to do a partial sit up while the doctor is examining your abdomen. As your abdominal muscles tighten, the doctor can feel the split between the two large Rectus Abdominus muscles.

If muscle repair is required during your Tummy Tuck then a full abdominoplasty will usually be necessary.

A Mini Abdominoplasty or mini Tummy Tuck typically does not allow enough exposure or visibility to complete a full repair of a Diastasis Recti.

Muscle repair during tummy tuck

You are on the right track.  My advice:  Don't return to the office that rendered an opinion without directly looking at and feeling your belly.  It is impossible to offer a professional evaluation with clothing covering your belly.   If you plan to have more children, strongly consider deferring full tummy tuck until after the final child.  I NEVER do a tummy tuck without tightening the fascial envelope surrounding rectus abdominis muscles, because it is this maneuver, and this maneuver alone, that narrows the waist, flattens the post-partum bulge, and allows sufficient skin advancement to close with a low scar.  For step by step technical details, check out the procedure animation for abdominoplasty on our website.

Steve Laverson, MD
San Diego Plastic Surgeon
5.0 out of 5 stars 46 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.