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

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.

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.

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.

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.

The determination as to whether or not muscle tightening would be beneficial can only be made with a physical examination. With the patient laying flat they are asked to elevate their head as though they are performing a sit up. The surgeon will then feel the central line of the abdomen extending from the rib cage down to the pubic pubic bone. If a separation exists then repair is usually beneficial.
Abdominoplasty (tummy tuck) is one of the most frequently performed and popular procedures and plastic surgery. Most women who undergo abdominoplasty do so after they are done childbearing. Unfortunately childbearing causes significant stress of the abdominal wall in all directions. Many women also experience separation of the rectus muscles of the abdominal wall. These are to parallel muscles running from the rib cage down to the pubic bone. Fortunately this separation can be repaired during the course of a full abdominoplasty. In general when stretch marks are present the best operation is usually a full abdominoplasty.
In a full abdominoplasty an incision is made from one hip to the other. I prefer patients to bring in the lower portion of the two-piece plating sutures they would most like to wear. This allows me to design the incision in the most favorable location. It is best to put the incision as low as possible. In general this usually means approximately 7 cm from the opening of the vagina.
After this incision is made the skin and fat layer is separated from, and elevated off, of the underlying muscle layer. This separation continues up to the belly button. An incision is then made around the belly button releasing it from the skin and fat layer being elevated. This allows for elevation of the skin and fat layer to continue up to the rib margin. At this point the entire central muscle layer is exposed and can be tightened from the rib cage all the way down to the pubic bone. The skin and fat layer is then pulled snugly down to the lower incision and the excess skin and fat is removed. The belly button, which is still attached to the muscle layer, is then brought out through a new incision at the same level it was at the beginning.
In the ideal situation the original incision which was made around the belly button is pulled down far enough to be discarded with the extra skin. Occasionally this skin cannot be tightened enough to allow for the removal of the opening created by the original incision around the belly button. In this situation the opening has to be closed leaving a vertical incision somewhere between the belly button and the pubic bone. Most often, with careful attention to detail, the closure of this vertical incision can result in a very acceptable scar.
In a mini abdominoplasty the incision is designed along the same lines as the full abdominoplasty. Very often the length of the incision for the mini abdominoplasty is similar to the full abdominoplasty incision. Even if it is shorter healing time for the incision will be essentially the same because incisions healed from side to side not end to end. After the incision is made skin and fat layer is elevated up to the belly button but not past it. Because the skin and fat layer is not elevated off of the upper abdomen complete tightening of the muscle layer is not possible.
After the skin and fat layer is elevated it is pulled down tightly and the excess is removed. No tightening of the skin above the belly button is performed. Very often during the course of the mini abdominoplasty the rest of the abdominal wall is liposuctioned to remove excess fat.
Although the recovery time for a full abdominoplasty is somewhat longer than a mini abdominoplasty the results are worth it.
If you are considering a tummy tuck be sure to consult a surgeon certified by the American Board of Plastic Surgery who performs these procedures on a regular basis.

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.

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, peterejohnsonmd.com

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.

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.

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.