Is a vertical scar necessary as well as a horizontal for diastasis recti surgery? (photos)

Question

I have severe diastasis recti and am in the process of scheduling surgery.I met with the surgeon and he said more than likely I am going to need a vertical cut as well as a horizontal. He also said I will more than likely lose my belly button. This is going through insurance and where I am from there is only 1 plastic surgeon who accepts my insurance. I am 5'2 and currently weigh 115. Pre pregnancy weight was 110 and I weighed 140 while pregnant. Just looking to see if this is normal! Thanks!

David J. Wages, MD · Answer

Thank you for your question and photos.  There are many reasons one may make recommendations on treatment options.  No online reviewer can diagnose or make treatment recommendations without an examination.  Based on the images I believe that there are trade-offs to each option for repair.  A vertical incision may provide the maximal improvement in contour while a transverse incision may have limited benefit.  With a vertical or horizontal scar it would be unusual to need to sacrifice the umbilicus.  I would recommend a face to face consultation with a board certified plastic surgeon who specializes in diastasis repair.  Good luck.

James E. Chappell, MD · Answer

I suspect, based on photos, that at most a short vertical scar will be necessary in addition to the horizontal "bikini" scar that will presumably be used.  If the vertical part is necessary I would suspect it would be because the belly button is relatively high, you are not the tallest person in the world, and you don't have that much skin laxity above the belly button.  What that last sentence means is that the surgeon might not be able to remove all of the skin from the belly button down to the pubic region, and therefore he may not be able to include removing the skin next to the hole that is left in the skin when the belly button is dissected free without causing undue tension, so the skin on either side of that hole needs to be repaired, meaning you get a vertical scar above or joined to the horizontal scar.  Sometimes people call where the scars meet an "inverted T".  I doubt I would offer a big long vertical scar just for the skin laxity overall, opting instead for a longer "bikini" scar.  Best of luck to you.

Michael McClure, MD · Answer

Typically you would need to have a horizontal incision for this operation.   There can be reasons for a vertical incision so I would be certain to ask your plastic surgeon why a vertical incision is required.  You need to make sure all of your questions are answered before proceeding.  Best of Luck

Nick Masri, MD, FACS · Answer

a horizontal tummy tuck type incision is the standard approach for a rectus diastasis repair. A vertical incision is rarely necessary except in cases of extreme weightloss or skin excess. Based on your photos you may have excessive skin in the upper middle aspect of your abdomen which may warrant the vertical component. I prefer to extend the horizontal component to just beyond the hips in an effort to redrape the skin to displace the midline skin excess. This is an aesthetic approach to dealing with a problem with both aesthetic and functional issues. Discuss this with your plastic surgeon. Best Wishes

Robert L. Kraft, MD, FACS · Answer

A horizontal scar which is inside the bikini line is generally used in abdominoplasty. However, there may be militating factors in your case as the diastasis is so severe.

Is a vertical scar necessary as well as a horizontal for diastasis recti surgery? (photos)

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