Repair of supraumbilical diastasis recti? (photos)

Question

I have three wonderful daughters who are the lights of my life but left me with some unfortunate abdominal results. I have a 3 finger width diastasis which is mostly supraumbilical as well as a small umbilical hernia. The diastasis does extend infraumbilically as well but is more shallow and narrower there. I do not have much redundant skin and have good skin integrity with no stretch marks. Is my only option for repair of the diastasis a full abdominoplasty? Willing to travel for results.

Jerome Edelstein, MD · Answer

Hello,Thank you for your question. You may be a candidate for the FAB or floating Abdominoplasty procedure. If you do not have much excess skin or fat, but do require diastasis recti repair.Using a small incision in the lower abdomen, this new tummy tuck surgery technique allows the tummy to be tightened and shaped with optimal results. Also referred to as an extended Mini Abdominoplasty, this procedure is an excellent option without the telltale signs as there is no incision around the belly button. Excess skin is removed through the incision; the belly button is temporarily detached and ‘floats’ above the muscles. This allows the muscles to become tightened and reshaped from sternum to pubic area, that is, along the entire length of the abdomen, as opposed to a typical mini tummy tuck where the muscles are only tightened below the belly button. The skin on the abdomen is then made smooth and firm, and the belly button is reattached from the inside with the option of moving it down one or two cm if necessary. To sculpt to an even greater degree, liposuction is performed, resulting in beautiful tight abs with a scar that is minimal and discreet.I recommend that you seek out board certified Plastic Surgeons in your area who perform this procedure and book your in-person consultations. Your Plastic Surgeon will examine you, your skin, and discuss surgical options with you.All the best

Scott C. Sattler, MD, FACS · Answer

Its reasonable to approach your rectus diastasis and umbilical hernia repair from a low pelvic incision. This would eliminate a visible scar with underwear on.

Afshin Parhiscar, MD · Answer

Dear ejean1127Congratulations on having 3 daughters, you must have your hands full!!  Repair of the diastasis is independent of skin excision or re-positioning. What that means to you is if you don't have excess skin, you don't need a full abdominoplasty.  Based on your examination, the entire procedure could be done through a small horizontal incision at the level you would have a C-section scar and if needed a peri-umbilical incision. Look for an experienced and well trained Plastic Surgeon certified by the American Board of Plastic Surgery. See more than one consult and make a well informed decision.

Shwetambara Parakh, MD · Answer

With minimal to no excess skin , repair of rectus diastasis and repair of umbilical hernia can easily be performed by an incision in the pubic region (roughly the size of C-section). There will be no scar in the belly button rather this will be repaired from the inside through a procedure called floating the umbilicus. You should consult with a board certified plastic surgeon in your area.Good luck !

Larry S. Nichter, MD, MS, FACS · Answer

It is difficult to help you without an in person examination as that is the best way to decide on the course of treatment. Far more important than the technique is the skill and experience of your
plastic surgeon. Choose your surgeon rather than the technique and let them
explain why one technique may be better than another.

See the below link on some suggestions on
finding the most qualified Plastic Surgeon for a abdominoplasty. From your photos you may be a candidate for umbilical hernia repair and using this incision to repair the supraumbilical diastasis recti with or without endoscopic assistance.  Repair of Diastasis Recti is typically done as part of a Tummy Tuck or Mommy Makeover procedure (regardless of technique) and consists of bringing the Rectus Abdominis muscles together by suturing (sewing) the inside edges of the muscle fascia together. I have found that it makes no difference if the suture material is absorbable or permanent, and typically I perform a two layer repair to insure that the correction is secure. Single layer closures may have a higher tendency of dehiscence (separation) that would require reoperation for repair. Although Diastasis Recti Repair can be done endoscopically for minor separations, this is no longer as popular of a procedure as there is a tendency for midline redundant skin unless there is wide undermining. Recovery is similar to most plastic surgical/muscle repair procedures: no heavy lifting or vigorous exercises for 4-6 weeks depending on your plastic surgeons wishes. With core exercises as part of your daily routine following this procedure you are well on your way to develop a “six pack Abs of Steel”.

Richard Baxter, MD · Answer

A mini tummy tuck, which will leave only a short and low scar, can allow for full muscle repair including the upper abdomen using a technique called umbilical floating. This detaches the belly button from underneath (so no external scar) which would also facilitate repair of the hernia.

Curtis Wong, MD · Answer

requires access to get to that and that would mean an umbilical float where your umbilical hernia could also be repaired at the same time and your muscles repaired.  If you don't have much skin laxity above the belly button, you could float your belly button an inch down and no one would notice.  If there is more skin laxity, it will require some modification that your surgeon can discuss with you.

Robert Singer, MD · Answer

There are a variety of surgical procedures or combinations that
can produce good results in patients with  diastasis recti, depending on multiple factors
including their anatomy and degree of desired improvement: A mini tummy tuck,
an umbilical float modified tummy tuck, a full abdominoplasty. Each of these
can be produce different degrees of improvement.

No
matter which procedure that you decide to undergo, it is advisable that you
should wait until you are finished having children.

Following
the advice of anyone who would presume to tell you what to do based on two
dimensional photos without taking a full medical history, examining you,
feeling and assessing your tissue tone, discussing your desired outcome and
fully informing you about the pros and cons of each option would not be in your
best interest. Find a plastic surgeon that you are comfortable with and one
that you trust and listen to his or her advice. The surgeon should be certified
by the American Board of Plastic Surgery and ideally a member of the American Society for Aesthetic Plastic Surgery (ASAPS). You should discuss your concerns with that surgeon in person.

Robert
Singer, MD  FACS

La Jolla, California

Neil T. Chen, MD · Answer

Thank you for the question. From your pictures, you appear to diastasis as you described. To address the diastasis and to repair the hernia, we usually do abdominoplasty. However, if you indeed do not have any laxity of skin and want to minimize the scars, you may be a candidate of limited incision repair from the belly button. I would recommend to talk to a few qualified surgeons first before you travel. Good luck.

Steven Wallach, MD · Answer

You might be the rare candidate for an endoscopic diastasis repair if you do not have significantly loose skin. You should have the hernia repaired as well.

Repair of supraumbilical diastasis recti? (photos)

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