How High Up Torso Does Diastasis Repair and Tummy Tuck Go?

Tightening the fascia that surrounds the rectus muscles is commonly performed as part of a standard tummy tuck. Some patients have an easily felt separation between the mid-line muscles known as a diastasis, while others just have an overall laxity. Tightening this layer to restore a more flat abdominal profile usually involves a tapered tightening that extends from the lower part of your breast bone to the pubic bone.

In some cases, the tightening of the deep layer can exaggerate the looseness horizontally of the skin. Having a clear understanding of the shape improvements and effect on the skin is important to discuss before surgery. Tightening the upper abdominal skin after surgery is difficult and often not worth the additional scarring required. Allow yourself to heal completely (more than 6 months) before evaluating your result to closely.

Dr. Mosher

Usually the diastasis repair goes from the sternum to the pubic bone.  It varies depending on the patient's need.  Your surgeon can demonstrate for you in your consultation. Good luck.

A TT typically will have varying amounts of muscle repair along the torso where it is tightened the most at the waist so there's no ribs or pelvic bones limiting the tightening and thus reducing the waist as much as possible.  The upper abdomen can be stubborn sometimes and you may need liposuction but only on exam would one be able to tell because this area is tough to examine.

Most plastic surgeons repair the diastasis from the lower end of the rib cage to the pubic bone.

I always advise patients preop that they will see somewhat less improvement over the upper abdomen compared to the lower. This is mainly due to the fact that the flap, or apron, is being pulled downward  from below. As we get higher on the abdomen the effect of the pull decreases. If it did not, then your breasts would be pulled down along with your tummy.

I usually do a small amount of liposuction over the upper abdomen at the end of the procedure. This tends to flatten the area enough to avoid postop bulging. However, the skin in this area may still not be as tight as you would have wished.

Remember: a tummy tuck is surgery, not magic!

Tightening and flattening the abdominal wall with plication sutures is probably the most important part of a TT procedure- it recreates a feminine and youthful form in a way that liposuction or simple skin excision cannot achieve. I plicate the abdomen from the xyphoid to the pubic bone level. Partial plication will create a 'partial' result, and who wants that ?

The true answer is: however high and low it needs to be.  In other words, the extent of the repair is decided upon inside the operating room after the area is exposed and the condition of the tissues.  What you feel has been repaired or not is may or may not reflect what really was repaired.  I would discuss your observations frankly with your plastic surgeon and determine how much these "problem areas" will resolve over time.

The repair will usually go very close to the xiphoid process of the sternum which is the bottom of your breastbone. I have found this area to usually be a little bit more resistant to repair. It just seems that the lower abdomen can be tightened a little easier. In addition the lower abdominal skin is usually tighter as well since the lower abdominal skin gets stretched more during the procedure. These two occurences could lead to what you're seeing. However most of the intra-abdominal fat is up in the upper half of the abdomen and might be pushing this portion of your abdomen more. Your surgeon should be able to explain the findings in a way you can understand. It is certainly possible that these findings are just your normal underlying anatomy as well. Best of Luck Dr Harrell

The purpose of sewing the rectus muscles (technically the fascia of the muscles) is to bring them closer together to help correct one component of the abdominal bulging problem. (the skin and the fat are the other two) This is usually done from just under the rib cage (xiphoid process) the whole way down to the just above the pubic bone. But it is up to the plastic surgeon's discretion as to whether it is beneficial to cover this entire vertical length or not. More pain after surgery comes from more muscle sewing so there is no reason to do more  than is absolutely necessary. Not every patient needs the entire muscle length brought together. It is extremely common to see a differential amount of abdominal improvement between above and below the belly button. The best and most flat result is seen between the belly button and the pubis because this is where the skin and fat is completely removed. Between the rib cage and the belly button, there still may be some amount of bulging as this skin has just been pulled down and stretched but not removed. That is likely the reason you have some bulge remaining in this area, it is not due to muscle protrusion. This can be improved later with some liposuction to thin out the tissue thickness in this area.

It may be that your muscle repair was up to your breast bone, but you can still have loose skin in your upper abdomen.  A standard abdominoplasty does not address the upper abdomen very well as it focuses on tightening the skin in the lower abdomen where the laxity is usually worst.

In order to address upper abdominal laxity specifically, you would be looking at a reverse abdominoplasty.  However this is another relatively major procedure and will leave you with scars in your upper abdomen, just below your breast.  You need to leave at least 6-12 months before considering this procedure.

Generally the muscle repair goes from just under the breast bone to the pubic area, but there may be patients who have a bit different anatomy and thus don't need exactly the same thing.

Just tightening the muscle in the lower abdomen as is sometimes done in a "mini" tuck can make the bulge worse up top.

I would say most patients (unless very thin) can't feel the internal sutures at all.