I Just Had a TT and my Surgeon Said Once Inside, He Saw I Did Not Need Muscle Repair, is This Common? (photo)

I believe in my surgeons skills. I am just shocked he said once he was inside I did not need muscle repair. I have had 3 c-sections gained and lost 80. Here is a before and after, do you think I will still get a nice final result? I am only 48 hours out. My husband and doc were showing me with there hands where my abdominal muscles were before and they are not really far apart, but also not super close. I really want to be able to get nice abs, I hope that is possible with working out now

Doctor Answers 14

I Did Not Need Muscle Repair??

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There is a group of women, some by fitness, some by good fortune, who have tight abdominal muscles in spite of needing a TT after pregnancy or weight loss. From the photos I am seeing a nice result in the after picture, and no suggestion of laxity in the pre-op photos you have attached. 

The muscle tightening sutures cause a considerable amount of the total postop pain, so when they are not going to do any good, I agree with not placing them.

Thanks for your question, best wishes. 

Seattle Plastic Surgeon

Tummy Tuck Without Muscle Repair

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While most women who have had three children and lost 80 lbs would need muscle tightening as a part of their tummy tuck, I would trust your surgeon's judgment. He actually saw the position of the two rectus muscles and could see if there was any significant separation. Contrary to some patient's perception, tightening the rectus muscles does not create 'great abs'. It will not produce abdominal muscle definition but instead contributes to an increasied abdominal flattening over what skin and fat removal alone can do. If the muscle tightening is not felt to contribute to that goal, then there is little purpose in doing it. Not every woman who udnergoes a tummy tuck does get muscle tightening although the vast majority do.

No Muscle Tightening with Tummy Tuck

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      If your muscles had no diastasis or separation at the midline, your surgeon did you a favor by not plicating.  The plication should always be anatomic, and that is one rectus abdominis muscle should be next to the other.  Some surgeons plicate without adhering to this, and one rectus abdominis is on top of the other.  This makes the recovery and subsequent working out very painful.  In addition, if you were able to achieve a 6 pack, you would have a three pack in this situation

Muscle Repair after Tummy tuck

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One of the best parts of a tummy tuck is that not only can your surgeon remove extra skin and fat from your tummy, but he/she can also tighten up your rectus muscles at the same time.  These are the muscles that give you the "six pack" abs appearance.  Most women who have had multiple pregnancies can really benefit from the tightening of the muscles which really slims the waist.  That being said there are a small group of women who have had pregnancies in the past for whom the muscles did not stretch or get separated.  In that case it is not necessary to tighten them during the tummy tuck.  It sounds like you may have been one of the lucky ones.  If so, congratulations and I hope you will have a fantastic result.

Was Muscle Repair Needed During Tummy Tuck?

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Most patients in your situation can benefit from a muscle repair but it is possible that you did not have a significant weakening of the the abdominal wall and your surgeon made a decision based on what was seen during surgery. Looking at the pictures you submitted, I think you will have a very nice result. 

Karol A. Gutowski, MD, FACS
Chicago Plastic Surgeon
4.9 out of 5 stars 76 reviews

Questions about a skin only abdominoplasty

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When we talk about muscle repair or diastasis recti repair at the time of an abdominoplasty we are referring to a plication of the anterior abdominal wall fascia.  This fascia wraps around the paired rectus muscles like a sausage casing.  With pregnancy and weight gain and weight loss this fascia gets stretched out.   The fascia has no elastic qualities and once over stretched there is no degree of exercising that can correct the problem, surgery is the only answer.  I would agree that it is unusual not to perform a fascial repair at the time of an abdominoplasty.   I check, pre-operatively, the degree of laxity of this layer.  I have the patient relax and push out their abdomen and perform a crunch.  This being said your surgeon is in the best position to know what needs to be done.  The fasical repair causes most of the pain following an abominoplasty and if it is not needed then you should have a smoother post operative recovery.  Fascial repair improves the resting tone of the abdomen and not abdominal muscular strength.   

Jeffrey Zwiren, MD
Atlanta Plastic Surgeon
4.5 out of 5 stars 20 reviews

Muscle repair during tummy tuck - best chance for an "internal girdle"

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AS I explain to patients - although the muscle repair hurts - I perform it on nearly every patient who has had children because it would be quite difficult to go back and do it later if the abdomen is not as flat as desired.

Muscle repair in tummy tuck

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After 3 C-sections, it is unlikely that you did not need muscle repair. Perhaps you could ask your plastic surgeon for clarification. At 48 hours postop, there is absolutely nothing to judge in terms of the position of the muscles. Relax, stay hydrated, don't overdo and give things a chance. It is far, far too early for speculation of any kind.

Muscle repair with tummy tuck is most most common

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It seem unlikely that after three pregnancies and an 80 pound weight loss you would not need muscle plication and correction of a diastsis. Those who do not need muscle sutures are quite uncommon. Luck just might be on your side, and only time will tell.

Peter E. Johnson, MD
Chicago Plastic Surgeon
4.0 out of 5 stars 44 reviews

Tummy Tuck; No Muscle "Repair" Necessary?

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Although your chosen plastic surgery will be your best resource when it comes to exactly how far your rectus muscles had separated, generally speaking very few patients with your history ( pregnancies and weight loss)  get away without the need for plication  of the abdominal wall muscles during tummy tuck surgery.

 At this point, all you can do is exercise patience and allow yourself many months (and even up to one year) before evaluating the results of surgery.

Best wishes for an uneventful recovery.

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.