Laparoscopic plication of recti or full tummy tuck? What are my options? (photos)

Question

A gen surgeon said I didn't have DR. 3 plastic surgeons said I don't need a tummy tuck and 1 said have plication. My DR varies between 2 finger width to 6cm gap. How do I really know how wide DR gap is with so many conflicting diagnosis? I had 2 c sections. I train at the gym. My core feels so weak and sticks out when I lift weights. I can't do certain yoga positions like plank or upward dog or back bend. My tummy protrudes when I squat. I don't know which procedure to go for. 5.5 y post natal.

Lucian Ion, FRCS · Answer

The easiest way to confirm whether you have diastasis of the recti is:-  lie down completely flat-  place the tip of your right hand fingers in the midline of your tummy above the bellybutton aligned   and press moderately-  sit up holding the pressure-  if you feel the muscles coming together and squeezing your fingers it means that  when relaxed they were sitting apart.  if you feel the muscles contracting under your fingers, there is no diastasis The scientific way would be to have an MRI scan or an ultrasound which can also identified the presence of a hernia,  commonly combined with the diastasis.Because your skin has very good elasticity,  you are a suitable candidate for an endoscopic assisted abdominoplasty either without skin reduction or just with a small reduction at the level of the C-section scar.

Christian West, MD, FRCS (Plastic Surgery) · Answer

Hi. The best way to confirm and image a diastasis is a CT scan. This allows your doctor to measure the width of the diastasis at many different levels across your tummy, and it also should show whether the stretched connective tissue between the six-pack muscles (linea alba) bulges outwards. 
I appreciate that, despite training your core muscles, diastasis can still cause loss of core strength because the six pack muscles are misaligned, and therefore don’t work optimally. 
For wide and symptomatic diastasis I recommend Rives-Stoppage retrorectus mesh repair as the strongest and most durable repair. I perform this via a cosmetic tummy tuck (abdominoplasty) approach to leave the most discrete scar concealed in the bikini line. This is the most effective way I am aware of to correct the muscular bulge caused by diastasis, and give a flat tummy.

Ahmed Ali-Khan, FRCS (Plast) · Answer

Hi thank you for your question. My expertise includes abdominal wall reconstruction on the NHS as well as my private cosmetic practice. Divarication can normally be felt. Another useful test is to lie flat and lift both feet in the air to tense the tummy - a significant midline bulge indicates divarication might be present. Finally an ultrasound scan will accurately measure the distance between the rectus muscles (ideally should be no more than 1-2cm); in abdominal wall reconstruction patients I use CT scans to assess the anatomy but you shouldn't require that.
I agree you don't appear to need a tummy tuck from a cosmetic perspective, therefore if there is separation a keyhole approach might be best for you. A tummy tuck approach might be necessary sometimes (without removing any skin) if there is scarring from previous surgery as this can sometimes make a keyhole approach impossible.
Best wishes

Laparoscopic plication of recti or full tummy tuck? What are my options? (photos)

Answers (3)

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Laparoscopic plication of recti or full tummy tuck? What are my options? (photos)

Answers (3)

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Recommended reading

Everything you need to know about Diastasis Recti Repair

Our mission is to create a world where every investment in modern beauty is Worth It.