Should not fascia be tightened at time of DIEP surgery?

The good thing about DIEP flap is the preservation of all the abdominal muscles and fascia when compared to a TRAM flap, which makes abdominal hernias less likely. Usually we do not need a fascial tightening during a regular DIEP surgery. But if you had had a rectus diastasis and it was repaired at the time of DIEP, then the current problem may be related to either:* Loosening of diastasis repair sutures or some sort of incisional hernia on the DIEP pedicle side. Differential diagnosis may already be evident to your surgeon, as he knows the details of your surgery. But for me, it needs both a physical examination to localize the weakness (whether it is in the midline or on one side) and an ultrasound examination to see the tissue layers. Then, either a fascial tightening with or without mesh enforcement can be planned.