I’m a 27 year old female who lost 145 lbs. Do I need muscle location? (Photos)

Question

I’m a 27 year old female who lost 145lb. I have a lot of loose skin on my abdomen but it retracted pretty well for how much weight I have lost. I’m in my 4th year of veterinary school and currently on rotations, so I have a limited amount of time (4 weeks) for recovery before returning back to clinics. I was contemplating a TT with no muscle repair as I think it would cut the healing time, but am afraid of looking boxy. I had a consultation with one surgeon who said that I probably could get by without muscle repair, but I’ve seen some really bad TTs and am scared.

J. Timothy Katzen, MD, FACS · Answer

Hello, and thank you for your question about whether you need a rectus abdominis muscle location or repair after losing 145 pounds at the age of 27. First, congratulations on your weight loss.  Next, let’s examine what your weight gain did to the rectus abdominis muscle.  The increase in peritoneal or visceral fat pushed the rectus abdominis muscle and created rectus diastasis.  The fascia around the rectus cannot contract because it lacks elastic properties.  Thus, the fascia is still weak.  Therefore, most plastic surgeons specializing in reconstructive surgery after massive weight loss would strongly recommend that you undergo rectus muscle repair.  During an abdominoplasty, also known as an extended tummy tuck or a 360-degree circumferential overbody lift, five items are addressed.  Excess abdominal, hip, and butt skin and fat are removed.  The pubic region (mons) is raised and reduced, and the umbilicus (belly button) is repositioned.  And perhaps most importantly, the rectus abdominus muscle is plicated from the sternum to the pubis. The rectus muscle repair will not interfere with your healing time.  The muscle repair will give you much superior results than no muscle repair.  If you opt for an abdominoplasty or body lift without muscle repair, you will likely appear more boxy than if you undergo those procedures with muscle repair.  In conclusion, most plastic surgeons would highly recommend undergoing muscle repair during a tummy tuck, especially after a history of massive weight loss.  Why waste time, money, effort, and time off from school to get a suboptimal result?  It would be disappointing if you underwent an abdominoplasty or lower body lift without the muscle repair, and then later discovered that you needed the muscle repair, then you’d have to undergo a second surgery, a second expense, more time off work, and more pain.  Therefore, most plastic surgeons would recommend that you undergo muscle repair.  Four weeks off should be sufficient time for muscle repair and a return to work.  However, why not wait until school is finished?  Good luck.
To get an accurate assessment of what exactly you need, schedule a free virtual consultation.  Most plastic surgeons offer free virtual consultations.  If you have any more questions regarding tummy tucks, abdominoplasties, or abdominal liposuction, contact an experienced plastic surgeon.  Since the tummy tuck surgery is a major procedure, please seek an experienced, board-certified plastic surgeon with significant experience in performing tummy tucks.  Do your research.   If you cannot find an experienced tummy tuck plastic surgeon in your area, consider traveling to another state for treatment.  Sincerely, Dr. Katzen, MD, MBA, FACS, FICS. ( Plastic Surgeon, President of the American Society of Bariatric Surgeons, certified by the American Board of Plastic surgery, Fellow of the International Society of Aesthetic Plastic surgery, American College of surgery, and International College of surgery and member of the American Society of Plastic surgery, American Academy of Cosmetic surgery, RealSelf Hall of Fame, and RealSelf Doctor Advisory Board for Medical Review and Consumer Panel.

Gregory Lakin, MD · Answer

Thank you for your question. Rectus muscle repair should only be performed if a true diastasis is present. If the gap is minimal (

Fouad V. Atalla, MD · Answer

A tummy tuck (abdominoplasty) can be performed with or without muscle repair (also called muscle plication), depending on your individual needs. Muscle repair is typically recommended if the abdominal muscles have separated&mdash;a condition known as diastasis recti, which is common after pregnancy or significant weight changes.
It’s important to know that the recovery time is generally similar whether or not muscle repair is included in your procedure. The overall healing process, activity restrictions, and downtime are typically comparable in both cases. 
The only way to know if you need muscle repair is to schedule a consultation with a board-certified plastic surgeon. During the consultation, the surgeon will examine your abdomen to assess whether muscle separation is present and whether repair is necessary for optimal results.
Remember, the decision to include muscle repair is highly individualized, and your surgeon will help determine what’s best based on your anatomy and goals.

Guray Yesiladali, MD, FEBOPRAS · Answer

After a large weight loss, not every patient has significant muscle separation. If your abdominal wall is still strong and the gap is minimal, a tummy tuck without muscle repair can still provide a good contour. This approach does usually mean a somewhat easier early recovery, although returning to full clinical rotations in only four weeks will still be challenging no matter which technique is used. Most surgeons recommend at least six weeks before resuming demanding activity.
The “boxy” look you are worried about is less about whether muscle repair is performed and more about how the skin and fat are reshaped. In the right candidate and with precise technique, natural curves can be achieved even without tightening the muscle. Muscle repair is most valuable when there is a clear diastasis or when functional support is needed for the core.
I have also shared a detailed video where I explain how tummy tuck results differ with and without muscle repair, and show examples from patients after weight loss. This may help you visualize what to expect in both scenarios.
&mdash; Güray Yesiladali, MD

Leila Kasrai, MD, FRCSC · Answer

Each surgeon has their post-operative instructions which include limitations on physical activity. If your school involves intense physical activity, such as dealing with larger animals, you may be advised to wait even longer than 4 weeks before returning. For this reason, it would be best to speak with your surgeon to see whether 4 weeks is sufficient first.

Michelle Zweifler, MD · Answer

During an abdominoplasty, if there is a diastasis then the muscle is usually plicated; not all patients need the muscle tightened.  With massive weight loss, a standard tummy tuck is an option, a circumferential abdominoplasty (to minimize dog's ear), and fleur-de-lys with a vertical component (to help contour the waist and remove excess skin in 2 directions)

Daniel Butz, MD · Answer

If you haven’t had children and you have minimal muscle separation you could likely have a great result without repairing the muscle. Boxy results are often a result of skipping the liposuction when it would’ve been helpful. 
Make sure you choose a board certified plastic surgeon who has a lot of results that you like and you trust. Get a couple opinions. Don’t choose the ‘easier’ surgery if it’s not the right one for you. You only want to have one tummy tuck.

Danivel Cespedes, MD · Answer

Congrats on your weight loss, 145 lbs is an incredible achievement! Given how well your skin has retracted, a tummy tuck without muscle repair could be an option, especially if you're on a tight recovery timeline during vet school.
That said, muscle repair isn't just about looks it helps define your waist and prevent that “boxy” shape you're worried about. If your core feels strong and you’re not dealing with diastasis or back pain, skipping it might be okay, but only with a surgeon who truly understands post-weight-loss bodies.
If you're hesitant, consider getting a second opinion. Not all tummy tucks are created equal and a well-done result should leave you feeling confident, not concerned.

George Marosan, MD · Answer

Thank you for your question and photos. First of all, I do not plan a surgery "that you probably could get by without muscle repair" and hope others don't either. As a board certified plastic surgeon with years of experience in body sculpting techniques, I do what will give the best possible results for my patients based on their anatomy. Yes, you can do less, but then you are setting yourself up for another surgery. A secondary surgery might not turn out as good. I would recommend a full abdominoplasty with muscle plication, low pubic bone level incision and lifting the sagging pubic tissues. I do these surgeries in our office surgical suite under deep intravenous sedation and not general anesthesia. Initial recovery is 7-10 days, but in one month you can return back to your clinical duties. Good luck.

Chet Mays, MD · Answer

Thank you for your inquiry! You have excess abdominal skin from weight loss making you a great candidate for an abdominoplasty procedure. The amount of recovery time is the same whether you get muscle repair or just skin removal. We would love to see you in person and help you reach your goals. Schedule a consultation with a Board-Certified Plastic Surgeon like myself and we can create a surgical plan for you!