Will Component Separation Flatten Tummy? Want my muscles back in place for function and want a flat tummy again. (5'4, 135lbs )

Question

Full TT to repair large diastasis. 2 Failed MRs from just below BB to rib cage. Large up ab bulge. Bottom flat. Seen two surgeons. 1st said he will just do a mesh, no plication. Says I do not have a hernia. 2nd wants to do component separation. Says I have a ventral hernia. Recommended a Gen Surgeon in the area with expertise that would take insurance for it. Since CS releases the side of the abs, will it fix the bulge and flatten tummy or just bring muscles to center with side laxity?

Bradley A. Hubbard, MD · Answer

Thanks for your question. It would be helpful to know what the two "failed" MRs mean. How was muscle repair performed from BB to below rib cage? A midline incision? I am concerned with how different your two consults were. Might be worth finding an experience board certified PS or getting a CT scan to better understand hernia vs. diastasis (weak or stretched muscles).  - If you have a hernia you should have a biologic mesh under the muscle then muscle repair or component separation on top of the mesh. Component separation only if the hernia is large.- If you have diastasis I would need to know more about what surgery was done before to understand how/why it failed.

Vasdev Rai, MD · Answer

Both the options described by you are used to reconstruct muscle wall and give support. With weak tissues flat tummy as desired by you is difficult to achieve.

Grady B. Core, MD · Answer

Components separation is a technique for ventral hernia repair that is only indicated when there is an absolute tissue deficiency. A routine ventral hernia or diastasis would not qualify. In fact , CS is rarely indicated, and even when it is should still be performed with an underlay mesh technique to reduce tension on the repair. A referral to the repair decision tree I published in the chapter on abdominal wall reconstruction in the last issue of Reoperative Plastic and Reconsyructive Surgery edited by Grotting will show you the progression of decisions. For a recurrence of upper abdominal bulging after prior adequate repair I would first be sure your weight is down to near ideal body weight to reduce intra abdominal fat (which causes tension on the repair) , then I would treat it as a "functional" ventral hernia and repair it directly with a running permanent monofilament suture in 2 layers over a mesh underlay. I wish you all the best.

Nicholas Tarola, MD · Answer

Thank you for your question.  Your past surgical history is a little unclear and there seems to be some disagreement as to whether or not you actually have a hernia.  An abdominal examination and likely a CT scan of the abdomen are required to give an accurate opinion and surgical recommendations.  That being said, a component separation surgery is typically not indicated to repair a rectus diastasis.  A diastasis does not cause problems or symptoms which is the reason insurance companies do not cover repair.  A component separation is usually the procedure of choice for large hernias or hernias that have recurred following repair.  Having performed this procedure a great deal, component separation is a very effective procedure with a low rate of hernia recurrence but it is not without its risk of complications.  Consult with a board certified plastic surgeon who is experienced in abdominal wall repair for a full evaluation and to discuss your options.

James E. Leake, MD (retired) · Answer

if you have had 2 failed MRs, chances are,  you have poor quality tissue strength. my usual choice would be attempt at some tissue repair in your midline. then i would use mesh and/or other support products for the repair. i would do the CS last. but to achieve the "flat stomach" will be very difficult, try to achieve some improvement and be accepting of that.

Will Component Separation Flatten Tummy? Want my muscles back in place for function and want a flat tummy again. (5'4, 135lbs )

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