Poll: Tummy Tuck Crossbow Technique

Hello, and thank you for your question regarding the Crossbow Technique used in tummy tuck surgery for diastasis repair. Not only have I heard of the "Crossbow" technique, but I also perform it selectively in appropriate cases. However, it’s important to understand that not every patient needs the Crossbow Technique, and it’s typically reserved for patients with significant abdominal wall laxity, often after massive weight loss.

In the traditional component of the technique, the rectus abdominis muscles are plicated vertically, from the sternum to the pubic symphysis using permanent sutures. This vertical plication tightens the abdominal wall with a natural horizontal pull, which is standard in most abdominoplasty procedures. The “crossbow” addition introduces a perpendicular, or horizontal, plication that includes the oblique muscles, resulting in a vertical pull. The goal is to provide a more corseted, cinched-in waist and flatter abdominal contour.

However, there are some important considerations and potential drawbacks to this approach. Plicating the oblique muscles, which are accessory muscles for respiration, can lead to shortness of breath postoperatively, especially in the early healing phase. Some patients experience such discomfort that they seek emergency care, concerned that something is wrong, when in fact it is due to the muscle tightness caused by excessive or multidirectional plication. For this reason, most plastic surgeons do not routinely perform oblique muscle plication.

In patients with severe abdominal protrusion and a large peritoneal cavity — such as those who have lost a significant amount of weight — the Crossbow Technique can offer some benefit. However, even in these cases, the amount of plication possible for the obliques is often limited to 2–3 cm, compared to up to 8 cm for the rectus muscles. Because of this small gain, many experienced surgeons feel that the additional risk and discomfort may outweigh the benefit in routine cases.

So yes, the Crossbow Technique has its place, but its use should be tailored to individual anatomy and goals. Patients should have a thorough consultation with a board-certified plastic surgeon who understands both the functional and aesthetic impacts of various muscle plication techniques.

I hope this helps clarify your question about the Crossbow Technique in tummy tuck surgery.

Sincerely,
Dr. Katzen

After elevation of the abdominal skin, if there is a separation of the rectus muscles, it is usually evident, and the fascia overlying the medial portion of both rectus muscles can be approximated with interrupted and running sutures to repair the diastasis to flatten the tummy. This returns the muscles to the correct anatomical position. In some patients, the fascia which lies across the front of both rectus muscles will also be stretched/ loose and a vertically oriented, crescent shape suturing of that fascia can be done to narrow the waist. Suture tightening of other portions of the abdominal fascia can be done on an individual bases, only if that fascia is lax. The fascia overlying the external oblique is thin and may not support tight sutures. By far the most common fascia tightening is to repair the central diastasis, with other areas addressed on an as needed bases. Best wishes.

Most abdominoplasties have plication of the rectus muscle in the vertical fashion. If there is still bulging below the umbilicus, at times a horizontal or oblique plication of the fascia is performed; referred to by some as "Tummy Tuck Crossbow Technique". This procedure is performed more commonly in revisional or secondary tummy tucks; or at times decisions are made intraoperative to minimize the supra-pubic bulge.

The goal is a flat abdominal wall, and there are many ways to achieve it in a satisfactory fashion. That's what patients want to. It sounds like you are more interested in taking a poll than any issues you may be having.

The technique should be chosen based on the patient's anatomy not patient's request. Some have long torso, some have short torso, some have had massive weight loss, some still have a BMI of 30. There is no such one technique that fits all.

When viewing an abdominoplasty and reinforcing the fascia, I routinely use a figure 8 stitch. A figure 8 stitch pulls both horizontal and vertical when the knot is tied. If you are interested in the strongest repair possible then I recommend reinforcing with mesh. Mesh has been used since the 1950's for hernia repairs of the abdominal wall and used for reconstruction all the time. It can be used to reinforce diastasis recti, in severe cases.

Best Wishes,

Gary Horndeski, M.D.

In a standard tummy tuck a plication of the rectus abdominis is performed in a vertical fashion. In most patients this is sufficient to provide an aesthetically pleasing result. In very few patients and added plication in a transverse fashion may also be required. This transverse plication can be performed in many different fashions to address the issue. Most patients do great with a vertical plication only.

Hope that helps.

Yes, most surgeons are familiar with this technique and most patients do not need or want this, especially those with any reflux and those with inner abdominal fulness from excess internal fat.

Thank you for your question. I have never heard it called Cross Bow, but yes, i do this all the time... when needed. most people only need the vertical tightening. Some patients need the vertical as well as the Oblique tightening.