Component Seperation Technique and Diastasis Recti?

Question

My board certified plastic surgeon has recommended both anterior and posterior repairs via a component Seperation technique for my Diastasis recti. How is this different from a standard repair? Also, can this be done without mesh because I am allergic? Will it hold? Thanks

Ronald J. Edelson, MD · Answer

I see no need for either component separation or mesh in tummy tucks I have  performed.  They may have their place in a severely stretched out tummy with a true hernia, but those cases are not the typical tummy tuck.  Component separation and mesh are used in really bad reconstructive cases but not in the routine case.

Jon M. Grazer, MD, MPH, FACS · Answer

Component separation is usually reserved for wide hernia repair that 
cannot be closed without tension or mesh. A tummy tuck with moderate 
diastasis rectus, does not require separation of components.Without
 a physical examination and an MRI of your abdomen, it is not possible 
to determine if you  need to have separation of component repair.You state that you are allergic to mesh. If you know you are allergic to mesh that would mean you have already had mesh for some type of repair. If that is the case, you may have a hernia that needs separation of components. Separation of components does not always entail use of mesh. There also many different types of mesh and ADM's, that are available that are not reactive.Any repair that requires mesh, or separation of components, is at risk of failure.Yours,Jon M. Grazer, MD, MPH, FACSPlastic SurgeryNewport Beach, CA

Sam M. Sukkar, MD · Answer

Component separation is a technique utilized to allow the muscle wall to be sutured back in the midline. A standard diastasis doesn't typically require this to be performed and the muscle edges can be brought back together without much difficulty. If you a severe diastasis or a hernia this technique can be useful. Mesh is typically used as additional support over the repair, but is not usually necessary, adds expense and is a foreign body that could cause problems down the road.without pictures, a definitive answer is hard to provide with any accuracy.good luck!

Kenneth Hughes, MD · Answer

This would be unusual, but an exam would be necessary to make a determination.  I
would search for the board certified plastic surgeon who you feel is
most likely to give you the best results and who performs hundreds of
these procedures each year. I would look at patient reviews as well as
before and after photos on that surgeon's website.Kenneth Hughes, MDLos Angeles, CA

Donn M. Hickman, MD · Answer

The component separation method is usually employed for more complex muscle separations and large hernias where a mesh or other implantable material is not considered.  It is an aggressive and tedious procedure and has features of what are called relaxing incisions used to gather more tissue on either side of the defect or diastasis.  If your surgeons feels this is necessary you may have a large problem he has assessed.  He may not be inclined to use mesh. Ordinarily non-eviserating or non-intestinal bulging defects can be repaired by conventional methods with and without mesh. Relaxing cuts can be made as necessary in the right place. The right place is the key word.  Often patients are receiving so much technical information when it is the experience and judgment of the surgeon rather than the specific operation per se that is important.  Seeing the particular case if more important than concurring with a particular method. The textbooks of hernia and diastasis repair contain countless variations on a theme for such matters and in good hands all methods can be successful when applied correctly.   Large diastases and large hernias despite our tireless expert efforts, can from time to time recur, especially when weight is gained, health is poor, and in smokers.

S. Daniel Golshani, MD, FACS · Answer

Excellent question. In deciding whether a component separation technique is necessary first it must be determined whether you have a large ventral hernia and a true fascial defect or a diasthesis recti which is a separation of the muscles without an actual hernia  being present. When a defect of larger than 5-7 cm is present up and down the abdomen with a ventral hernia present as well,  a component separation can be done to advance the rectus muscles and close the defect. In this case a mesh may also be utilized. However a component separation by design requires that the surgeon enter the peritoneal cavity to release the posterior rectus sheet, something that we almost never do when there is no hernia and a disasthesis recti is only present. In my experience with a very large number of abdominoplasties and patients with various degrees of diasthesis , I have been successful using a two layer imbrication with excellent results . Sometimes multi-directional muscle tightening is also necessary . It is generally advisable for the plastic surgeon to stay away from the peritoneal cavity unless truly necessary as in the case of a large ventral hernia which may then necessitate component separation. It is best to seek second opinion consultations from other board certified plastic surgeons. Best, Daniel Golshani, M.D., Beverly Hills.

Joseph B. Eby, MD, FACS · Answer

Hello Diasasis and thanks for your question. Diastasis Recti as you are aware occurs when the rectus muscles stretch and thin as well as widen at the linea alba resulting in an area of weakness in the midline. This can present as a small bulge or a very large protuberance resembling a hernia. The difference between diastasis and a true hernia is that a hernia has a defect (hole) in the fascia allowing the intrabdominal contents to push through the defect. With large, recurrent or previously infected hernias a component's separation procedure can allow for primary repair with or without the use of mesh. If you only have rectus diastasis and no hernia a components separation with mesh placement would at first sound like a bit more complicated than necessary to repair. However, I have seen cases of severe diastasis (looking like a balloon or football) which would require a more complex approach such as mesh placement or components separation. It would probably be good to seek out a second opinion with another Board Certified Plastic Surgeon since only an in-person evaluation and exam can provide the detailed assessment necessary to give you a truly informed opinion.

Frederic H. Corbin, MD (license restricted) · Answer

Thank you for your question and Dr Eby has given you a very good answer.  Since you have concerns I would seek other opinions from experts in your areaDr Corbin

Robert A. Hardesty, MD, FACS - Account Suspended · Answer

Thank you for your question.without photos or a examination I can only give you general information.My colleagues have given you a very good overview of the concepts and indications for the  component  separation technique for abdominal hernias and large diastasis  repair.Mesh is often used and some are absorbable: TIGR  or SERI My best wishes,

Component Seperation Technique and Diastasis Recti?

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