I am scheduled for a a TT with flank lipo in April. I am 32 years old. I have lost a total of 60 lbs, and have kept it off since June of 2007. I am 5ft 7" and weigh 165. I see where others have posted that they know how many inches, etc. their abdominal muscles have seperated. I have never been pregnant. Is there a chance that my muscles will not need tightened (stitched) or can being overweight seperate them just as much? Thank you in advance for your professional opinion.
Plication with Full Tummy Tuck
Doctor Answers 15
Full Tummy Tuck Should Include Plication
The terms tummy tuck, abdominoplasty, and plication can be misleading. In general the changes to the female abdominal wall from significant weight loss (obtained by diet and exercise) can be similar to those changes subsequent to child bearing +/- significant weight loss. A rectus diastasis ( separation of the rectus abdominis muscles, usually because of thinned or stretched fascia) is not the only indication for a plication. At times it is helpful to contour and strengthen the abdominal wall after massive weight loss (MWL) in the absence of a significant rectus diastasis, but where stretched or weakened fascia is encountered that envelopes the muscles. Be sure to review with your surgeon what his preoperative plan is and how that might change given what he finds at surgery.
Full plication not always needed in abdominoplasty
During the preoperative visit your surgeon should do a full evaluation of your abdominal wall in the standing position, with your normal muscle tone and then with the muscles relaxed in order to determine if you will need a rectus muscle plication or not, how extensive in length or the degree of plication. Besides pregnancy or significant weight gain there are genetic and morphological factors that will determine if the abdominal wall will need reshaping or not. In summary, most patients will need muscle plication in a full abdominoplasty but not "everybody" requires it.
Abdominal Muscle Tightening in Tummy Tucks: Creating a waistline
Abdominal muscle tightening or midline plication can be used to repair a diastasis recti which is spreading of the central abdominal muscles, and/or to shape the abdomen and help create a waistline. I do not use it on everyone, but in general someone who has had children and/or has lost weight will have some element of abdominal spreading which would benefit from correction. I use 2 layer of internal sutures to hold this in place and have found that in combination with liposuction, it can help create a waistline in tummy tuck patients.
I hope this helps.
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The need for plication in a tummy tuck.
You certainly can have a separation (diastasis) of the muscles from increased abdominal weight if that excess weight was underneath the muscle (known as "visceral fat"). However, it is much more common following pregnancy. During your tummy tuck, your plastic surgeon will evaluate your muscle separation and repair it if necessary. This repair is straightforward with the goal of improving the underlying abdominal wall so that the contour effects of the tummy tuck result in a flat, attractive abdomen.
Separation of tummy muscles,diastasis recti, tummy tuck surgery, repair of muscles with tummy tuck,abdominolasty
The tummy muscles usually separate not only during pregancy but also with weight gain for fat is accumulated around the intestines within the belly. After pregancy or weight loss, the separation becomes apparent. Sometimes, the Tuppler method can help to correct this. This diastasis though is usually surgically corrected with bringing the muscles together during a tummy tuck procedure. This also narrows the waist.
Muscle plication vs no plication
I usually check to see how the tummy looks ahead of time. If it looks flat to begin with, you might not need muscle plication. If it looks like it's bulging, obviously plication is needed. If it is flat because you hold your stomach in and bulges when you are relaxed, then muscle plication will make it tight so you don't have to suck it in. I think this is something that needs to be agreed upon before the procedure. But your Plastic Surgeon might have a different way of going about things: discuss it before the procedure so you know what you are getting.
Plication with Abdominoplasty
Every patient is different, so there is no way to give you specific advice. However, while pregnancy can cause diastasis, obesity can too. I suspect that you will require plication during your abdominoplasty to achieve the best result. However, you should discuss your concerns with your surgeon.
Tummy tuck and liposuction, weight loss
A good preoperative examination can usually demonstrate muscle widening of the abdomen. There are patients who have never been pregnant who have muscle widening. This can be due to weight issues, trauma, other previous surgery, inherent muscle weakness, some connective tissue disorders etc.
A surgeon can determine intraoperatively if the muscles have to be tightened. Your recovery will be a lot easier if the muscles don't have to be tightened. Tightening of the muscles, if needed, will result in a better outcome.
Tummy Tuck Without Muscle Plication
Some patients who have never been pregnant do not need to have their muscles plicated in order to obtain a good result from abdominoplasty. This is something that your surgeon should have discussed with you at the time of your initial consultation. This is a question which he or she should answer before your surgery is performed.
Muscle Tightening Determined in Surgery
Whether you will need muscle tightening is determined intraoperatively. Since you have never been pregnant it is likely that your muscles will not be diastatic (split). Increased weight with signicant intra- abdominal fat can stretch your abdominal wall. It is not so much that your muscles split but the fascia (envelope around the muscles) gets lax. To give you better tone, your surgeon may elect to tighten this area. Not doing this would give you only a partial correction of the problem and not give you the flat stomach you are looking for after surgery.