Repair Separated Muscle Suture Endoscopically After Tummy Tuck?

I had a full tummy tuck in Feb 2010. On my 1 week ck up my upper abdomen was very distended, but I was having some constipation issues. Even after that has passed, my upper ab is sore and significantly bulged and hard. It has not gone down and I am one month post op. Today, we did an ultrasound and found that the suture is separated. I was told that I will need the surgery again. I have been doing some searching and was wondering if I can have endoscopic surgery to place a new suture?

Emotionally, I am not prepared to go through this again. Also, I am taken aback that I have to pay all the hospital fees again - is this common practice? This surprised me because when I initially spoke to my surgeon I was told that they would take care of any problems but that they had never had one. I am not prepared for another week in a full compression garment, etc., or another $3000-$4000.

Doctor Answers 8

Open repair, via minimal approach

This is not a very typical complication.  I repair the muscles with two separate, independent layers, and it would take disruption of both layers, which would need a lot of force, to undo the initial repair. I would recommend an open approach, with a two layer repair.  Going via the belly button only is an option, but likely to be difficult, and it is more important for your safety and lasting results to have good visualization of the muscles.  The scar is already there, so might as well re-use it. Good luck.

Chevy Chase Plastic Surgeon
4.7 out of 5 stars 106 reviews

Discuss all revisional options!

Unfortunately, we occasionally see patients who develop severe abdominal distention following abdominoplasty surgery.In most cases, this is due to constipation which appears to be related to general anesthesia and pain medications.Although rare, this condition can rarely cause the sutures that hold the muscle together, to pull apart recreating the original defect.
When this situation arises, surgical intervention is always indicated.Although, endoscopic surgery is an option, there’s really no significant advantage with this technique in someone who has already had a lower abdominal incision.
Under these circumstances, re-opening the original incision provides the exposure to make sure the muscle repair is done correctly.In this situation, it’s probably appropriate to perform a double layer closure.
It’s important that you thoroughly discuss these issues as well as the cost of revisional surgery with your plastic surgeon.It’s not unusual for plastic surgeons to perform revisional surgery for free, but it’s customary for the patient to cover the operating room and anesthesia charges.Your surgeon should be able to discuss these issues and formulate a treatment plan that addresses your anatomic findings and achieves your aesthetic goals.

Richard J. Bruneteau, MD
Omaha Plastic Surgeon
4.9 out of 5 stars 194 reviews

Best way to Repair a Separated Tummy Tuck Muscle Repair

I am sorry for what you are going through. If fault was to be assigned, it is not your fault but neither it is the fault of your surgeon, your anesthesiologist or the hospital that you had bad luck and your distention caused the muscles to pull apart. Many Plastic surgeons would repair it for free, not because they have to but because we like what we do, we like our patients and we share in their disappointments and happiness and would like to make them happy.

Endoscopic muscle tightening was in vogue in the early years of endoscopic surgery and a variety of instruments, some from brazil and long stitch holders from the US, were devised for such purposed. In revision cases the scar tissue is quite intense and makes such attempts at mini-incisions last too long and with marginal results. Understandably, most surgeons would prefer to open the tummy tuch incision and perform the procedure under direct visualization to better place the muscles together.

Peter A. Aldea, MD
Memphis Plastic Surgeon
4.9 out of 5 stars 108 reviews

Re-operation for a diastasis recti after a tummy tuck

This probably occurs more commonly than we think and results in differing degrees of upper abdominal buldging after a tummy tuck. In order to repair it, i would wait until all of the inflamation and scarring subside, maybe 3 to 6 months, and then do the procedure in an open fashion with a 2 layer permanent suture repair. You have already had one complication so why risk another with a minimally invasive approach when you already have the scars and you really will have an easy time of recovery. As far as cost, it is a common policy to be responsible for hospital and anesthesia fees for revision procedures.

good luck and i hope this helps.

Andrew P. Trussler, MD
Austin Plastic Surgeon
4.9 out of 5 stars 45 reviews

Suture failure after tummy tuck

I am so sorry to hear of your problem.

My advice is to get this fixed asap, before scarring sets in and makes repair difficult. The matter of who pays is another difficult issue. Each surgeon has his own policy on this, but you ar efacing a very steep financial bill.

Best to you.

Scott E. Kasden, MD, FACS
Dallas Plastic Surgeon
4.7 out of 5 stars 101 reviews

Endoscopic repair of diastasis after tummy tuck not a good idea.


As long as your surgeon does not charge you another surgical fee, I am afraid it is the accepted standard that you pay for operating room and anesthesia for a revision. Of course, in New York City, we make all this very clear to patients in advance.

Forget endoscopic approach. Bad result, and won't save you any money. Sounds like you need another tummy tuck. Sorry!

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon
4.8 out of 5 stars 9 reviews

Endoscopic repair of abdominal diastasis

 I am sorry you had a complication which is very unusual with this surgery, but it can happen.  Endoscopic repair is certainly a possibility if the surgeon is experienced in this type of repair.  Other times just the umbilical incision can be used and in some cases it may be necessary to reopen the lower abdominal incision.

As far as costs, that is something you should discuss with your surgeon.  Good luck in your surgery.

Steven Schuster, MD, FACS
Boca Raton Plastic Surgeon
4.0 out of 5 stars 6 reviews

Endoscopic repair of rectus diastasis.

An endoscopic surgery can be used to repair the disrupted muscle repair but there may be alot of scar tissue and it may be very difficult to achieve a full correction.

Otto Joseph Placik, MD
Chicago Plastic Surgeon
4.9 out of 5 stars 81 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.