Has anyone had diastasis recti repair with minimal scarring?

Question

I don't have much excess skin and only wanting to fix my separation. I have had 2 c-sections and have finally accepted my second scar because it's below my bikini line. If I were to get a TT I wouldn't want the scar any longer or higher than what I've already got. I've looked at so many TT pictures and the scar seems high in all of them. Is this a reasonable request or are there other surgeries that I'm not aware of?

Thomas P. Sterry, MD · Answer

I have two answers for you.First, Yes, the Diastasis Recti can be repaired without performing a full on tummy tuck.  BUT, I'm not sure how your results would look after the fact.  For instance, a general surgeon would simply make a vertical incision on your tummy and of course, that would be unfavorable.  They might also attempt a laparoscopic repair, but that could leave a ridge along the tummy.  A plastic surgeon would attempt to get it done from below through the C-section scar, but that is very challenging and would likely involve significant risk for bleeding which is difficult to control from so far away.  Frankly, the simplest technical thing to do is a tummy tuck like incision which helps us gain access as well as re-drape the skin (even if you don't remove any).  This brings me to the second answer…Tummy Tuck scars should NOT be high on the belly!  Apparently you've seen some conservative surgeons work.  I have an example for you below.  I recommend you watch the video because at 3:55 you can see her low scar two years after surgery.Good Luck!

Gary M. Horndeski, MD · Answer

The abdominoplasty scar is hidden by underwear,
however, it extends from side to side.Diastatis recti can be repaired by a row of sutures, however, I
recommend to reinforce it.The technique
is called Abdominoplasty with Mesh Reinforcement.The mesh increases the mechanical strength of
the abdominal wall resulting in a hourglass figure, early satiety, weight loss
and maintains the reduced weight.Mesh
reinforcement is only used in people who are not planning future
pregnancies.Best Wishes,Gary Horndeski, M.D.

Shim Ching, MD · Answer

Diastasis repair can be done through a C-section scar.  It may need to be lengthened to achieve this, but minimizing the length of scar can be done.Please see the linked photos.  This patient had primarily a diastasis repair through an limited incision.This does require special instruments and is more difficult, but the minimizing the scar helps achieve the best results.

Ronald Schuster, MD · Answer

It is really impossible to tell you how much skin needs to be removed without an exam. Once the diastasis is repaired, there will be a lot of extra skin that needs to be smoothed out and some removed. Sometimes this can be done with a modified approach that does keep the scar a bit shorter. You shoud be able to discuss this when you go for your consultations. Good luck.

Joseph M. Perlman, MD · Answer

It is rare that a patient needs the diastasis repaired without removal of excess skin. However there are those patients can be treated with minimal incisions without skin removal. Although I don't do the procedure, I've read reports of laparoscopic diastasis repair, similar to the repair of abdominal hernias laparoscopically. Other patients may just need the lower portion of the diastasis (for spreading of the vertical abdominal muscles in the midline) repaired and this can be done as a mini tuck

Peter E. Johnson, MD · Answer

We do expose the rectus through the C-section incision and through the limited incision are able to reach all the way to the chest and repair the diastasis when there is little or no skin excess. A reach yes but easily done and others probably do the same.

Heather J. Furnas, MD · Answer

Some plastic surgeons have done a repair of the diastasis recti with an endoscope and long instruments, but it's a difficult procedure that involves cutting through the base of the belly button. It can take 4 to 8 hours to do, depending on the experience of the plastic surgeon. This approach doesn't allow the skin to redrape if a wide diastasis is repaired. Because there are so many constraints, most plastic surgeons will probably not offer this option.Without an incision that is long enough for the surgeon to both see and be able to manipulate his/her instruments, it's difficult to repair the muscle, particularly above the belly button. If the lower muscle is repaired, and the upper muscle remains separated, the upper portion can bulge more. The best thing to do would be to see a board-certified plastic surgeon for an evaluation. He/she can tell you what your options are.

Has anyone had diastasis recti repair with minimal scarring?

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