Do I need muscle repair during tummy tuck? (Photos)

Generally speaking, abdominal muscle separation can be determined during an in-person assessment. However, confirmation can be made during the actual surgery, at which time it can be corrected.

Hello. Thank you for your question regarding whether you need muscle repair during your tummy tuck. Thank you for your history and picture. The pictures you provided show a mildly distended lower abdomen. There is no particular rule when it comes to muscle tightening or plication during a tummy tuck. Usually, in general, the rectus muscles are plicated during all tummy tucks. Usually, muscles are tightened for patients over 50 years old, women who have had children, or those with a history of weight loss of more than 100 pounds. It appears that you may not fit any of those criteria. Therefore, you could “get by” without muscle plication. However, most plastic surgeons would ask, “Why not perform muscle tightening in your case? What is the harm?” Therefore, most plastic surgeons would perform muscle plication in your case because it yields better results than a tummy tuck without muscle tightening. Good luck. I hope that I have answered your question regarding whether you need muscle repair during your tummy tuck. Most plastic surgeons offer free virtual or in-office physical consultations.  Therefore, explore what other plastic surgeons have to say. If you have any more questions regarding tummy tucks, abdominoplasties, or abdominal liposuction, contact an experienced plastic surgeon. Since the tummy tuck surgery is a big procedure, please seek an experienced, board-certified plastic surgeon with significant experience in performing tummy tucks.  Do your research.   If you cannot find an experienced tummy tuck plastic surgeon in your neighborhood, consider traveling out of state.  Sincerely, Dr. Katzen, MD, MBA, FACS, FICS. ( Plastic Surgeon, President of the American Society of Bariatric Surgeons, certified by the American Board of Plastic Surgery, Fellow of the International Society of Aesthetic Plastic Surgery, American College of Surgery, and International College of Surgery and  member of the American Society of Plastic Surgery, American Academy of Cosmetic Surgery, RealSelf Hall of Fame, and RealSelf Doctor Advisory Board for Medical Review and Consumer Panel.)

It is likely that your surgeon told you what they did based on your physical exam which showed the absence of diastasis recti, otherwise known as separation of he rectus abdominus muscles. Your photos also show that your rectus abdominus muscles appear to be in good shape so muscle repair may not be necessary. Good luck?

Based on your photos, there’s no clear sign of diastasis, and your abdomen looks well-supported, which is consistent with not needing muscle repair. Of course, the only definitive confirmation is during surgery, but your surgeon’s in-person evaluation is usually reliable.
However, if you’re not planning future pregnancies and want a more defined waistline and stronger core support, then I would recommend rectus muscle plication, as it can further enhance your contour

Thank you for your photo. It is difficult to determine whether muscle repair is required during a tummy tuck from just a photo. The best way to determine whether a muscle repair is required is to have the patient lie on the examination table and do a partial sit up while palpating the central portion of the abdomen. If the examiners fingers can fit between the muscles, then repair will usually benefit them to re-create a solid flat foundation of the abdomen. Check with your plastic surgeon about what would be best for you.

Most surgeons will be able to tell by your medical history and physical exam if a muscle repair will be beneficial for the outcome of a tummy tuck. The abdominal wall looses some of its elasticity once it has been overextended, like in pregnancies or after a large weight loss. One can also palpate the midline and the edges of the "sixpack" muscles. A rectus diastasis can be identified by physical exam. Some use radiographic imaging, like ultrasound or even CT. If a patient is physically fit, has not been pregnant, and weight loss is considerate - the patient may truly not need a muscle repair. Recovery will be much easier, as will be the return to weight lifting and working out. I hope this helps

It is possible to make an educated assessment before surgery, but the final determination is made during the procedure. Some patients do not require muscle repair, but for many, even a mild degree of abdominal wall laxity can be improved with plication.
In my practice, I perform muscle tightening in about 99% of tummy tucks because most patients have at least some level of rectus muscle separation or laxity after pregnancy or weight changes. Even when separation is minimal, repairing the abdominal wall often enhances the final contour and provides a flatter, more toned appearance.
Photographs can give a good indication of whether muscle laxity is present, but they are not definitive. The most accurate assessment is done in surgery, where the abdominal wall can be fully evaluated.

The first question is if you have noticeable diastasis, meaning a bulge in-between your six-pack muscles when you do a sit up or plank type of action. Your muscles look flat in your photo so this is likely not a major issue in decision making. Assuming so, the I would recommend liposuction with skin excision and umbilical transposition. This is a tummy tuck type of skin excision WITHOUT muscle tightening. This can be done with an oral cocktail for sedation and local tumescent anesthesia, so you never go "under". There are no drains with resumption of activity as tolerated. Also, you get the benefit of liposuction of the abdominal flap in the same setting, so you lose the fatty bulk which is NOT done in a formal abdominoplasty. There is an overall lower complication rate and down time compared to a traditional tummy tuck. This is a great option for many women out there . . . An in-person exam will help determine which option is best for you. See attached case for reference. i hope this helps, thank you!

From the photos it appears that your abdominal wall looks relatively flat, which can suggest that muscle separation may be minimal. However, this visual assessment alone is never enough to determine whether muscle repair (rectus plication) is required.
The need for repair depends on the integrity of the fascia and the presence of diastasis recti, which can only be confirmed during a physical exam by checking how the muscles respond when you engage your core. Sometimes even a small gap that isn’t visible in photos can cause laxity or bulging.
During surgery, your surgeon will always re-evaluate the muscle tone and decide whether a plication is needed to achieve the best contour and long-term support.
I hope your recovery and results bring you both comfort and renewed confidence.Güray Yeşiladalı, MD

Thank you for your question!One of the best ways to determine whether you need muscle repair before surgery is through an ultrasound. This allows us to clearly see if there’s a diastasis (separation of the abdominal muscles) that would require plication.
Just by looking at photos, it’s not possible to know for sure. If there’s no diastasis, a tummy tuck focused on removing excess skin and improving laxity would still give you a smoother, firmer abdomen.