Should Stomach Muscles Always Be Tightened During a Tummy Tuck?

I'm scheduled for a full TT with some lipo and BA. I've had 4 pregnancies but my stomach muscles have not separated, only a fingertip space between them when flexed below and above the belly button. I'm 5'3", 125#, 39 yrs, exercise and workout core regularly. I have loose, stretch marked skin and poochy stomach fat I can't get rid of. My surgeon says I won't need a repair. But should I ask for them to be tightened anyway to get the best results from the TT? Or would it not make any difference?

Doctor Answers 25

Should Stomach Muscles Always Be Tightened During a Tummy Tuck?

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Abdominal muscle (Six pack / rectus abdominis) separation is NOT the only irreversible damage brought on by pregnancy. The fact that a lime sized uterus becomes the size of a large watermelong and maintains those dimensions for monthS, means that the abdominal wall (muscles and skin) had to stretch and finally split to accomodate such a large intra-abdominal mass. Even if there was not a significant splitting of the muscles you can BET that the abdominal cavity is much larger and the muscles and overlying skin are looser.

Now - multiply this by 4.

Having performed hundreds of abdominoplasties, I am still impressed by how much stretching these bodies have been put through by multiple pregnancies, how much overt and subtle stretch damage took place and how important is proper tightening of the abdominal muscles if the woman is to regain her "Before Baby" tummy, only better.

In my opinion, deciding not to perform an abdominal  muscle tightening on a woman who either had a single large baby OR several pregnancies is to rescue defeat out of the jaws of cosmetic victory. It is choosing a mediocre result over an amazing cosmetic result.

In someone as thin as you, the potential for a truly beautiful tummy is palpably real. You should NOT have to ask your surgeon to do "a muscle repair". He should understand the importance of doing it and offer it to you. As unsettling as it is for me to say it about a colleague, I would get another opinion.

Good Luck.

Dr. Peter A Aldea

Memphis Plastic Surgeon

Have your muscles tightened.

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Thank you for posting your photos.  It helps a lot.  The second photo shows you leaning over with tightened muscles.  The very right photo you have relaxed muscles.  There is a big difference which tells me there is abdominal wall laxity that will be improved with muscle plication. You will get a flatter stomach that will last you longer if you have your muscles tightened.  You will not always be 39 and 20 years after my own TT I can honestly say that I don't exercise as much as I used to.  It is true that it will cause a bit more pain which is why I always use pain  pumps.  Years ago I started threading them under the fascia (the covering of the muscle) on either side of the midline my patients and I can tell you they have been far more comfortable than I was the first few days after surgery.  Unless you have another abdominoplasty you won't have another opportunity so I would not pass it up. 

Lori H. Saltz, MD
San Diego Plastic Surgeon
4.3 out of 5 stars 29 reviews

Muscle Plication Is Sometime Not Needed with Abdominoplasty

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Although you would get a flatter abdomen overall with plication (tightening of the muscle wall), because your muscle wall laxity is limited and the majority of your skin laxity is low, you can elect NOT to have the plication.  This will make your surgery less painful and shorten your recovery.  

When I do perform plication, I use a pain pump which drips Marcaine onto the plication for the first 3 days.  This decreases the pain significantly.  

If you were my patient, I would give you a choice and tell you as long as you don't mind some slight roundness to the lower abdomen you could go with no plication.  It would be similar to what you have now, but just without the skin laxity.  I would also let you know that with a full abdominoplasty and plication of the muscles you would get the best result possible.  It is a trade off and you have the luxury of deciding because your changes are limited (especially considering you have had four children).

A final option for you, if you don't mind some upper abdominal skin laxity is just to remove the lower abdominal skin through a very low incision.  This is sometimes called a lower abdominoplasty or panniculectomy.  It gets rid of the lower abdominal skin without lifting the skin of the upper abdomen and would less recovery and cost.  I hope this helps you in your decision



Should my muscles be tightened with a tummy tuck

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I don't think that I have seen a woman after 4 pregnancies who would not benefit from having the muscles tightened.  It will help you get a tighter, flatter stomach.  It does hurt more for the first few days and does somewhat prolong the recovery and cause some limitations in activity for a longer period of time.  I do not let my patients perform any abdominal or core exercises for 6 weeks after having the muscles tightened.  That being said, it is entirely elective and does not need to be done.  You can just have the skin tightened which will help you greatly. 

Jeffrey E. Kyllo, MD
Seattle Plastic Surgeon
4.7 out of 5 stars 13 reviews

There's no good reason NOT to tighten the muscles in a tummy tuck

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You only get one shot at a great result with a tummy tuck and after 4 pregnancies, I can virtually guarantee you that you would have a better flatter result with some appropriate muscle tightening performed.  It is quick, easy, and only adds a little temporary pain in the recovery but dramatically improves the result.

I have done several TT's this week and in one the muscles were 2-3 inches apart and in another they weren't apart at all.  However, both had equal general laxity of the abdominal wall and needed muscle tightening.  So the actual distance between the rectus muscles is not a good indicator of the need for muscle tightening, it is more a matter of how loose you can make your abdominal wall when you totally relax the muscles.

Also, are you sure you don't need to retighten the breasts with your augmentation as it looks like you had a reduction before and have some pretty loose lower pole skin.  If you already have the scars, it might be nice to tighten up the breast and imporve its shape and tone because the implants alone won't do that.  Just a thought to consider...

To tighten the muscles

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After looking at your photos I would say yes to tightening your muscles a little.It will be a little more uncomfortable post op but well worth it.

Robert Brueck, MD
Fort Myers Plastic Surgeon
4.9 out of 5 stars 69 reviews

If the muscles are together, no repair necessary.

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The term "muscle tightening" is a misnomer when applied to a tummy tuck. What is performed is a plication, or folding, of the fascia of the abdominal wall to correct bulging that occurs when the abdominal wall is lax. This commonly occurs following pregnancy as the rapid enlargement of the womb distends the abdominal muscles and stretches out the fascia. In some women, the abdominal wall recoils back to its original shape following pregnancy. In these cases, the abdominal wall plication is unnecessary and provides little improvement to the overall contour of the abdomen. If you don't need it, why do it?

David Bogue, MD
Boca Raton Plastic Surgeon
5.0 out of 5 stars 26 reviews

Should Stomach Muscles Always Be Tightened During a Tummy Tuck?

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I'm answering your specific question of YOU having your muscles repaired while you are having your TT. Understand none of us, expert posters, have examined you in person, so your chosen surgeon has an advantage over us. If he believes you do not need a MR than either he is correct or he mis diagnosed you, I can not say. Just to be sure have the muscle repair done to avoid that issue. It might not matter in  the final evaluation of your result, but if you do not that if you have a moderate result you would always be questioning yourself with the "what if", "why didn't I" issue. 

Fascial Plication During Abdominoplasty

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Body contouring operations are very patient specific. With respect to abdominoplasty, the amount of fascial plication varies depending upon individual needs. The amount of separation between the rectus muscles may vary significantly between women; but usually the more separation that is present between the muscles, the more the abdominal wall protrudes in the standing position.

Your pictures show that you have been much luckier than some women, and have not developed the degree of musculofascial looseness that many would after having four children. However, it is still evident from your pictures that you have some looseness in the muscle and fascia of your abdomen - even if your muscles are not separated in the midline. So I believe that you need to have a plication performed with your abdominoplasty. Fascial plication will definitely improve your result, and it is the only way to achieve a flatter, tighter abdomen. This plication will increase post-operative pain and prolong your return to strenuous activity, but it will make your abdominoplasty more complete.

Speak with your surgeon about your concerns so that both of you can reach a conclusion about how to best address this situation before surgery.

Kenneth Dembny, II, MD
Milwaukee Plastic Surgeon
4.9 out of 5 stars 36 reviews

Muscle repair during tummy tuck

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Procedures should be tailored to individual patients.  During surgery with muscle relaxation, additional laxity may be apparent that is not appreciated during an office visit exam.  If there is no laxity when you are under anesthesia, there is nothing to be gained by tightening the muscles further.  Muscle tightening ("fascial plication") is the major cause of post-operative discomfort during a tummy tuck, plays the greatest role in post-operative activity restrictions, and can potentially contribute to other post-operative complications as well.  Performing a plication just to say that it was done does not make much sense, but communicate with your surgeon that if your abdominal wall appears lax under anesthesia and muscle relaxation, you would like to have the "muscles tightened".

Good luck.

My response to your question/post does not represent formal medical advice or constitute a doctor patient relationship. You should continue to follow-up with your plastic surgeon in order to receive formal evaluations and maintain your doctor patient relationship.

Craig S. Rock, MD
Houston Plastic Surgeon
5.0 out of 5 stars 29 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.