Severe Diastasis Recti - What is the best treatment? Mesh? Ventral Hernia? (photos)

Question

I have a severe diastasis recti after having 2 C-sections. The doctors think I have an unidentified connective tissue disorder which played a role in my stomach stretching so much. Does this look like a ventral hernia? The doctors don't seem to think I have a hernia, but I'm not so sure. Is this something I should try to submit to insurance? Is mesh recommended? Attached is my before baby picture and me now so you can see the drastic difference. Thanks for your help!

Anita Patel, MD, FACS · Answer

You may have diastasis recti from pregnancy, which is quite common. Based on the photo alone, one cannot tell if you have a hernia or not. That would require a clinical exam and possibly imaging if it was unclear. Diastasis recti is not covered by insurance. Hernias on the other hand, are typically covered by insurance, but are not the same thing. Mesh is not typically used for repair of rectus diastasis, but may be used in hernia repair. If your doctors do not think you have a hernia, there is nothing to submit to insurance, since insurance does not cover repair of diastasis recti. If there is any uncertainty, you can always get another plastic surgeon's opinion and imaging if indicated. The good news is diastasis recti can be repaired, and is commonly repaired as part of a tummy tuck, which would also address any excess skin on the abdomen post-pregnancy.

David J. Wages, MD · Answer

Thank you for your question and photos.  In addressing your concerns keep in mind that no online reviewer can diagnose and prescribe treatment without more information and an exam. In general, I see many women who have had multiple pregnancies and C-sections.  After which it may not be possible to improve the abdomen without surgery.  One of the most common concerns is laxity of the abdomen due to the muscles being stretched and the space between the muscles separating (diastasis recti).  I would begin with with a face to face consult with a Board Certified Plastic Surgeon who has experience in these areas. During your visit your surgeon should be evaluating your health to determine if you are a good surgical candidate and examining your tissues to get a sense of what type of procedure your tissues will allow. Only with a hands-on exam can this be determined. One can diagnose a hernia or diastasis with physical exam.  Rarely does one need an xray or ct scan for diagnosis.  Once an exam and opinion is rendered then you can decide if surgery is right for you. In my experience, I have rarely needed to utilize mesh.  Good luck.

Shirin Towfigh, MD · Answer

Unfortunately, it looks like a severe diastasis and not a ventral hernia. 
Plastic surgeons vary in their technique. If the diastasis is very wide, I think mesh implantation will give a longer lasting outcome, as you probably do have a component of collagen deficiency

Praful Ramineni, MD · Answer

You appear to have a significant rectus diastasis in addition to some excess skin.  Diastasis (unlike a true hernia) is not covered by insurance.  A diastasis may be able to be corrected in the traditional manner with suture plication (tightening), however in certain cases, if the abdominal tissue is weak/connective tissue disease, a mesh may need to be used to reinforce the abdominal wall.  If your tissues are inherently weak, even if you plicate aggressively, the results will tend to be short lived and a recurrence is likely (mesh doesn't stretch).  This determination is best made by your surgeon.

Nick Masri, MD, FACS · Answer

You definitely have a weakness of your abdominal wall fascia and a seperation of the rectus muscles of you abdomen. You need a thorough physical exam to evaluate the possibility of a hernia. Maybe even a CT scan. Having said that, you are definitely not alone. Mothers may develope all types of "baby bulges" after child birth. Some women may have multiple pregnancies and maintain a flat washboard abdomen, and others have one child and have an extensive weakness similar to yours. 
Unless you truely have some type of connective tissue disorder, which you should have evaluated by a rheumatologist, then you need a tummy tuck. Depending on the intraoperative findings , I dont think a mesh will be of any help in treating your probable diastasis. An in person consultation is needed to give you the best recommendation. Find a board certified plastic surgeon with experience treating hernias and complicated abdominal wall  reconstructions. Best Wishes

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