What is the Best Technique to Ensure Diastasis Will Stay Repaired?

The looseness of the upper tummy is either due to the sutures breaking or the fact that it was not tighten enough in the first place. There are many different ways to tighten the tummy. Some docs use absorbable sutures while others use permanent ones. Some do a single layer repair while others will do two or three layers. Finally it is easier to tighten the lower part so that as the lower area is tightened first it puts more pressure on the upper area which makes it more difficult to get really tight. Usually it's not a problem but perhaps that helps to explain your case. 

Hello Lisa,

It is certainly possible that you inadvertantly ruptured supporting sutures that held your muscle repair together, but it is unusual to do that, even with coughing. There is no special suture technique to keep a muscle plication repair intact except for using multiple individual sutures in addition to any 'running' type sutures. 

I really wonder what  is your bulge truely caused by. Much more common than suture rupture is a formation of fluid under the skin called a seroma.  Seromas can be treated in the office by aspirating the fluid (serum), and don't need a second operation.  I would double check with your surgeon to make sure that it is not a seroma that can be treated easily and immediately!

Best of Luck!

Thank you for the question.

Sometimes despite best efforts and techniques separation of diastasis repair  can occur.

The best way to ensure the diastasis recti stays repaired is to pick a board-certified plastic surgeon with  significant experience with the procedure. Personally, I use a 2 layered permanent suture repair,  with every attempt to find the right balance between sufficient typing of the  muscle repair ( without over tightening).

Best wishes.

It would seem uncommon for you to have a bulge starting 6 weeks post op that was flat at 5 weeks.  Without the advantage of examining you it is difficult to speculate why.  If re operation is considered, I might suggest waiting for 6 months to allow your soft tissues to soften and see what develops in the rest of your fascial plication.  When sutures pull through it may be on the basis on thin soft tissues or sutures being pulled too tight.  The type of suture is probably less important.  I saw an interesting presentation at the QMP meeting from last October outlining some peculiar anatomic variations which can predispose to recurrent fascial laxity following standard pliction procedures.  Might suggest your PS look into this topic.  

I can not say without an exam if you did any harm. It does happen however. My suggestion is to wear a surgical garment for another 6 weeks or so, and be careful. hopefully it stabilizes and you do not need the procedure. Stay in touch with your surgeon as they are the best ones to evaluate how much of an issue it will be.