How Are the Muscles Tightened in a Tummy Tuck?

I'm going to try to answer this question with as little doctor-speak as possible. When you gain and lose a lot of weight or go through pregnancy your tummy gets stretched out and then relaxes back down. The muscles of your tummy also stretch out. The main muscles we are talking about are two big muscles that run up and down in the middle of your tummy. They are called the rectus abdominus muscles. They are supposed to be side by side like two columns right next to each other. With weight gain and/or pregnancy they can stretch out in the up and down direction as well as pull apart in the middle, separating from side to side. It is the side to side separation that is the real problem.

The splitting apart of the muscles is called diastasis recti. This separation is the cause of the poochy shape of the lower tummy after pregnancy. Here ls the main problem: you can exercise the muscles to make them strong again in the up and down direction, but there is no natural way to firm things up again from side to side. There is no way to exercise your muscles in a sideways direction. 

A tummy tuck can bring those muscles back to the middle where they belong but pulling them into position and keeping them there with stitches. When they are separated they are a bit weaker than they should be. This is due to the physics of how they work. They are meant to be together in the middle, so when they are put back that way they probably work a little better. You might not notice a big improvement when doing exercise, but some patients do feel stronger and more stable.

I hope this info helps!

The stretching forces of pregnancy can cause the rectus abdominis muscles to pull apart from each other.  This is called rectus diastasis.  When this happens, the position of all the muscles of the abdominal wall shift out of position, upsetting the balance of your "core" or abdominal wall and back.  Tightening the connective tissue between the rectus muscles, to pull both muscles back into the middle so they are right up against each other, restores the proper postioning of all the core muscles.  Abdominal exercises become more efficient and effective after tummy tuck with repair of the rectus diastasis

Abdominal wall tightening (muscle plication) is performed routinely during  a tummy tuck procedure. This is basiclally done by using permanent stitches and forming a pleat, like a tailor would do when taking in a shirt, which runs vertically from the pubic bone up to the sternum (breast bone). This creates a flat appearing abdomen by relocating the abdominal muscles back into their original position. Pregnancy, aging and weight fluctuations can weaken these muscles.

Discuss this in further detail during your consultation with a board certified plastic surgeon.

Best wishes,

Dr.Bruno

The muscles of the abdomen like all parts of the body are encased in a fibrous envelope (fascia), so the muscle repair actually involves stitches into the fascia. This is necessary because the muscles often get pushed apart with pregnancy, but the direction of muscle contraction doesn't pull them together with exercise. Muscle tone is always a matter of exercise so the results of working out after tummy tuck may look better than without but the surgery won't make the muscles stronger.

5.  the Rectus Abdomini (your six pack) that was stretched with pregnancy or weight gain if you haven't obviously been pregnant.  It needs to be tightened.

4. The muscles are not cut, but are "Imbricated" (folded centrally and sewed to tighten) in a "north-to-south" position.  

3.  If you are a  "massive weight loss" patient (classified as greater than 70 pounds) you may also have an imbrication in the "east-to-west" position as well.

2.  Be careful about procedures which are marketed as "less painful" or faster recovery without doing a muscle tightening as you may be dissatisfied with the bulge after surgery.

1. Make sure you feel comfortable with your surgeon and that he or she has tons of great B&A's (before and after photos) to show you.  

Hello! Great question. Muscles are brought together by sutures. Bringing the muscles together is a powerful boys shaping technique and is the one of the main advantages of tummy tuck surgery! Dr jeneby

You have asked 2 different questions in my reading of your posting. One is technical, in that, the method of recti plication is that issue. Each doc has their methods of suture, incisional, mesh plication. As gfor the second issue of better muscle response after TT. I know of no studies showing or responding to this issue. 

The fascia which surround your abdominal muscles are usually tightened with a series of sutures horizontally. The degree of tightening and the suture type may vary but one attempts to not actually injure the muscles themselves. After post op healing is complete you can work on strengthening your abs more. Best wishes

The underlying issue with regard to the rectus abdominus muscles of the abdominal wall ("the Abs") is not that they stretch out longitudinally with such causes as pregnancy but that there is increased separation between the left and right muscle, an area that is usually occupied by a narrow strip of tissue. It is this separation that results in most of the bulging of the abdominal wall.

The correction of this is to bring and sew the the muscles back "together" again (by plication). Various suture techniques can be used to accomplish this. What this does is restore the integrity of the abdominal wall which should improve certain functions and even help improve such issues as lower back pain. Because the muscles are back to a more anatomical position, you may find that certain exercises can be more effective in muscle toning.

Hello,

There are some misunderstanding about muscle tightening among patients.  It is frequently believed that the muscles are cut and sewn tighter.  In reality, muscles are deisgned to stretch and contract so the pregnancy process doesnt so much as stretch the muscles as much as it stretches the enveloping connective tissue of the muscles and in between the muscles.  That is why women who have had children see a laxity or roundness of their abdomen after childbirth.  Muscle repair or muscle tightening is therefore better termed muscle fascial tightening since its the fascia (connective tissue) that gets tightened.  I have used myofascial tightening as a term to describe the process in my textbook  "Atlas of Abdominoplasty". 

After a tummy tuck, therefore, the muscles are the same as before, perhaps better positioned, but their function should be largely unchanged.

All the best,

Dr Repta