Can a Diastasis Recti Repair Go Back To Pre-Op Status Because of "Inherent Weakness" of My Fascia?

All muscles are encased in a tough silvery white dense tissue layer called the fascia. The fascia  condenses at the very ends forming ligaments and tendons with which our muscles attach to bones.  When the abdomen becomes greatly distended it stretches out and splits the muscles. The most important restorative feature of a Tummy Tuck is the takin in of loose muscles and correcting the separation of the six pack (rectus abdominis) muscles. Here, stitches are placed into the fascia and used to keep it together until the repair is cemented by scar tissue.

However, all Plastic surgeons have seen cases of very weak abdominal fascia. This is usually seen in the fascia below the belly button than in the fascia above the belly button. However, this something which is obvious at the time of surgery.

Recurrences of the muscle separation (diastasis) can be associated with a weak fascia (as above), a malnourished patient, a smoker or a person with frequent coughing (causing repeated stress of the repair), poor surgical technique OR a combination of one or all of the above. 

When it comes to stitching the fascia together there is a great variety among Plastic surgeons in the TYPE of suture used, The manner in which the stitching is done and in how many layers of stitching is done to prevent recurrence.

Since none of us were present at your surgery no one can definitively state one way or another if your fascia "was to blame" or other factors are responsible for your recurrence. If you wish it corrected you may want to get your medical records and see another Plastic surgeon in second opinion.

Peter A. Aldea, MD
Memphis, TN

Hello,

This is possible, but it is always hard to know what the event really was.  It could be your tissues, or the suture type, or the amount of straining that you had after surgery, or any combination of these.  At this stage, the options for abdominal wall tightening would be to redo the tummy tuck to allow access to the abdominal wall or to utilize an endoscopic technique.  I would recommend strong suture bites using a non-dissolvable suture.  If significant tissue weakness is suspected a dermal matrix product can be used to reinforce the abdominal wall but this rarely necessary.  Wearing your abdominal binder for 4-6 weeks and refraining from rigorous activity for about 6 weeks would also be prudent.

All the best,

Dr Remus Repta

Diastasis can recur through trauma, intrinsic muscle weakness or because the repair didn't hold. You may know that men have recurrent hernias after surgery so the same principle is involved. You will need a revision which may include mesh or allograft. I agree that it is difficult to predict whether a diastasis will recur but the important thing is to move forward.

There are a number of reasons for recurrence and you may not be able to determine what was the exact cause.

What you should consider if you are gong to redo the procedure is to use some additional material to reinforce your own tissue.  After all if this occurred spontaneously it may be that your tissue was inherently weak and so this will recur if something different is not tried.

There are a number of synthetic mesh products on the market and allograft materials made out of dermis which can help to reinforce the weaker tissue.

Thank you for your question and good luck.

This could be from thin tissues, weight gain, cough or excessive straining before complete healing, surgical technique etc so you can see that there is no way to determine what happened for sure.  If your result was great early on, your surgeon likely did a great job.  All you can do is consider redoing it and maybe reinforcing it with mesh or dermal allograft material.