Diastasis After Tummy Tuck 2 Years Ago?

Question

After having two children, I had a full tummy tuck 2 years ago to repair my stomach muscles and remove excess skin. After thinking I had an umbilical hernia, the surgeon said I have abdominal diastasis. Why did this happen and what should I do now? My plastic surgeon specifically said she was repairing my stomach muscles. However, the general surgeon I saw told me that it is almost impossible to repair them because no procedure will hold them together. Is this true?

Vincent N. Zubowicz, MD · Answer

Almost every patient can have a flat abdomen with an abdominoplasty. It requires repair of the fascia of the abdomen that is painful but necessary for the best result. Only rarely will these repairs fail.

J. Timothy Katzen, MD, FACS · Answer

Thank you for your question regarding diastasis recti after your tummy tuck. It’s understandable that you’re concerned, especially since your surgeon specifically repaired your abdominal muscles during the procedure.

While it’s uncommon for diastasis recti (the separation of the abdominal muscles) to reoccur after a tummy tuck, it is possible. Several factors could contribute to this, including physical strain, genetics, or significant changes in weight. Even though muscle plication (repairing the muscles) is a standard part of a tummy tuck, if excessive stress is placed on the abdomen during recovery or in the years following, the muscles could stretch or separate again.

The statement that it’s "almost impossible" to repair the muscles permanently is not accurate. Muscle plication during a tummy tuck, when done properly, should hold the muscles together. However, in rare cases, the sutures used in the repair could fail, or the muscles could separate again due to lifestyle factors or inadequate healing.

Since you’ve been diagnosed with abdominal diastasis again, I recommend consulting a board-certified plastic surgeon for a second opinion. A revision procedure may be necessary to re-tighten the muscles. This time, you and your surgeon can discuss specific steps to ensure long-term results, such as strengthening your core muscles gradually and avoiding activities that could strain the area post-surgery.

Sincerely,
Dr. Katzen

Otto Joseph Placik, MD · Answer

This is a common sentiment shared by several general surgeons and one of the more common reasons that they refer the patients to plastic surgeons. Generally, I have had over 15 years experience with this procedure and it is extremely rare for the diastasis to recur.
I also encourage patients to undertake a Pilates style exercise regimen which strengthen and reinforces the core muscles and the repair. However, I have had occasion to see a few recurrences. Some of these are related to early postop activity damaging the repair (one from exercise and one from severe nausea and vomiting) and weight gain.
If the diastasis is repaired, the use of supporting materials such as mesh can be utilized to reinforce the repair and minimize recurrence. I do not routinely use mesh on the first attempt but I do use a double layer repair of permanent sutures.
To see one example, view the above video.
Otto Placik

David Shafer, MD, FACS · Answer

PrinDeb77,
Your surgeon should have fixed your diastasis at the time of your abdominoplasty - this is an inherent component of the procedure.  Whether you had an umbilical hernia or not, the diastasis can be repaired.  Diastasis is a weakening of the muscles.  During the repair, the edges are sewn back together.   If you still have a diastasis, then I would recommend going back to your plastic surgeon and have them explain what they did during your original surgery.  Good luck.

Jonathan Fisher, MD · Answer

A full Tummy tuck should not have Diastasis and that is a result of errors in the procedure or even negligence, it would be dangerous to speculate on this without seeing your case but I would seek out a second opinion on the subject.

Peter A. Aldea, MD · Answer

In order for a uterus to bring a baby to full term, it needs to grow from the size of a lime to the size of a large watermelon. The only way the body can allow this to happen is by some stretching of the side muscles but mostly through the massive stretching and expansion of the skin and muscles of the front tummy. The six pack (Rectus) muscles are both stretched and split from one another allowing the pregnant uterus to push forward. After delivery, there is NO complete recovery and a "snapping back" of the stretched out skin and muscles. For this reason, the vast majority of women who diet and seriously exercise still cannot regain their before-baby figures. To do so requires a well-executed Tummy Tuck the fundamental portion of which involves a repair and tightening of the 6 pack (Rectus) muscles.

	I hate to speak ill of a colleague but your general surgeon is absolutely wrong. I have performed hundreds of Tummy Tucks and have never had a splitting or recurrence of the muscle separation. But I suppose it can happen if the repair was poor, if you had vomiting, straining or exercising before scarring made the repair more secure.

	Unlike the general surgery ventral hernia population which is older, sicker, often has COPD (active or former smokers), may be obese, all of which contribute to recurrence hernia, this is NOT the case with our patients. For the most part, the Tummy Tuck population is younger, thinner, free of medical issues and much more motivated.

	As regards your case, I would advise you to carefully consider what possible event could have caused your muscle re - separation. If you need a second opinion, by all means get one. But - although it is more challenging the second time around, there is NO reason why you cannot have another Tummy Tuck with muscle repair and get the figure you want.

	Good Luck.

	Dr. Aldea

Pat Pazmino, MD, FACS · Answer

A tummy tuck is a very popular and effective way to contour the abdomen and tighten the muscles. If you notice some loosening of the muscle after your tummy tuck, it is possible that some of his teachers that were used to tighten muscle may have loosened. Your best bet is to be evaluated by a board-certified plastic surgeon who has a great deal of experience in abdominoplasty and body contouring techniques. They will be able to determine the cause of this bulge and recommend a treatment plan that fix this directly.

	To learn more about tummy tucks, see photos, and help you decide which one is best for you, please visit us at the link below:

Steven Wallach, MD · Answer

Weakness of the abdominal wall after pregnancy is usually related to stretching of the fascia or connective tissue that wraps around the rectus muscles. As surgeons we tighten this weakness by pulling the fascia together in the midline and sewing it. The scar tissue that develops from the two sided pulled together, holds the muscles closer to the midline and usually flattens the abdomen.

Robert M. Freund, MD · Answer

I agree with the last physician. The distatsis can be permanently repaired. I also use permanent sutures and that may help make the repair more durable. However, sometimes overzealous exercise can stretch the initial repair making the diastasis reappear.

Kenneth R. Francis, MD, FACS · Answer

Deb,
If you underwent a full tummy tuck 2 years ago, your plastic surgeon indeed repaired the diastasis or separation of the muscles. This repair is usually performed with a permanent suture material and is usually a lifelong result. So, your general surgeon is incorrect. However, diastasis repairs can separate for several reasons. Sometimes the stitches can break or untie, sometimes a dissolving stitch is used, and although rare, the muscle can again separate over time.  
One more likely scenario in your case is that you had a small umbilical hernia present at the time of your tummy tuck that was undetectable and has since increased in size, or an even MORE likely scenario is that your general surgeon is feeling the diastasis repair above and below the belly button. You see, we leave a hole in the diastasis repair for the belly button to come through to get up to the skin. I would suggest that you return to your plastic surgeon, who should be able to shed more light on the situation. Good luck!

Diastasis After Tummy Tuck 2 Years Ago?

Answers (15)

More Tummy Tuck Questions

WE SEND PRETTY
EMAILS

Answers (15)

More Tummy Tuck Questions

What Can I Do About Bulging, Sensation Problems After Tummy Tuck?

Full or Reverse Tummy Tuck for Upper Abdomen Laxity?

Is It Inevitable to Have Loose Skin and Muscle on the Tummy After Pregnancy?

Options for Improving Belly Button Appearance After Tummy Tuck?

Tummy Tuck Without Drainage Vs. with Drains?

How Long is the Recovery Period for Full Tummy Tuck?

WE SEND PRETTY EMAILS

WE SEND PRETTY
EMAILS