Diastasis After Tummy Tuck 2 Years Ago?

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?

Doctor Answers 15

Muscle Separation AFTER Tummy Tuck Muscle Repair

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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

Memphis Plastic Surgeon

Diastasis vs. umbilical hernia

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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!

Tummy tuck repair : Recurrent diastasis

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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

Otto Joseph Placik, MD
Chicago Plastic Surgeon
4.9 out of 5 stars 86 reviews

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I assume you have a bulge after your tummy tuck, and this can definitely be corrected.

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To prindeb75,

Hi. It sounds like, for whatever reason, you had an unsuccessful abdominoplasty. Unfortunately, the only way to have a flat stomach is to have a revision. If you do have a separation of the rectus muscles (diastasis), this can be permanently repaired. Perhaps the general surgeon is pessimistic because he has seen other bad results.

The bulge could also be caused by residual fat, and this can also be corrected.

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon

Diastasis recti explained

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Diastasis recti is the lateral separation of the vertically oriented recti abdominus muscles located on either side of your anterior abdomen. A umbilical hernia is essentially a hole through the fascai, or connective tissue, holding the two muscles together around the belly button.

Most commonly, a diastasis occurs with pregnancy, and the muscle remains farther apart than normal but there may not be an actual hole around the belly button. This separation is almost routinely, although not always, repaired by suturing the muscle and its fascia together to tighten the abdominal walls from side-to-side.

The scarring that takes place and the sutures that are often placed in rows on top of each other can provide a secure and long-lasting correction of the diastasis. Frequently, any hernia present is also repaired.

If you had a full abdominoplasty with muscle tightening, then your plastic surgeon, in all likelihood, performed the plication or repair of the diastased muscles.

Robin T.W. Yuan, MD
Beverly Hills Plastic Surgeon

Your repair could have torn loose

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I have never seen a diastasis recti repair tear loose, but conceivably, anything sutured can come loose. The sutures are not actually placed in the muscle, bu are placed in the tough fascia overlying the muscles. I use a nonabsorbable suture material, but some surgeons use a slowly absorbable material that may have absorbed more quickly in your case. If you still have a bulge, you may also have intra-abdominal fat (fat around your intestines). This can only be lost by diet and exercise. Your general surgeon is overly pessimistic. I would suggest talking with a different general surgeon. Most plastic surgeons can also repair umbilical hernias. They can repair your hernia along with the diastatsis at the same time.

William H. Huffaker, MD
Saint Louis Plastic Surgeon
4.9 out of 5 stars 51 reviews

They should have fixed your diastasis at the time of the abodminoplasty

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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.

Diastasis? not a good sign

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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.

A well executed abdominoplasty will fix abdominal wall problems.

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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.

Tummy tuck and diastasis repair

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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.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.