Repairing muscles after pregnancy
Yes, you can have just muscle repair done without having a tummy tuck, but I'm not sure that makes sense. After all, the muscle repair is the part of the tummy tuck that hurts the most. If you're going to have that done, why not get the added benefit from a fully tummy tuck with removal of the loose skin on the abdomen?
A mini-tummy tuck does not repair the muscle all the way from the ribs down to the pubic bone, and it does not remove any loose skin around or above the belly button. After twins plus another child, this "mini" procedure will truly just give you "mini" results, and I would bet you'd be back for a revision within a year.
You will need a full tummy tuck
With the degree of stretching you have sustained, the tightening of your rectus diastasis will leave you with substantially MORE loose skin than you presently have. Only a full tummy tuck can deal with that loose skin properly.
I operated on a woman who had a 3 inch diastasis just last week and it was AMAZING how much skin laxity was present after. I almost needed to do the full horizontal scar plus a full vertical scar to remove it. I was able to use some veteran tricks and avoid the vertical scar but it was very impressive how much skin was there.
I have also tried to do a repair of a wide diastasis after twins through a mini incision and left the skin to shrink because her skin tone seemed excellent. It didn't work well at all and I would never do it that way again.
A full tummy tuck is necessary to repair a diastasis recti, a mini tummy tuck will not
A full tummy tuck is necessary to repair a diastasis recti. During a full tummy tuck, the surgeon can expose all of the rectus muscle so that it can be properly repaired.
A mini tummy tuck is done on the lower abdomen below the umbilicus or belly button. During the mini tummy tuck the surgeon cannot repair the upper part of the rectus muscle.
If the lower muscle diastasis recti is repaired during a mini tummy tuck and the upper muscle is left unrepaired, then an unsightly bulge will be seen in the upper abdomen above the umbilicus.
If you have had a few children and now have a diastasis, I would suggest having a full tummy tuck to repair the weak muscles.
A full tummy tuck is your best option
Having had twins, your abdominal muscles most likely have stretched apart much more than what typically occurs with a single pregnancy. Every patient I have ever seen that has had twins ultimately needed a FULL tummy tuck, even when there is not necessarily that much "loose skin." It is the inside that needs the most tightening, the myofascial wall (covering of the muscles). A mini tummy tuck (or mini-abdominoplasty) is really MINI RESULTS. If you are considering surgical improvement to give you your abdomen back, I would most strongly recommend full correction with a full abdominoplasty.
The abdominoplasty incision I perform is placed low inside of any swimsuit bottom or most underwear. This gives "access" to the abdominal wall which is what needs to be "tightened." You will need tightening (or plication of the fascial wall) in BOTH the lower and upper abdomen. A full tummy tuck gives the BEST access to the upper abdomen. Also when removing the loose skin, it gives the BEST "redraping" of the skin and correct position of the belly button.
A mini-tummy tuck typically ONLY deals with plication in the lower abdomen. It is POSSIBLE, however very challenging to approach the upper abdomen for plication in a mini tummy tuck and the accuracy of doing so will surely be compromised. Also by not incising around the belly button the loose skin in the upper abdomen is not pulled down and oftentimes can end up with a wrinkle or area of residual fullness in the upper abdomen. Also by not incising the belly button the belly button can be "pulled down" unnaturally and it can look weird. There are very few true ideal candidates for a mini-tummy tuck and I would anticipate that someone having had twins with moderate to severe rectus diastasis would NOT be a good candidate for a mini tummy tuck.
I hope this helps!
Diastasis can be repaired without tummy tuck
Yes, you can. The plastic surgeon can repair the diastasis endoscopically, using small incisions. However, the surgeon has to discuss with you if you might need mesh to repair the diastasis; in this case it would be harder to do endoscopically. It is very unusual for someone to need repair of diastasis but not removal of excess skin. If you do have excess skin, in my experience you will be much happier with a full abdominoplasty. Make sure you discuss the pros and cons of each option with your surgeon so you can make the best choice for you that fits your goals. Hope this helps.
Separation of your rectus abdominis muscles which occurs commonly with pregnancy is readily corrected by suture repair at the time of TT. If the separation is not extensive and only limited to below the belly button, then a "mini" TT may be adequate for correction.
On the other hand, if your issue is mostly a muscle issue without a significant skin problem then it is possible (rare) to perform a repair of the muscles through a small (C-section like) incision with special instruments and even more rare to repair from inside the abdomen usually by a general surgeon.
Rectus diastasis and tummy tuck
There are a number of key anatomical steps in a full tummy tuck:
liposuction of the abdo and flanks
excision of excess lower abdominal tissue
reapproximation of separated rectus muscle
recreation of a belly button
If you have no excess skin or fat, then you may be a candidate for a endoscopic assisted tummy tuck where the belly button is "floated" and the muscles reapproximated. The incision is still a transverse one just above the pubic region, but smaller than a full tummy tuck.
If you have excess skin then you will need a mini or full tummy tuck, which one can't be determined until you have been examined by a plastic surgeon.
I hope this helps and good luck.
Repairing a Diastasis Recti Involves an Abdominoplasty at the Same Time
The paired rectus abdominus muscles are located on either side of the midline and are oriented vertically. They extend from the rib cage to the pubic bone and are the muscles we use when performing sit ups. There is usually only a minimal gap between these muscles under normal circumstances.
During pregnancy the abdominal wall becomes stretched by the rapid expansion of the intra-abdominal contents. In many cases, this results in separation of the two muscles in the midline with the formation of a diastasis. This separation extends from the pubis bone to the rib cage and is especially noticeable when the abdominal muscles are flexed. Flexion typically results in a midline bulge that extends from the pubis to the rib cage.
Correction of a diastasis recti involves suture repair of the gap between the pubic bone and the rib cage. This repair requires exposure of the underlying muscles by separating them from the overlying skin. Once this maneuver is performed, you have essentially performed an abdominoplasty. All that’s left to be done is remove the excess skin and close the wound.
Under these circumstances, it would be pointless to repair the diastasis without performing an abdominoplasty. This would give the added benefit of removal of excess skin, fat, and stretch marks. If you are considering this option, make sure you consult a board certified plastic surgeon.
No, a full abdominoplasty is not necessary to fix a rectus diastasis
A rectus diastasis, which is a gap between the rectus abdominus or "six-pack" muscles, CAN be fixed through a c-section incision if your plastic surgeon can do it - it's not easy get up to the ribs through a smaller scar, but it definitely can be done. If your skin quality is great but you have a pregnant looking bulge, this a great procedure for you.
To get the terminology straight, a "full abdominoplasty" means that the scar is long, and that there is a scar around the belly button. Technically speaking, all the skin between the pubis and the belly button is removed, and the upper abdominal skin is pulled down and looks a lot better. Usually a plication is just automatically part of this procedure.
A "mini-abdominoplasty" just addresses the skin between the belly button and the pubis, so it won't improve the skin on your upper abdomen at all. It can still be used to fix the lower muscles, or the whole rectus diastasis. So when you talk abdominoplasty, either mini or regular, you are talking about the amount of skin removed and the scar more than about the way the surgeon deals with the rectus muscles.