Rectus Diastasis Repair After Hysterectomy?

Question

How long after a c-section hysterectomy do I need to wait to have surgery to fix my rectus diastasis?  I am 7 weeks post-surgery and I can't take the bulging and discomfort especially when I try to eat.

Farbod Esmailian, MD · Answer

After pregnancy it takes about 6-8 weeks before the uterus shrinks back to normal size.  So theoretically you would have your tummy tuck when you are 2 months out from your c-section without any issues.  In general though you probably have some more weight to shed off and it you wait you will likely have a better result than if you were to have your surgery done when you are 2 months out from surgery.
I would say move forth with surgery if you feel that you are at the weight you are going to be or if you think you will not be able to shed any more weight.
Good luck.

J. Timothy Katzen, MD, FACS · Answer

Hello, and thank you for your question about repairing rectus diastasis following a recent hysterectomy. I completely understand how frustrating and uncomfortable that bulging sensation can be — especially when you're trying to heal and regain control of your core again.

Rectus diastasis is a condition where the two vertical abdominal muscles (the rectus abdominis) have separated, commonly from pregnancy or significant abdominal stretching. Repairing it involves surgically bringing those muscles back together, usually through a tummy tuck or abdominoplasty with muscle plication.

Because you had a c-section hysterectomy just seven weeks ago, your body is still in the early stages of internal healing. Most plastic surgeons — myself included — recommend waiting at least 3 to 6 months after a major abdominal surgery like a hysterectomy before undergoing another procedure involving the abdominal wall. This timeframe allows:

Proper healing of internal sutures and scar tissue

Reduction of inflammation and swelling

Time to assess your new baseline anatomy, especially now that the uterus has been removed

A lower risk of complications like wound separation, infection, or prolonged recovery

Although you’re understandably eager to address the diastasis and improve both your comfort and appearance, rushing into surgery too soon could compromise your healing and lead to a more difficult recovery. That said, your discomfort — especially the sensation of bulging after eating — is very real, and it’s important to document your symptoms and track any functional impairments (like back pain or digestive difficulty). Some insurance companies may consider rectus diastasis repair medically necessary if there are functional limitations, although coverage varies widely.

In the meantime, consider wearing a medical-grade abdominal binder or compression garment to provide temporary support. Gentle core strengthening exercises under the guidance of a physical therapist (once cleared by your gynecologist) may also help reduce symptoms until you're ready for surgery.

Wishing you comfort and clarity as you heal, and when the time is right, a smooth path toward repair.

Sincerely,
Dr. J. Timothy Katzen, MD, MBA, FASMBS, FICS
(Certified by the American Board of Plastic Surgery and President of the American Society of Bariatric Plastic Surgeons; Fellow of the International Society of Aesthetic Plastic Surgery, American College of Surgery, International College of Surgery, and American Board of Metabolic and Bariatric Surgery; Member of the American Society of Plastic Surgeons, American Academy of Cosmetic Surgery, and RealSelf Hall of Fame)

Once you are fully healed from your hysterectomy, please consult a board-certified plastic surgeon experienced in abdominal wall reconstruction to discuss surgical options and determine the best timing for repair.

Ricardo L. Rodriguez, MD · Answer

Agree with other posts about waiting 2-3 months. 
Here's another suggestion: as soon as your Ob-Gyn releases you, start doing abdominal exercises. This strengthens your abdominal muscles, but more importantly, makes the muscle closure more secure, and the recovery faster.
Be sure to ask for a pain pump, it will make your recovery that much easier. I have attached below a link to a blogpost on pain pumps and how they improve recovery.

David Shafer, MD, FACS · Answer

In most cases, diastasis repair / abdominoplasty can be preformed at the same time as hysterectomy. However, since you have already had the surgery, it would be best to wait three to six months to have another surgery.

Otto Joseph Placik, MD · Answer

This varies tremendously among different practitioners. However, the vast majority of physicians usuallyrecommend to defer surgery for 3-4 months prior procedures. This allows sufficient time for the healing process to proceed.

Steven Wallach, MD · Answer

Too bad you did not have the tummy tuck at the same time.  I would have you wait about 6 months to completely heal before going in to tighten the diastasis.

Pat Pazmino, MD, FACS · Answer

Tummy tucks are a popular and effective way to recontour the abdomen. These are very commonly done after a woman has had childbirth or a C-section. Pregnancy can change the body and abdomen of a woman and can often separate the two abdominal muscles causing a rectus diastasis.
	Once you are done stealing from the C-section and have completed breast-feeding, patients should wait approximately 6 months before considering any abdominal surgery. This will give your body time to heal and allow your abdomen to return to its normal state before receiving its repair.

	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:

Nirav Savalia, MD · Answer

Hello,
There is no consensus on how long you have to wait obviously (from the answer already posted), however, I agree with the other authors that your body needs to have reached some level of stability before moving forward with a tummy tuck. Your muscles need time to strengthen, your skin needs time to heal, and you also need to emotionally ready for a major operation that has a significant recuperation time.
You probably should wait at least 3-4 months, if not longer. I personally would wait at least 6 months.

Nina S. Naidu, MD, FACS · Answer

Hi,
You are only 7 weeks out from your surgery, so don't be too frustrated that you notice bulging at this point.  Some of this may be from the separation of your rectus muscles, but there is also likely some soft tissue swelling at this point which is contributing to the fullness that you see and feel.  I agree with the other surgeons that a minimum of 6 months wait would be indicated prior to additional surgery.  However, in the meantime you can purchase an abdominal compression garment which will provide some support to the abdomen while your swelling comes down.  This should also make you more comfortable.  Once you are cleared by your OB/GYN, you should start some exercise to help strengthen your muscles so that you are in good shape prior to your next surgery.  Good luck, /nsn.

Peter A. Aldea, MD · Answer

Dear Lpr1967,
Ideally, the diastasis COULD have been repaired in a joint operation GYN-Plastic at the time of the hysterectomy.
Now - for it to be done safely and minimize complications, it would need to be done when the inflammation has subsided. That period varies from person to person 4-6 months is the usual range.
Hope this answered your question. Cheer up, the time will pass by quickly and the result will be much better.

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