Can a Tummy Tuck repair stretched muscles that are not separated? Or does it only repair if there is separation?

Question

My personal trainer told me I do not have abdominal separation but after two pregnancies my stomach is not the same. If I relax and don't consciously hold in my stomach my measurements at my belly button is 40", versus 35" if I contract my muscles. I also have a lot of the usual mom issues -bladder control and bloating, pelvic floor weakness, lower back issues. Will a tummy tuck help? Can hernia repair be done simultaneously?

Leila Kasrai, MD, FRCSC · Answer

A board certified plastic surgeon can check if you have abdominal muscle separation. A tummy tuck can correct this issue, and hernia repair may be performed at the same time.

William Andrade, MD · Answer

Hello, even if there isn't a large gap between the muscles (rectus diastasis) it is still possible to tighten the muscles to some extent.  The final outcome varies between patients, because some times their tummy bulge isn't just due to loose muscles, but also due to their internal body organs and fat.  A tummy tuck does not remove fat deep to the muscles so sometimes even after tightening the muscles, some bulging can persist.  If you have an in-person consultation the surgeon will be able to provide advice specific to your anatomy.  As for your concern about a hernia, your family doctor could do an assessment and possibly imaging to determine if you just have loose muscles or a true hernia.

Gary M. Horndeski, MD · Answer

If you are not planning future pregnancies, I recommend abdominoplasty with mesh reinforcement. The mesh creates a more hourglass figure by compressing the abdominal wall resulting in early satiety and helps maintain a reduced weight. This will also correct the hernia. However, if you are having issues with bladder control and pelvic floor weakness then I recommend you consult with a urologist to have those issues corrected first before undergoing a tummy tuck. A tummy tuck can make those issues worse.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Michele A. Shermak, MD · Answer

Hello! 
You almost certainly have a separation of your muscles in the midline. The muscles do not loosen and lengthen like stretching pasta. They separate. And the muscles can weaken particularly with abdominal surgery that cuts the rectus muscles.
I would recommend you see a board certified plastic surgeon to assess your anatomy and come up with an appropriate plan.

Michael Kreidstein, MD, FRCS(C) · Answer

As you describe, fascia is the tissue that controls your abdominal wall when you aren't contracting your muscles.  Pregnancy stretches the fascia in both vertical and transverse directions, and not just in the midline between the rectus muscles.  Fascial plication should be done to restore the strength of the fascia wherever it is weak, and can be used to augment a hernia repair.  
I have many patients who have recovered from stress incontinence and chronic lower back pain after fascial plication.  Your muscles need to push against something to be effective- try pushing an object while your feet are on ice for a demonstration.  Recovering abdominal wall stability will allow your back muscles to be more effective and (eventually) restore a better posture.

Gerald Minniti, MD, FACS · Answer

Your personal trainer should stick to exercise and not plastic surgery.  I've never met a woman who's had  childbirth that didn't need abdominal wall repair.

Carmina Cardenas, MD · Answer

After a pregnancy plus the genetics, the majority of women develop saggy skin in different degrees, loose muscle, some of them develope dyastasis which means the real separation of the recti muscle in the midline. And all above together or separated. Each body is different. 
A trainer is not the best person to determine the quality of your tissues, the expert on the Abdominal wall will be the Plastic and Reconstructive surgeon. 
If you have realized your abdominal wall has become loose after the pregnancies, most likely you will be a wonderful candidate for a Muscle repair and if you have saggy skin, and /or saggy mons, you will be a perfect candidate for a Tummy Tuck with muscle repair. 
Muscle repair, is a procedure I perform in 99.9% of the TT and body lift I do, and after almost 20 years of practice and being myself a patient of a Body lift, I can tell that it will help to give support to your back muscles, and the bloated appearance of your abdomen. BUT you must acknowledge that if you already have bladder issues, you must get it fixed by a urologist-gynecologist because the tightening of the muscle repair may aggravate the bladder leaking. 
Be encouraged!!
Dr. Cárdenas

Daniel Barrett, MD · Answer

Dear Mom.of.boys.40,
tummy tuck will help with loose skin and muscle separation. But it will not help with bladder issues or back issues. If you are considering a surgery, I would suggest you to consult a board-certified plastic surgeon. Only after a thorough examination you will get more information and recommendations.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Camille Cash, MD · Answer

From your description it sounds as if you have abdominal wall laxity which is not uncommon after pregnancy.  This can be addressed during a tummy tuck, creating a flatter, tighter tummy.  The surgery is not designed to address bladder control, pelvic floor or lower back issues.  Hernia repairs can often be done at the same time as a tummy tuck.  The best place to begin is a consultation with a board certified plastic surgeon near you.

Connie Hiers, MD, FACS · Answer

If you have a hernia, this needs to be repaired. Depending upon the location and size of the hernia depends if it can be repaired at the same time as the tummy tuck, or done separately.  After pregnancy, most women have some separation of their abdominal muscles which can be tightened with the tummy tuck.