What are my options for diastasis and upper skin laxity? (Photos)

Question

I am 37, female, 130 lbs, 5’7, I’ve had 3 babies via c section. I have an upcoming breast revision and I’m wondering how this could be addressed

Mazen Harake, MD · Answer

At 5 feet 7 inches and 130 pounds, your weight appears relatively lean. After three pregnancies and cesarean deliveries, the likely issues may include diastasis recti, lower-abdominal skin laxity, upper-abdominal laxity, and possibly a cesarean scar tethering the lower abdomen.
A mini tummy tuck would usually be inadequate if laxity or muscle separation extends above the belly button. A full abdominoplasty can:
Remove lower-abdominal excess skin.Repair rectus-muscle separation when appropriate.Lower and revise the cesarean scar.Tighten the abdominal wall from the pubic region toward the upper abdomen.If the laxity extends significantly above the navel or there is excess skin in the upper abdomen, an extended tummy tuck or fleur-de-lis abdominoplasty may be considered. The latter adds a vertical scar but allows removal of tissue in the horizontal direction as well.
Liposuction may improve contour around the flanks or upper abdomen, but it does not correct diastasis or remove loose skin. Since you are planning breast revision, the abdomen and breast procedures may sometimes be combined, but the safety of doing so depends on operative duration, medical history, prior operations, and the extent of each procedure.

Gregory A. Buford, MD, FACS · Answer

From the photos your provided, it appears that you have rectus diastasis that extends from the top to bottom of your abdominal wall with a noticeable bulge at the area below the belly button.  You don't appear to have a ton of extra skin.

I feel that you would be an ideal candidate for the TrueTuck as this procedure allows for even greater amounts of skin removal given use of the quilting/shaping sutures and their ability to hold the abdominal skin on a little greater tension early on and allow for increased skin removal.

To give you a little more information, the TrueTuck Tummy Tuck is the culmination of 26 years of performing tummy tucks and feeling like we could be doing a little better job.  The TrueTuck Tummy Tuck includes the following:
-Circumferential 2 phase liposuction (ultrasonic + power-assisted) + Renuvion Skin Tightening
-Use of Quilting/Shaping sutures to effectively reduce space between the skin flaps, eliminate the need for drains, and create a more corseted look to the torso
-Mons Lift with internal suture suspension to create a more optimal transition from the abdominal to the pelvic area
-Customized shaping of the umbilicus

I hope this information is helpful and wish you the very best in your surgical journey.

Mert Demirel, MD · Answer

After three C-sections, abdominal fullness can come from diastasis, loose skin, scar tethering, or a combination. If there is true muscle separation, exercise can improve core strength but usually cannot fully close the separation once the fascia is stretched.
A full tummy tuck is usually the most complete option because it can repair diastasis from the upper abdomen to the lower abdomen, remove lower abdominal skin, and improve the C-section scar area. It also allows the belly button to be repositioned.
A mini tummy tuck is more limited. It mainly treats lower abdominal skin and sometimes lower muscle laxity, but it usually does not adequately address upper abdominal diastasis or upper skin laxity.
If your concern is mostly upper skin laxity and muscle separation, non-surgical tightening treatments may give only mild improvement. They cannot replace muscle repair or remove true excess skin.
My advice would be to get an exam focused on the amount and location of diastasis, skin laxity above and below the belly button, and the C-section scar. If you are already planning breast revision, ask your surgeon whether combining it with a tummy tuck is safe for your operative time and recovery, or whether staging the procedures would be wiser.

Robert M. Wald, Jr., MD · Answer

Repairing your diastasis is required to flatten your abdomen. A mini tummy tuck would also help out with the excess upper abdominal skin. You could do this at the same time of your breast surgery.

Chet Mays, MD · Answer

Thank you for your inquiry.  We would love to sit with your to discuss your concerns.  An abdominoplasty consists of tightening the abominal muscles, liposuction the fatty areas of the abdomen and remove any excess skin. Make sure to consult a Board-Certified Plastic Surgeon to help you reach your goals.

Gregory Lakin, MD · Answer

Thank you for your question. After three C-sections, you would most likely benefit from a full tummy tuck with muscle repair. A full tummy tuck allows the surgeon to repair diastasis recti, remove excess skin, and tighten the entire abdomen, including the upper abdominal area. If you have excess fat in the flanks or waist, liposuction can be combined with the tummy tuck to further improve your overall contour. The best way to determine the extent of your muscle separation and skin laxity is to have an in-person examination by a board-certified surgeon. If you're already planning a breast revision, many patients choose to combine it with a tummy tuck as part of a mommy makeover, provided they are a good surgical candidate.

Julia Spears, MD · Answer

Thank you for your question and photos. Following three pregnancies, your concerns may be related to a combination of abdominal skin laxity and separation of the abdominal muscles (diastasis recti). A physical examination would be necessary to confirm muscle separation and determine how much excess skin is present.

If you have significant diastasis, a tummy tuck with muscle repair is generally the most effective way to tighten the abdominal wall while also addressing loose skin above and below the belly button. Liposuction alone will not repair muscle separation and, particularly in a thin patient, may make skin laxity more noticeable. Since you are already planning a breast revision, it may be possible to combine the procedures depending on the extent of surgery, your overall health, and the anticipated operative time. I would discuss this with your board-certified plastic surgeon to determine the safest and most appropriate approach for your anatomy and goals.

Leila Kasrai, MD, FRCSC · Answer

It looks like you may have abdominal muscle separation, a common issue that develops with multiple pregnancies. This can be corrected with a tummy tuck, and any loose skin can be removed at the same time.

Kadir Berat Oyur, MD · Answer

We have reviewed your photos. You appear suitable for liposuction with J-Plasma skin tightening to improve abdominal contour and skin laxity. A detailed consultation is recommended for final planning.

Jeffrey M. Darrow, MD · Answer

Thank you for your photos. You appear to be in excellent shape with minimum skin laxity of your abdomen and a moderate disastasis. The diastasis would need to be sutured together to recreate a flat foundation for your abdomen. If your skin is lax enough, a standard skin resection of your abdomen could be done. If your skin is not sufficiently lax, and scar position is negotiable, moving the abdominoplasty incision upward would allow the umbilical opening created at the time of the incision around the belly button, to be removed at the time of the skin resection, so your only incision lines would be around your belly button and across your abdomen. If scar position is of paramount importance to you, and you wish to keep it as low on your abdomen as possible, the umbilical opening may not be able to be removed at the of the skin resection and would be closed as a small vertical line just below the position of your new belly button and above the lower abdominal incision. Your upper abdominal skin will not be as snug and tight as your lower abdomen skin, as the further away from the incision, the less tightening occurs. Discuss these options in detail with your plastic surgeon. Best wishes.

What are my options for diastasis and upper skin laxity? (Photos)

Answers (17)

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