Should only lower abdominal muscle be repaired in a tummy tuck if upper abdominal muscle is not separated?

Hello Thoughtful395802. Thank you for your question regarding whether it’s advisable to repair only the lower abdominal muscles during a tummy tuck.

If your upper abdominal muscles are not separated and are still tight, then it may not be necessary to suture them during your tummy tuck. The focus on the lower abdominal muscles, where the separation or bulging is present, could be sufficient to achieve a flatter, smoother appearance. However, it’s essential that your plastic surgeon carefully evaluates the entire length of the rectus abdominis muscles to ensure that no issues are overlooked.

Repairing only the lower abdominals can still provide excellent results if the upper muscles are indeed intact and strong. It’s important to discuss with your surgeon the potential outcomes and to ensure that the approach taken will address your concerns about achieving a smooth and flat abdomen.

In some cases, if only the lower abdominals are repaired, there might be a slight risk of future issues if the upper muscles were later found to weaken or separate. However, if the upper muscles are currently in good condition, this approach is reasonable. A thorough consultation and evaluation with your plastic surgeon should help you feel confident in the plan.

Sincerely,
Dr. Katzen

Most surgeons routinely repair the fascia from the xiphoid down to the pubic bone. If only the lower part is repaired and tightened then it is possible that the upper portion could herniate and you will have a bulge and you will be dissatisfied. I recommend the full length of the fascia to be repaired. The muscle is not repaired but the fascia is.

Best Wishes,

Gary Horndeski, M.D.

I do not recommend just tightening the lower abdomen because it will push the abdominal content up and make the upper abdomen bulge out. The entire line needs to be done to prevent the unwanted bulge in the upper abdomen.

In a traditional tummy tuck (abdominoplasty) procedure, the primary focus is on addressing laxity and separation of the abdominal muscles, typically involving both the lower and upper abdominal muscles. However, the specific approach to muscle repair during a tummy tuck can vary depending on the individual patient's anatomy and needs.If the upper abdominal muscles are not significantly separated or weakened, your plastic surgeon may choose to focus primarily on repairing the lower abdominal muscles during the tummy tuck procedure. This approach allows for a more targeted correction of the area of concern while minimizing unnecessary manipulation of healthy tissue.Here are some considerations regarding muscle repair in a tummy tuck:1. Extent of Muscle Separation: Your plastic surgeon will evaluate the degree of muscle separation (diastasis recti) in both the upper and lower abdominal muscles during the pre-operative assessment. If the separation is more pronounced in the lower abdomen, they may prioritize muscle repair in that area.2. Customized Treatment Plan: Tummy tuck surgery is highly customizable to address each patient's unique concerns and anatomy. Your plastic surgeon will discuss your specific goals and concerns during the consultation and develop a tailored treatment plan that addresses your individual needs.3. Optimal Aesthetic Outcome: While muscle repair is a significant component of a tummy tuck, achieving an optimal aesthetic outcome also involves addressing excess skin and fat, contouring the waistline, and creating a natural-looking abdominal contour. Your plastic surgeon will consider all these factors when planning the surgical approach.4. Patient Preferences: Your preferences and expectations regarding the extent of muscle repair should be discussed with your plastic surgeon during the consultation process. They will take your input into account when developing the surgical plan.Ultimately, the decision regarding muscle repair during a tummy tuck will depend on various factors, including the extent of muscle separation, the desired outcome, and the plastic surgeon's assessment of what will achieve the best results for you. It's essential to have a thorough discussion with your plastic surgeon to ensure that your expectations are aligned, and you have a clear understanding of the proposed surgical approach.

It is best to suture both upper and lower abdominals if undergoing a standard tummy tuck. This will prevent potential bulging of the upper abdomen, which would make the contour odd. Since the surgeon will have access to the full area it is best to have it done now versus needing a revision to address it in the future.

Thank you for your question. I think this is a big mistake to not tighten above as well as below.

If the lower abdomen is tightened, relatively more than the upper, even though there’s no over separation, it will result in an upper abdominal bulging with a flat, lower tummy, which is quite distorting.

It takes another three minutes to complete the upper tightening as well. I see no reason why one wouldn’t plan to correct the entire potential abnormality. Good luck.

I think it’s second opinion is an order beyond that what you get on the Internet.

I have seen this happen to patients that come into my practice unhappy with the upper abdominal bulge. I would definitely repair the entire abdomen if you are having a full tummy tuck. This will give you a lower risk of an upper abdominal bulge unless you are having only a mini tummy tuck. Good luck, Dr. Schuster in Boca Raton Florida

I suggest having multiple consultations before choosing a provider or scheduling surgery.
Without including pictures, we can’t begin to make an assessment.
You also didn’t include if you’ve had previous pregnancies.
Women who’ve had pregnancy will have muscle separation to some degree.
Muscle separation typically involves the upper and lower abdomen.
Tightening of the lower abdomen only tends to make the upper abdomen bulge.
There are four variables that determine what the abdomen looks like.
Treatments should be based at addressing the variables that are causing the problem.
The four variables to determine what the abdomen looks like are as follows.
1) abdominal skin laxity typically due to previous pregnancies or weight loss.2) excess subcutaneous fat.3) muscle separation from previous pregnancy.4) excess visceral, or intra-abdominal fat.
A tummy tuck primarily treats abdominal skin, laxity, and muscle separation.
Liposuction reduces subcutaneous fat.
Excess visceral or intra-abdominal fat can only be reduced through weight loss.
Visceral, fat and muscle separation can’t have a similar appearance.
Any plastic surgeon should be able to differentiate between muscle, separation and excess physical fat.
Best,
Mats Hagstrom, MD