How to You Know if Your Abdominal Muscles Are Split?

I had a twin pregnancy that went to 39 weeks and a C section delivery. I weighed 226 at delivery (starting at 204) and have since gained weight back to that amount over 9 years. I have a very full upper abdomen and lower abdomen with an overhang of skin where my legs meet my torso. How do you know if you would qualify for reconstructive surgery due to a muscle split? Why wouldn't a regualr DR notice and recommend surgery?

Doctor Answers 6

Diastasis Rectus Repair During Abdominoplasty

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In general, if one is performing a full abdominoplasty and has excess skin above and below the abdomen and has had more than one child and there is a diastasis (widening of the rectus muscles from being pregnant) this can be corrected at the same time as the abdominoplasty. Also, diastasis rectus is a cosmetic procedure and certainly is not, unless there is an associated hernia, covered by insurance. The goal is to do abdominal wall re-shaping, contouring as well as liposuction to the back and flank areas to optimize the shape and contour of the female silhouette.

Dallas Plastic Surgeon

Determining the degree of diastasis

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Are you asking if you are a candidate for surgery or for insurance coverage?  Without photos it is hard to say, but your history of a twin pregnancy and overhanging skin sounds like you would benefit from an abdominoplasty.  The rectus muscles are separate muscles.  The space between them along the midline may increase with pregnancy and is usually tightened during an abdominoplasty.  How far the muscles are separated can be felt while you are doing an abdominal crunch.  It is very unusual for the separation to be so great that it causes a functional problem.  I have seen a couple over the past 22 years that I thought were great enough to justify surgery and both times they were declined by the insurance companies.  If your primary care physician discovered a hernia (something entirely different than diastasis) then I am sure he/she would recommend surgery and it would be covered by insurance. 

Lori H. Saltz, MD
San Diego Plastic Surgeon
4.3 out of 5 stars 29 reviews

Rectus Split?

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The best way to determine if you have a separation of your rectus muscles or distasis is to lay down and lift your legs and head off the floor at the same time and feel if there is a space between your muscles or a bulge. As to surgery for your condition, you should consult a board certified plastic surgeon in your area.

Richard Linderman, MD
Indianapolis Plastic Surgeon

Detecting separation of the abdominal wall muscles

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As Dr. Johnson described, the best way to detect a separation between your abdominal muscles is to place your palm over the midline area of your abdomen while you are doing a sit-up. For a full assessment of your situation and to find out what would be most appropriate for you, I would suggest that you consult with a board certified plastic surgeon in your area.

Steven Turkeltaub, MD
Scottsdale Plastic Surgeon
4.7 out of 5 stars 33 reviews

Detecting diastasis

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The easiest way to determine if a diastasis of the sit-up muscles has occurred with your pregnancy is to lay flat and pick your head up much like a sit-up and feel for the separation between the muscles. Often your finger tips will sink right into the gap as the muscles tighten.

Best of luck,


Peter E. Johnson, MD
Chicago Plastic Surgeon
4.0 out of 5 stars 44 reviews

Muscle Separation

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Thank you for your question.

In my experience, most women who have had pregnancies (especially twin pregnancy) do have the muscle separation and benefit from abdominoplasty surgery as well as suturing back the abdominal muscles.  I would recommend consulting with a board certified plastic surgeon to discuss your options in detail.

Sometime, insurance may cover a panniculectomy but you would need to check with your insurance directly.

I hope this helps.

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.