DIASTASIS RECTI REPAIR

Diastasis recti happens when the ab muscles (formally called the rectus abdominis muscles) on either side of the belly button separate, creating what's sometimes called a mommy pooch. 

This separation of the abdominal muscles (aka rectus diastasis or rectus abdominis diastasis) happens most commonly post-pregnancy, especially in women over age 35 who’ve delivered a high-birth-weight baby or had multiple pregnancies erode the strength of the abdominal wall. It can also occur in men with abdominal obesity.

Diastasic recti is very common: Research shows that nearly half of women who've experienced their first pregnancy have the condition at six months postpartum. Because it takes time for the body to readjust after pregnancy, that number dropped to one-third after a year. 

Some separation is normal, but it's considered diastasis recti when the gap that's created is more than two centimeters at one or more points of the linea alba (fascia), the layer of tissue that connects the abdominal muscles.

“The stomach protrudes because there is excess space in the abdominal cavity, and the internal organs fill this void, making a bulge,” says Dr. Tattelbaum. “Sometimes it can make a woman still look pregnant, even when she’s not.” 

Diastasis recti is not just a cosmetic issue. Organs like the uterus and bowels no longer have the abdominal muscles to hold them in—only a thin layer of connective tissue keeps them in place. 

Many doctors believe this lack of core continuity can contribute to lower back pain and umbilical hernias, when part of the intestine protrudes through the umbilical opening in the abdominal muscles, creating a soft swelling or bulge near the navel (umbilicus).

Your abdominal muscles work with your pelvic floor, so a separation of these muscles can also lead to issues like constipation, urinary incontinence, and prolapse.

Pilates and other abdominal exercises to strengthen your core can help alleviate lower back pain and help a pooch protrude less, but they can't truly repair diastasis recti. (Be sure to skip any movement or exercises like sit-ups, crunches, and planks that place strain on the midline or cause the belly to bulge outward; this can worsen the degree of muscle separation.) 

“The most common misconception of diastasis recti is that it can be fixed through rehab or physical therapy,” says Dr. Rady Rahban, a plastic surgeon in Beverly Hills, California. “That’s not true. When you get physical therapy or rehab, you’re not fixing the diastasis [muscle separation]. You’re strengthening the abdominal musculature so you have less of a bulge and less strain on your back, but you’re not healing or bringing the muscles together.”

Pros

• Diastasis recti repair can flatten a protruding belly (in the right patient). “The degree of flatness will be determined by your starting weight and how well you maintain your weight,” says Dr. Tattelbaum. 
• It can strengthen your core and may improve issues like back pain, constipation, urinary incontinence, and prolapse, while reducing your risk of umbilical hernias.

Cons

• It’s a major surgical procedure that comes with two to three weeks of intense recovery. If you still have small children, you will need significant help with childcare during this time. 
• It leaves a long scar below the bikini line. 
• Some numbness of the lower abdomen is normal and permanent.
• Diastasis recti surgery is expensive, and because it's usually considered a cosmetic procedure, it's not covered by health insurance.

• Average Cost:
• $14,058

• Range:
• $6,000 - $25,000

The price you pay will depend on the experience level of your surgeon, their practice location, and whether your repair is combined with other procedures. 

Most surgeons also offer payment plans and accept plastic surgery financing options. You can request a personalized cost estimate and discuss your payment options during your initial consultation.

You can finance your treatment with CareCredit.

The diastasis recti repair photos in our gallery have been shared by the provider who performed the procedure, with the patient's consent.

Unfortunately, the surgery isn’t something you can claim on your health insurance. “A common misconception about diastasis recti repair is that it’s somehow going to be covered by your insurance,” Dr. Rahban says. “It’s not, because unfortunately, in this country today, there is no insurance code for diastasis recti repair, even if the diastasis is incredibly significant and causing you a lot of function issues.” 

If you also need a hernia repair, that procedure may be covered by insurance, which could defray the costs of your diastasis recti repair by covering at least a portion of your facility and anesthesia fees. Just be aware that you’ll need to have substantial documentation from your doctor to make your case.

Diastasis recti surgery is usually an outpatient procedure that's done under general anesthesia, which means you’ll be totally asleep. It can be done laparoscopically, endoscopically, or through the more invasive direct repair, which Dr. Rahban recommends.

“While those other techniques have their allure because they’re minimally invasive, you never get an appropriate repair, in my opinion,” he says. “This is one of those conditions where without getting direct visualization and direct repair, you don’t get complete correction and outstanding results.”

To do the repair, your surgeon will go through a lower abdominal incision to suture the fascia that covers the muscle edges together in the midline, in an effort to make the abdomen tight and flat. 

Occasionally, your surgeon will encounter an unknown hernia and repair it before completing your procedure. If you're also having a tummy tuck, the entire procedure will take about three hours, while a standalone repair procedure could take as little as an hour. 

Once you’ve recovered, you’ll be sent home with instructions on how to care for your midsection during your recovery. It’s also important to have someone there to take you home from your surgery and stay with you for at least the first 24 hours.

Plan on two to three weeks of downtime (depending on the complexity of your procedure) and about six weeks before you’ll healthy enough for strenuous activity or vigorous exercise.

You can expect bruising and swelling around the incisions, and pain—especially for the first few days. Your doctor will likely prescribe pain medication. Dr. Tattelbaum points out that “newer drugs such as Exparel can diminish the discomfort for a much longer period of time postoperatively and diminish the need for narcotics.”

Dr. Rahban doesn’t sugarcoat it: “In terms of recovery, it’s painful,” he says. “Any type of muscle work, whether it’s a C-section, hernia repair, or diastasis repair, is uncomfortable because the muscle and fascia are involved—and they tend to have a lot of nerve sensation.”

You also won’t be able to stand up straight for a week or two, and it’s not healthy to force it while your incisions are healing.

You're going to need support with daily activities, especially during the first five days, when you’ll have the most pain and difficulty moving. You might also need help getting out of your compression garment to shower and fastening it afterward. You'll continue to need some help during week two, to avoid strain that could cause complications.

Your surgeon will probably recommend moving a few times a day to prevent blood clots, but most say you’ll need to avoid heavy lifting (including holding small children) for four to six weeks after surgery.

You should be able to resume all of your normal activities within six weeks of your surgery.

Diastasis recti repair surgery performed in combination with a tummy tuck is generally safe, when it's performed by a board-certified plastic surgeon with extensive experience in the procedure.

However, it's still a major surgery, and complications are possible. A 2015 study published in Plastic and Reconstructive Surgery shows that a tummy tuck has a complication rate of 3%, compared to 1.5% for most other cosmetic surgeries. 

Hematoma (when blood collects under the skin) is the most common complication, but infections and blood clots (thrombosis) are also possible. In rare cases, those blood clots can reach the lungs, which can lead to death.

So how dangerous is it? According to Minneapolis plastic surgeon Dr. Richard Tholen, “Published mortality rates associated with tummy tuck range from 0.02% to 0.16%. To put this in perspective, the death rate for elective C-section delivery is about 0.02%.”

Your surgeon will discuss all of these risks at your consultation.

“You can see the results of diastasis recti repair immediately, because the abdomen has been flattened,” Dr. Rahban says. “While there’s still some swelling and the area gets flatter with time, the effect should be pretty immediate.”

It can take six months to a year for the swelling to fully resolve and for you to see your final results.

The results of the repair should be permanent, but “how flat you stay will depend upon your starting weight,” says Dr. Tattelbaum.

Weight gain and pregnancy can also put pressure on the area and cause the abs to separate again, so doctors on RealSelf say it’s best to wait until you’ve finished having children to repair your abdominal separation, and to maintain a stable weight.

“When your rectus muscles are separated, the only solution is repairing that separation and bringing the muscles together,” Dr. Rahban says. This means there are no treatment options, outside of surgery, to fully resolve diastasis recti.

However, patients with mild ab separation can consider Emsculpt Neo. “Emsculpt technology uses electromagnetic energy that triggers supramaximal contraction—20,000 in a 30-minute period—to build new muscle and tighten diastasis recti,” explains New York City dermatologist Dr. Bruce Katz. “Studies have shown that the treatment can help improve [diastasis recti] by about 19%.”

Another option for milder cases of ab separation is a mini tummy tuck, which doesn’t involve as big an incision as a full abdominoplasty. It tightens only the lower belly though, so a full tuck is usually the best option for severe diastasis recti. 

Doctors say that most patients get the best result from a full tummy tuck, which removes excess fat and sagging skin from above and below your belly button. It may also include liposuction to sculpt the waist and flanks. 

“It is very unusual for someone to need repair of diastasis but not the removal of excess skin,” says New York City plastic surgeon Dr. Tracy Pfeifer. “If you do have excess skin, in my experience, you will be much happier with a full abdominoplasty. Make sure you discuss the pros and cons of each option with your surgeon so that you can make the best choice for you that fits your goals.”

That said, Dr. Tattelbaum cautions that “It’s important to have realistic expectations. A tummy tuck is not a weight loss surgery, and the ultimate flatness depends on how much weight is carried inside the abdomen. Patients with full figures can be streamlined and excess skin removed, but only a good regimen of diet and exercise can make a patient slender.”