Richard A. Baxter, M.D.

The Art Behind Plastic Surgery

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Aug 07

Dr. Baxter

Is a muscle repair with tummy tuck always necessary?

Posted by Dr. Baxter

I was surprised to find out on a review of my recent tummy tuck cases that I was only doing a muscle separation repair in about half of them. The reason this was a surprise is that abdominal muscle separation (called a diastasis) is very common in patients considering a tummy tuck, especially after pregnancy. When the rectus muscles – the ones that form the “six pack” look – become pushed apart with pregnancy, there is only a sheet of connective tissue bridging the gap. Some degree of separation is normal with pregnancy, so repair is routine with tummy tucks.

Why then doesn’t every patient get a diastasis repair with their tummy tuck? To begin with, not all of them have a diastasis. Weight loss patients for example, who have a tummy tuck to remove excess skin, often do not have a diastasis. Another example is after Caesarian section; because an opening is made between the muscles, they are sewn together afterward, closing any gap that there might have been in the lower abdomen.

Can abdominal muscle separation be fixed with exercise?   ab-wall-repair.jpg

Like every other body contouring procedure that plastic surgeons do, tummy tucks are not for conditions that can be corrected with diet and exercise. There’s a growing interest in exercise regimens that purport to correct abdominal muscle separation (rectus diastasis), some claiming 100% success. Peer-reviewed studies on the subject do not support such claims however; a recent review concluded that most studies were of “poor quality” and that “exercise may or may not help” with abdominal muscle separation. It does make sense to me that abdominal circumference could be reduced and core strength improved. But in order to narrow the gap between the muscles, they would need to be able to contract horizontally. Keep in mind that the rectus muscles are oriented vertically, as when you are doing sit-ups. The recommended exercises emphasize the use of other muscles such as the transversus abdominis, but contraction of this muscle actually pulls to the side, not closer to the middle.

Advantages of not doing a muscle repair

There’s a big advantage to not having the muscle repair when it isn’t needed: faster recovery. Although a muscle separation is not a true hernia, the repair and recovery process is similar. Usually this means no lifting for 6 weeks. With a tummy tuck not involving muscle repair, return to most daily activities is more like 2 weeks in many cases.

On the other hand, occasionally the muscle tightening does more than restore normal anatomy. Another potential benefit is cinching the waistline for better contouring. This is usually more noticeable however when there was a muscle separation, and the additional improvement from doing it when the muscles are already in good alignment is probably minimal.

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