A tummy tuck (abdominoplasty) is a cosmetic surgical procedure that contours the abdomen by removing excess skin and fat. It also offers a functional benefit: fixing Diastasis Recti (DR), which is the separation of the large vertical abdominal muscles. The repair of this muscle separation is often combined with the full tummy tuck. This combined approach restores the structural integrity of the core, contributing to a flatter abdominal profile and alleviating associated physical symptoms.
Understanding Diastasis Recti
Diastasis Recti (DR) is a condition where the two columns of the rectus abdominis muscles (the “six-pack” muscles) separate from each other. This separation occurs along the linea alba, the connective tissue running down the midline of the abdomen.
The primary cause of DR is increased intra-abdominal pressure, most frequently occurring during pregnancy as the expanding uterus stretches the abdominal wall. While common in postpartum women, DR can also affect men and women who have experienced significant weight fluctuations or have weak abdominal walls.
Symptoms include a visible bulge or “pooch” in the middle of the abdomen, which may become more pronounced when contracting the muscles. Beyond aesthetics, this separation can lead to functional problems, including lower back pain, poor posture, and core weakness. The laxity in the abdominal wall can also increase the risk of developing a hernia.
The Surgical Solution: Rectus Plication
The actual correction of Diastasis Recti is performed through a technique called rectus plication, which is typically incorporated into a full abdominoplasty. Rectus plication involves suturing the stretched connective tissue of the linea alba to bring the separated rectus muscles back together to the midline.
The surgeon creates an internal “corset” by placing rows of strong, often permanent, sutures along the midline fascia that encases the abdominal muscles. This tightens the abdominal wall, which immediately reduces the abdominal bulge and restores the muscles to their proper anatomical position.
By repositioning the muscles, rectus plication addresses the underlying structural cause of the abdominal protrusion, which cannot be fixed by simply removing skin or fat. This repair not only improves the abdominal contour but also enhances core stability and strength. The plication typically uses non-absorbable sutures to ensure the long-term durability of the repair.
Non-Surgical Management and Candidacy
Non-surgical management is the first-line approach for Diastasis Recti, particularly for mild cases or in the initial postpartum period. This treatment involves targeted physical therapy focusing on deep core stability exercises, such as those that engage the transverse abdominis muscle. A physical therapist can teach specific techniques like abdominal bracing and pelvic tilts to improve muscle function.
However, non-surgical methods, while improving core strength and symptoms like back pain, cannot always fully close the gap in the connective tissue in cases of severe separation. Surgery becomes an option when conservative treatment has failed and the separation is significant, often defined as a gap of two centimeters or more.
Candidacy for a combined tummy tuck and rectus plication typically requires a patient to be in good general health and maintain a stable weight. It is recommended that women postpone the procedure until they have completed their family planning, as a subsequent pregnancy can stretch the abdominal muscles again and potentially compromise the repair. The decision to proceed with surgery is driven by both functional concerns, such as persistent back pain, and aesthetic goals.
Post-Procedure Recovery and Long-Term Results
The recovery process following a tummy tuck with rectus plication is more substantial than a procedure without muscle repair due to the deep internal suturing. Most patients experience moderate discomfort, often described as muscle soreness, for the first few days, which is managed with prescribed pain medication.
Movement is limited for the first few weeks. Patients are typically instructed to wear a compression garment continuously to support the newly tightened abdominal wall and reduce swelling. Light activities can usually be resumed within two to three weeks, but strenuous exercise and heavy lifting are avoided for about six weeks to allow the internal muscle repair to heal completely.
The long-term results of rectus plication are durable, especially when performed with permanent sutures. The repair can last for many years, provided the patient avoids significant weight fluctuations or subsequent pregnancies. While swelling can take several months to fully subside, the improved abdominal contour and restored core function are noticeable soon after the initial recovery period.