Diastasis recti (DR) is a common condition defined by the separation of the two large, vertical bands of muscle in the abdomen, known as the rectus abdominis muscles. This separation occurs when the connecting tissue, the linea alba, stretches and weakens, creating a gap that can lead to a noticeable bulge in the midline of the stomach. While often seen after pregnancy, DR can also occur in men or following significant weight changes. When non-surgical methods like targeted physical therapy fail to resolve the issue, surgery becomes the definitive treatment option to restore the integrity of the abdominal wall.
Primary Medical Specialists for Diastasis Recti Repair
The surgical repair of diastasis recti is primarily performed by two distinct types of medical specialists: plastic surgeons and general surgeons. The choice between the two often depends on the patient’s primary goals, whether they are focused on aesthetic outcomes or functional core restoration. Both specialists are trained to perform the muscle plication—the process of stitching the separated muscles back together.
Plastic surgeons frequently approach DR repair as part of an abdominoplasty, commonly known as a tummy tuck. Their training emphasizes cosmetic results, focusing on body contouring, removing excess skin, and placing incisions strategically to minimize visible scarring. When the patient has significant excess skin or fat alongside the muscle separation, a plastic surgeon is often the preferred choice to address both issues simultaneously.
General surgeons, particularly those specializing in complex abdominal wall reconstruction or hernia repair, also perform DR repair. Their focus is largely on the functional restoration of the core, ensuring the abdominal wall is strong and correcting coexisting defects like hernias. A general surgeon may perform the muscle repair without the extensive skin and fat removal associated with an abdominoplasty, often using minimally invasive techniques.
Overview of Surgical Repair Techniques
Regardless of the specialist performing the operation, the fundamental technique for correcting diastasis recti is plication, which involves suturing the stretched linea alba to bring the rectus muscles back to the midline. This plication can be performed using various surgical approaches. The most comprehensive and traditional method is the open repair, typically performed as a full abdominoplasty.
Open repair involves a horizontal incision made low on the abdomen, usually extending from hip to hip. This allows the surgeon direct visualization and access to the entire length of the separated muscles. The surgeon lifts the skin and fat to expose the rectus sheath, which is then tightly sutured, often in one or two layers, using permanent material to create a durable repair. This approach is most effective when there is significant excess skin or fat, as these can be removed to achieve a flatter, contoured result.
Alternatively, many surgeons utilize minimally invasive techniques such as laparoscopic or robotic-assisted repair. These methods involve making several small incisions through which specialized instruments and a camera are inserted. This technique is preferred for patients with minimal excess skin and fat, as it results in smaller scars and generally allows for a faster recovery. During a laparoscopic repair, the surgeon usually plicates the posterior rectus sheath, whereas open surgery typically plicates the anterior sheath.
The choice between using only sutures or adding a surgical mesh is another consideration in the repair. Simple suture plication is the standard for most diastasis recti corrections. Mesh reinforcement may be used, particularly if the patient has a coexisting ventral hernia or a very wide separation that requires additional support for stability. Mesh can be placed in various positions, such as the retrorectus space, and may be synthetic or biologic, depending on the surgeon’s preference and the patient’s anatomy.
Navigating the Consultation and Choosing a Surgeon
Selecting the right surgeon involves a careful review of their credentials and experience with diastasis recti repair. It is important to confirm that the surgeon is board-certified, such as by the American Board of Plastic Surgery or the American Board of Surgery, as this confirms they have met rigorous standards for training and skill. Patients should specifically seek a surgeon who performs this procedure frequently and is comfortable with the full range of techniques, including open and minimally invasive options.
During the consultation, patients should inquire about the surgeon’s specific experience, asking how many diastasis recti repairs they perform annually and which technique they recommend based on the patient’s anatomy and goals. Key questions should also cover the expected recovery timeline, potential complications, and what to expect regarding scar placement and visibility. Understanding the surgeon’s rationale for their chosen technique, such as plicating the anterior versus the posterior fascia, provides insight into their expertise and experience.
Regarding the financial aspect, patients should be aware that diastasis recti repair is frequently considered a cosmetic procedure when performed as part of an abdominoplasty. However, if the condition is causing functional problems such as chronic back pain, pelvic floor dysfunction, or is associated with a hernia, the repair component may qualify for insurance coverage. Patients must work closely with the surgeon’s billing office and their insurance provider to determine coverage eligibility based on documented medical necessity.