Answering 10 Questions About Rectus Diastasis Repair

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The rectus abdominis muscle, also known as the “six-pack” muscle, is a long, flat muscle that runs from the pubic bone up to the sternum. A paired muscle, the rectus abdominis is divided into two halves by a fibrous connective tissue called the linea alba.

Because the linea alba is made of tendinous material, it does not heal the same way muscle injuries do. The sustained internal pressure that comes with significant weight fluctuations, pregnancy, weightlifting with poor form, swelling from excessive fluid retention, and advanced age can permanently damage the linea alba.

When the connective tissue connecting the abdominis rectus muscles is distended, the two halves of the muscle separate. The result is a stomach bulge that cannot be corrected without surgery, which doctors call rectus diastasis.

1. What is rectus diastasis repair?

For some people, rectus diastasis is less noticeable. If it is not healed within a year of injury, however, it likely will require surgery to be corrected fully.

Rectus diastasis repair is a body contouring surgery where a surgeon stitches the sides of the rectus abdominal muscles back to a reinforced linea alba, thus closing the muscle separation and restoring an aesthetic abdominal contour.

2. Am I a good candidate for rectus diastasis repair?

The ideal candidate for this procedure will have separated abdominal muscles that are resistant to improvement through exercise and physical therapy. 

For the best results, prospective patients should be done bearing children, be non-smokers, and be near their stable ideal weight.

3. How do I prepare for surgery?

Rectus diastasis repair is an invasive procedure that will be more successful if you take the following steps prior to your surgery:

  • Stop smoking. Smoking compromises lung tissue and heart function, which complicates the use of anesthesia. It also reduces the amount of oxygen available to the body’s blood and tissue, which slows the healing process and increases infection rates. Smoking cessation prior to surgery will reduce your risk of heart attacks, blood clots, pneumonia, and infection both during and after the surgery. Dr. Maman does not perform cosmetic surgery on smokers.
  • Get close to your ideal weight. Patients with a higher BMI tend to not have results as favorable as those with lower BMIs. In addition, exercise and a healthy, nutrient-rich diet can facilitate faster recovery.
  • Have realistic expectations. There is no such thing as a “perfect” body, especially since what is considered “perfect” varies from person to person. The primary goal of rectus diastasis repair surgery is to restore function to core muscles that are critical to daily life. The aesthetic benefit is important to most patients as well, but patients who expect improvement over perfection are more likely to be satisfied with their results.

4. What happens during rectus diastasis repair?

Rectus diastasis repair is most often performed using the same techniques utilized in a tummy tuck, or abdominoplasty.

During a rectus diastasis repair, a surgeon will make a horizontal incision just above the pubic bone. Abdominal skin is retracted as the surgeon secures abdominal muscles together using permanent sutures. 

After the repair to abdominal musculature is complete, the surgeon will trim away excess skin and pull the newly tightened skin together with non-permanent stitches, creating a new belly button and smoothing any puckering. 

Some patients choose to add liposuction to their rectus diastasis repair, but it is not necessary. Liposuction often improves the aesthetic appearance by removing stubborn pockets of fat that prevent a smooth, flat stomach.

5. What should I look for in a surgeon?

Plastic surgeons are trained in advanced surgical techniques that both repair damaged abdominal muscles and maximize aesthetic results.  A rectus diastasis repair is as much a cosmetic surgery as it is a reconstructive one.

It is important to select a surgeon who is certified by the American Board of Plastic Surgery. This certification is only granted after a rigorous education in plastic and reconstructive surgery.

6. What results can I expect?

Rectus diastasis repair should resolve a patient’s main complaints, including:

  • Eliminating the visible bulge or ridge running down the abdomen midline when contracting the abdominal muscles
  • Low back pain
  • Poor posture

After healing is complete, patients may find their ability to strengthen core muscles vastly improved. This surgery also delivers a smoother, flatter stomach and more svelte silhouette.

7. Are there any risks involved with this procedure?

Any surgical procedure involves risks that include bleeding, infection, deep vein thrombosis, and necrosis. Major surgeries are slightly more likely to result in complications than minor ones (3% compared to 1.5%, as demonstrated by a study published in Plastic and Reconstructive Surgery), but the overall complication rate for this procedure remains low.

The best way to avoid these risks is to be as healthy as possible before surgery and to choose a qualified, experienced surgeon with a reputation for excellence.

8. Will I have scarring?

It is not possible to avoid scars with a rectus diastasis repair, but there are steps that can be taken to minimize their appearance, including:

  • Following post-operative instructions carefully
  • Consistently using medical creams and ointments prescribed by a physician
  • Keeping the incision site clean to avoid infection
  • Following Dr. Maman’s scar treatment protocol (all materials are provided to you)

If surgical scars become a nuisance, there are procedures that can be undertaken to address them.

9. How long and difficult is recovery?

Rectus diastasis repair is an invasive surgery and requires significant healing time that is completed in stages. 

Most patients find the first week after surgery to be the most difficult, but the discomfort can be managed with both prescription and over-the-counter medications. A majority of people who undergo diastasis recti repair are able to return to work within two weeks after their drains are removed. Working on a laptop is possible within 48 hours.  Strenuous exercise or lifting of objects weighing more than 10 pounds should be avoided for a minimum of six weeks.

The second stage of recovery, lasting from six weeks to four months post-procedure, will vary by patient. During this stage, a surgeon will work with the patient to ease back into an exercise routine, manage scar care, and deal with any unforeseen complications.

During the final stage of recovery, swelling will fully subside and scar tissue will soften and flatten, reducing the pulling and tugging sensation common to surgical incision sites.

10. How long will the effects of diastasis rectus repair last?

Because the rectus abdominis muscles are stitched together with permanent sutures, the results are usually permanent. This does not mean, however, that the abdomen will always remain flat.

Dramatic weight fluctuations and post-procedure pregnancies can change the aesthetic results of the surgery or even, in some cases, re-tear the muscles.

For this reason, it is recommended that patients achieve a healthy body weight and be finished bearing children before having a rectus diastasis repaired. Patients wishing to maintain long-term results are also strongly encouraged to engage in a healthy lifestyle with adequate exercise and good dietary habits.

Transform your appearance with a rectus diastasis repair

For many people, both men and women, a rectus diastasis repair is the best way to restore strength and stability to the core and to restore a slim, fit appearance. When done by an experienced surgeon on a patient with realistic expectations, the results can be life-changing.

Dr. Daniel Maman is a Harvard fellowship-trained and board-certified plastic surgeon specialized in cosmetic and reconstructive surgery of the breast, body, and face.

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