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Abdominal muscle repair success rate

Q:

After delivering twins, I was left with a 10cm separation in my tummy muscle. It is now down to 2cm but after 2 1/2 years it will not close on its own.
In December 2012 I had a titanium mesh patch placed behind my belly button to fix the hernia there.
This has left me with a belly button that still sticks out and is now so hard that when it rubs against a bench it gets very tender/sore. They only patched the hernia while leaving the muscle open.
 
I am very slim, so tummy fat is not the issue. I look very pregnant all the time. I would like to get the tummy muscle sewn back together, while having a breast enlargement done ('c' cup), and my nipples drawn back in.
On a TV program I saw another women with a tummy just like mine (also twin pregnancy.) They cut around her tummy button, then cut similar to a 'c' section to sew the muscle back together. Although very scarred, her tummy was flat again. At least she looked good dressed.
 
I also saw on 'The Doctors' a women who had her nipples drawn back in so she wasn't on 'high beam' all the time. My breasts have become so small (right side 'AA', left side 'A') that wearing a bra is near impossible, but mandatory due to my nipples. However I would like to get larger breasts while I'm there. I have heard that a few years after the tummy muscle is sewn back together it often rips apart again, due to the center of the muscle being thread bare.

Can you advise on the long term success rate of this operation.
 
Your help would be appreciated.

A:

Most of the time severe diasthesis recti (separation of the abdominal muscles ) is done at the same time with tummy tuck.

If you are a candidate to only a mini-tummy tuck then the muscles can still be repaired using an incision around the belly button and another in the lower abdomen like a c-section. The shape of the belly button can be repaired, but need to see the operative note and the type of the mesh used. It is very possible you still have a belly button hernia, that is why it still bulges!.

Breast augmentation, you have many options, incision, type of implant, size of implant and position of the implant.

Nipple projection can be reduced in many ways. All options are discussed with you at the time of the consult with your plastic surgeon

A:

While difficult to advise specifically, everything you desire can frequently be treated with a Tummy Tuck and breast augmentation except for the prominent nipples. The Breast Augmentation may flatten the nipples some as the tissues remodel. If they do not, then they can be reduced later. For you, the only problem will be the umbilicus which may have been devasculirized by the hernia repair. Repair of the diastasis (the muscle separation), if done properly, should be permanent. 

A:

When you have a consultation with an ASAPS member Plastic surgeon, he will evaluate if you have skin excess, if you are a candidate for an Abdominoplasty, or if you just need to repair the muscle in the midline through the belly bottom or the pubic area. The breast augmentation is another issue to clarify in your consultation.

A:

The tissues which lie between your tummy muscles are stretched and this is what results in your abdomen buldging forward.  These tissues don't have any elasticity and won't correct themselves.  They need to be sutured together.  The sutures should hold the tissues well and the results should be permanent.  The muscle repair, the correction of the belly button and some tightening of the skin could be done by an incision low on your abdomen and should be very well hidden.  At the same time it should be no problem to do a breast augmentation and a nipple reduction to complete your "Mommy Makeover".

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