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Mini tummy tuck and recti diastasis didn't work, what now?

Q:

I am a 5'9" size 4, extremely fit athlete. After my 2nd pregnancy I looked 5 months pregnant if I didn't flex. My surgeon removed a small amount of skin (mini tuck) and closed my recti (3"). More than 6 months later, and with great ab definition WHEN I FLEX, I still look 5 months pregnant when I don't flex and my surgeon says she has never seen anything like it and will have to consult other surgeons. Any thoughts on how to get me back to normal?

 

A:

Without an examination no real answer can be given. I would recommend you get other opinions. Look for surgeons that perform the surgery regularly. 

A:

When minimal skin is removed and the diastasis is closed during a tummy tuck, patients usually experience a very nice improvement.  In some patients whose fascia is very lax, it isn't possible to get the abdomen flat since the fascia is simply too weak.  The tummy tuck tightens the fascia that is there, it doesn't create a new fascia.

That being said, when there is a considerable bulge due to looseness of the fascia, patients do best when a significant amount of skin is removed at the same time.

A:

An examination is required for accurate diagnosis.

Some time just tightening the anterior rectus fascia is not enough to tighten the muscles. The anatomy of the rectus muscle separation needs to be evaluated at the time of surgery. In few cases the posterior rectus fascia needs to be tightened as well as the the junction of the rectus and the external oblique muscles. That needs to be done through the entire length of the muscle, and needs a wider exposure like in full abdominoplasty.

Also one needs to make sure the sutures have not ripped apart, or there is a ventral hernia that is missed. A CT Scan of the abdominal wall may be of help.

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