Plication or tightening of the rectus (six pack) muscles is an ingrained part of the tummy tuck procedure. It’s so routine that most surgeons never think about not doing it. But is it always necessary? No it’s not, and a thorough exam will determine this.
The rectus muscles migrate laterally, widening in the center when there is pressure from the internal abdomen. This creates what we call diastasis or widening between the muscles. Internal pressure comes from pregnancy or weight gain. Usually after pregnancy or weight loss the muscles never return to their previous state resulting in laxity of the abdominal wall and the external appearance of the “pooch.” In the worst cases a pseudohernia can develop which is evident by a significant protrusion of abdominal contents during a sit-up.
During a tummy tuck we routinely use permanent stitches to tighten the muscles. But it’s not always necessary. During a consultation it’s imperative to determine pregnancies and weight issues then do a thorough exam to determine if there is diastase’s. Only if there is diastasis is it necessary to suture the muscles back together. Suturing the muscles not only tightens the abdominal wall but also returns the muscles to their appropriate anatomic location which allows them to function in their most biomechanically correct position.
If there is abdominal wall laxity I use permanent suture to repair the muscles in the midline. In addition if there more laxity after this I will tighten the the lateral aspects of the abdominal wall with corset sutures. This is a powerful maneuver that really reduces the waist size. But if there is no diastasis and no abdominal wall laxity then there’s no reason to suture the abdominal wall muscles. The down time and pain will be significantly less.
Please contact my assistant Katie at 703.752.6608 or click here if you would like to discuss your abdomen.