Diastasis recti repair: Restoring core strength and abdominal integrity

For so many people, especially women following pregnancy, changes in the abdomen can go so far past stretched skin or residual fat. One of the most overlooked, yet impactful, conditions that can occur in this area is known as diastasis recti.

This term refers to a separation of the abdominal muscles that can occur when the connective tissue between the rectus abdominus muscles (the "six-pack" muscles) stretches out and thins. While this issue is most often linked with pregnancy, it can also occur in both men and women due to weight fluctuations, abdominal surgeries and improper exercise techniques.

Diastasis recti isn't just a cosmetic issue. Rather, it can also lead to core weakness, lower back pain, poor posture and even urinary incontinence. And as awareness of this condition grows, so does the demand for effective, long-lasting solutions.

To learn more about diastasis recti and the ways in which this concern can be addressed, we reached out to ASPS Member Surgeon Tomer Avraham, MD.

ASPS: What exactly is diastasis recti, and how does it affect patients physically and functionally?

Dr. Avraham: Diastasis recti is a common problem that is related to anatomic issues with the abdominal walls. We have our two rectus abdominus walls that sit in the middle. Sometimes, separation develops between these two muscles. The most common circumstance is for women who have been pregnant in the past. When a woman goes through pregnancy and her abdomen gets much bigger, the rectus muscles splay apart to accommodate the growing uterus. Once she has her baby and the abdomen returns to her original state, there is often a space between these two muscles. That can cause a lot of distress, such as bulging and abdominal wall discomfort.

ASPS: Who is the ideal candidate for diastasis recti repair?

Dr. Avraham: The ideal candidate is someone who feels like they want this surgery and is also at or near their goal weight or a healthy weight. If you're very large or overweight and you carry a lot of extra fatty tissue around your organs, it will limit our ability to repair the diastasis.

ASPS: How are diastasis recti repair procedures typically performed?

Dr. Avraham: There are a number of different approaches to perform this procedure. We most often do it as part of an abdominoplasty (tummy tuck) – it's actually an integral part of a tummy tuck. We'll do a low transverse incision, which allows us to access the abdominal wall and remove the excess skin and fat in the lower belly. At the same time, we use surgery and sutures to reposition and repair the diastasis recti.

However, this does not give a solution to people, particularly women, who don't have a lot of skin and fat in their lower belly but still suffer from diastasis recti. To address this issue, there have been laparoscopic and robotic techniques that have been developed, allowing you to repair it from inside the abdomen. For us, I generally do this in cooperation with a general surgeon because it is surgery that is done inside the abdomen. I feel like it's the safest way to do it, and we can leverage their expertise to help with that. And very often, this is also done in conjunction with hernia repairs. A lot of people out there are walking around with belly button hernias or small abdominal hernias, especially women who have been pregnant, so this is an opportunity to repair that and the abdominal wall at the same time.

ASPS: Are there nonsurgical options for diastasis recti, and how effective are they compared to surgical repair?

Dr. Avraham: I am not aware of any nonsurgical techniques that can effectively repair diastasis recti.

ASPS: What are the key differences between minimally invasive versus traditional diastasis recti repair techniques?

Dr. Avraham: The incisions are where the key differences lie. Minimally invasive procedures use smaller incisions than traditional.

ASPS: What kind of results can patients expect in terms of abdominal contour and core strength?

Dr. Avraham: Anecdotally, women who have severe diastasis will complain of feeling weak in their core and even complain of urinary or bowel movement issues, which makes sense. I've seen women experience improvements in this area when it is repaired.

ASPS: How long is the typical recovery period, and what steps should patients take to ensure optimal healing?

Dr. Avraham: This is a surgery that requires real recovery. I usually tell women to expect up to two weeks out of work. In terms of ensuring optimal healing, for any cosmetic or plastic surgery, listening to the instructions of your surgeon is important – maintaining a healthy diet and a healthy weight, and absolutely no smoking or nicotine.

ASPS: What are some common complications or risks associated with the procedure and how are they mitigated?

Dr. Avraham: Any surgery carries a risk of infection and bleeding or wound healing issues. Maintaining a healthy lifestyle, making sure that you are not smoking and making sure your surgeon is aware of any medications or nutritional supplements that you're taking. You could have a sensation of tightness, but that should improve over time. Obviously, a rare complication is an injury to intra-abdominal structures. That's why it's important to have a multidisciplinary surgical team.

ASPS: What should patients look for when selecting a surgeon for diastasis recti repair to ensure safety and the best results?

Dr. Avraham: Number one – look for a board-certified plastic surgeon. They should have a sense of an appropriate surgical setting, either a hospital or a surgical center. You also need a board-certified anesthesiologist and a surgeon that they feel cares about them and is experienced and confident that they can deliver the results that they want.

To find a qualified plastic surgeon for any cosmetic or reconstructive procedure, consult a member of the American Society of Plastic Surgeons. All ASPS members are board certified by the American Board of Plastic Surgery, have completed an accredited plastic surgery training program, practice in accredited facilities and follow strict standards of safety and ethics. Find an ASPS member in your area.