The Surgeon Minute

Rectus Diastasis – How To Get Rid of the Abdominal Bulge

Rectus Diastasis – How To Get Rid of the Abdominal Bulge

Few things are more frustrating than working out hard only to continue to see a bulging abdomen in the mirror. For women who have rectus diastasis, a separation of the six pack muscles that run up and down the abdomen, no amount of exercise or physical therapy is going to flatten that bulge; the only way to repair this condition is surgically. Furthermore, it is likely that every woman who has had at least one child suffers from some degree of rectus diastasis.

Dr. Daniel Y. Maman of New York City has seen a definite uptick in his practice of women coming in to be treated for this troublesome condition. He discusses why it has such a high patient satisfaction rating, as well as why the internet is often wrong as to what you can really expect in terms of recovery.

What is Rectus Diastasis? 

Many of the women coming to see Dr. Maman for an issue aren’t always aware of rectus diastasis, and usually have no idea what the term actually means. Gynecologists are more commonly using the term, telling patients to seek the opinion of a plastic surgeon with problems. Patients get freaked out, thinking that they have a terrible diagnosis, but that’s just not true.

Rectus diastasis means “your rectus muscles, which are the six pack muscles that run up and down the center of the abdomen, have spread,” explains Dr. Maman. “That happens in 100% of women who have had at least one child.”

Rectus diastasis diagram.

Varying degrees of separation depend on the following:

  • state of a patient’s tissue
  • number of children
  • size of her pregnancies compared to the size of her frame

Dr. Maman has seen women with only one child and very wide rectus diastasis, as well as women with who don’t develop severe rectus diastasis until their second, third or fourth pregnancies. 

How to Treat Rectus Diastasis?

“There’s a common misconception that physical therapy or exercise or special compression garments could cure rectus diastasis,” says Dr. Maman. They can’t.

Rectus diastasis is a permanent separation of the six pack muscles, meaning that the tissue that connects these two muscles at the mid-line has stretched for good. “The only way to correct rectus diastasis is surgically,” shares Maman.

First, a horizontal incision is made low on the belly, below the bikini line where the scar can easily be hidden by underwear or a bathing suit. If a patient already has a c-section scar, “it’s a no brainer,” says Maman. He will simply excise the c-section scar and extend it a few centimeters on each side. Next, he knits the two rectus muscles back together at the mid-line, placing sutures on multiple levels to hold them in place permanently. Finally, any excess skin is removed, and the incision closed.

Rectus diastasis repair - Maman.

Dr. Maman will always ask a patient during the initial consultation if she plans on having more children. If you are done having kids, this is the perfect operation for you. However, if you plan on having more kids, it’s best to wait. Otherwise you run the risk of the muscles re-separating.  

Rectus Diastasis  Recovery

Dr. Maman performs this surgery in his surgery center as an out patient procedure. This means that you will go home the same day as your surgery. In many cases, he does require the patient to go home with one of his nurses or stay at the hotel that is adjacent to his office.

When it comes to recovery, it is important to remember that what you read on Google is not always true. Many patients who have researched this surgery on the web worry the recovery is tough. They’ve read how they’ll be laid up for 6 weeks, but the reality is that you will walk out of the office on the same day as your surgery. 

Rectus diastasis results - Maman.

The overall recovery does take about 4-6 weeks, with about 2 weeks of social downtime. You won’t want to go to a dinner party, but you can drive after 4-5 days. Patients may return to some exercise at 2 weeks and full exercise at 4 weeks, except no heavy lifting over 10 pounds for 6 weeks.

Any post surgical pain is well-controlled. Rather than strict pain, “patients say they feel abdominal tightness,” explains Maman. “It’s exceedingly rare for someone to complain of pain.”

To help with the initial recovery, Dr. Maman inject his patients with a long acting analgesic, called Exparel, during surgery. It goes straight into the abdominal muscles and keeps the belly numb for approximately 3 days, by which point the major recovery time – where pain would be the greatest – has taken place.

High Patient Satisfaction Rating

“This operation has one of the highest satisfaction rates of any operation that we do,” explains Dr. Maman. These patients have been frustrated by their inability to budge the belly bulge. They all come in complaining about the bulge in the belly that won’t go away no matter how hard they work out.

After surgery, they are thrilled with the return to their pre-pregnancy bodies. Having the contour of their abdomen restored is well worth any post op discomfort. Once the muscles are anatomically in the correct position, a flat stomach is no longer an impossibility. Women can then start to strengthen their core and actually see the results of their hard work.

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