Diastasis recti

Diastasis is a separation of the rectus abdominis at the midline of the abdomen of more than 2.5 centimetres, predominantly due to pregnancy. It causes the protrusion of the abdominal midline and varying degrees of discomfort. Unfortunately, physiotherapy is often not enough to correct diastasis, and the best solution in such cases may be abdominoplasty surgery, which significantly improves the appearance of the protruded abdomen and can eliminate diastasis, hanging skin and hernias.

 

Surgeon Dr. Rein Adamson / dr. Martin Adamson / dr. Siim Simmo
Anesthesia General
Surgery duration 1,5-2,5 hours
Nights at hospital 2
Sick leave 1-2 weeks
Price Lower (mini) abdominoplasty – from €3490
Full abdominoplasty – from €4190
+€600 for liposuction on sides (love handles)
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Diastasis recti

  • Distance between the rectus abdominis muscles >2.5 cm
  • Appears as a protrusion of the midline of the abdomen
  • May reflect a loosening of the entire abdominal wall (abdominal protrusion, especially after eating)
  • May prove to be more than just an aesthetic problem
  • Often accompanied by umbilical hernia
  • Occasionally accompanied by epigastric hernia – in the case of diastasis, the tissues in the midline of the abdomen are thin and weak

Diastasis is caused by:

  • Pregnancy
  • Excess bodyweight
  • Prior surgery
  • Congenital tissue weakness
  • Combinations of the above

 

Complaints:

  • Back pain
  • Bad posture
  • Restriction of mobility of the back and trunk
  • Limitations on exercising the abdomen
  • Pelvic pain
  • Constipation
  • Pelvic floor function disorder

 

Diagnosis of diastasis recti

  • Mostly diagnosed upon physical examination
  • Visible when lying down and/or lifting the head
  • Ultrasound, computed tomography, MRI scan (to confirm diagnosis, good for diagnosing hernia of the abdominal wall)

 

Treatment

  • Specific physiotherapy
  • Abdominoplasty (other surgical treatment the result of which is not aesthetically satisfactory or has little effect)

 

Abdominoplasty for treatment of diastasis

A contouring operation with a profound effect on the abdominal wall. Enables the elimination of diastasis, abdominal wall laxity, hanging skin and hernias.

Surgery lasts for one and a half to three hours.

Pros

  • Comprehensive impact on the function of the abdominal wall
  • Generally provides satisfactory aesthetic results
  • Resolution for diastasis without a longitudinal scar in the upper part of the abdomen
  • Correction of protruded abdominal wall contour through muscle plasty
  • Correction of hernias at the same time
  • Abdominal scar is usually in the bikini area
  • Can be combined with extensive liposuction
  • Elimination of stretch marks in the lower and mid-abdominal area

Cons

  • Long scar in the bikini area. One possible solution is to cover the scar with a tattoo one and a half years after surgery. In the case of a strong (hypertrophic) scar, tattoo coverage is less effective
  • It may be necessary to manipulate bodyweight before surgery to ensure a consistently good result
  • It may be necessary to construct a new bellybutton in the case of a large-scale umbilical hernia

 

Stages of surgery:

  • Releasing the abdominal wall from bottom to top
  • Correction of diastasis
  • Muscle plasty
  • Removal of sagging skin
  • Repositioning of the bellybutton
  • Drain placement (optional)
  • Sutures under and inside the skin

 

Problems and complications

  • Seroma or build-up of fluid under the skin in the abdomen (first 2-3 weeks after surgery). May require repeated punctuation. Likelihood up to 42%
  • Prolonged wound healing, suture abandonment. Likelihood 5%
  • Hematoma (swelling, bruises) and bleeding. Likelihood up to 2%
  • Likelihood up to 3.8%
  • Hypertrophic/contracting scar. Likelihood 1-3.7%
  • Post-surgery back pain
  • Skin sensory deficit. Likelihood 1.9%
  • Skin necrosis . Likelihood 3-4.4% (mostly non-extensive)

 

Arch Plast Surg. 2017 Sep; 44(5): 457-468.

Published online 15 Sept 2017 doi: 10.5999/aps.2017.44.5.457

 

Post-surgery instructions:

  • Bandage for six weeks
  • Refrain from lifting heavy items for six weeks (>5 kg)
  • Maintain a slightly forward-leaning posture for 10 days (due to tension in the skin covering the abdomen)
  • Refrain from exercises for the abdomen for six months
  • Physical activity promotes healing
  • Balanced diet promotes healing
  • Smoking slows the healing process and increases the risk of complications (bad wound healing, infection, skin necrosis)
  • Pain treatment as necessary, maximum: 1 g paracetamol 3 x a day and ketoprofen 100 mg x 2 or 1 g paracetamol and 16 mg codeine
  • Wound dressing for 10 days (in the case of no allergy – frequent)
  • Antibiotics: Cefuroksiim – Zinnat (in the case of no allergy) 500 mg x 2 for 5 days
  • Scar gels – silicone-based, after three post-surgery weeks assuming that the wound is dry and has no defects or infection.

 

See HERE for more information on abdominoplasty.

 

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