One of the traditional steps in most tummy tuck procedures is the correction of the separated rectus abdominus muscles or the recti diastasis. The stretching of the muscles and their enveloping sheaths caused by pregnancy often causes some visible separation in the midline which is commonly seen during tummy tuck surgery. While many patients think this is a hernia, it is not as there is no hole in it and no bowel contents can come poking through. The inner (medial) muscle margins are widely separated but the fascia remains intact.
This musculoaponeurotic laxity is treated during a tummy tuck by sewing together the anterior sheath of the rectus vertically down the midline from the xiphoid process to the pubis. This manuever is frequently misinterpreted to be ‘sewing the muscles together’ although technically the muscle sheaths are brought back in opposition and not the muscle per se. Different techniques have been described for performing the rectus sheath plication but most plastic surgeons use a single layer suture method using non-resorbable materials.
One of the questions patients occasionally ask about rectus sheath plication is…does it last? Will the muscle separation reoccur in the future? (barring any future pregnancies)There are many forces acting on this suture plication including pressure from the internal organs behind it and the external strain from body movements particularly during exercise. Since hernias are well known to recur, may not rectus plication as well?
In the August 2013 issue of the journal Plastic and Reconstructive Surgery, a published article entitled ‘Long-Term Ultrasonographic Evaluation of Midline Aponeurotic Plication during Abdominoplasty’ addressed this very question. This study evaluated 38 women who had abdominoplasties anywhere from one to five years previously. (18 patients who had surgery five years before – Group A, 20 patients who had surgery one year before- Group B) Physical examinations and ultrasoundswere done both above and below the belly button. Their results showed no rectus diastasis recurrences in Group A and two recurrences in Group B. Both recurrences occurred in the rectus plication above the belly button, an area that is exposed to greater stresses than below the belly button.
This study has shown that rectus sheath plication is a stable procedure that has a very low risk of recurrence. This supports what prior studies have shown in regards to the stability of this manuever in abdominoplasty surgery. That risk may be affected by the plication technique or the width of the diastasis although this study did not specifically evaluate methods or degree of muscle separation.
Dr. Barry Eppley
Indianapolis, Indiana