Tummy tuck surgery, or abdominoplasty, can make a dramatic difference in the shape of one’s abdomen and waistline. In addition to removing excess skin and fat, many tummy tuck surgeries have the muscles tightened as well. What muscles and how they are tightened is a frequent point of confusion.
The muscles that a tummy tuck usually tightens are the rectus muscles. They are a large paired vertical muscles that run down the midline from the ribcage to the pubic bone. They are quite wide, often 4 to 6″ inches in diameter that provide a strong band of vertical support to the abdominal area. These muscles, like all muscles, are enveloped in a sheath of tissue known as fascia.
In women due to pregnancy and childbirth, these paired muscles that are normally joined in the midline can become separated. Technically this is known as rectus diastasis or split rectus muscles. This is not to be confused with a hernia, which is not just a separation, but an actual hole between the muscles where the bowel is poking through.A hernia is most likely to occur at the belly button or umbilicus since this is a natural area of weakness of the muscle fascia. Men rarely have rectus diastasis or umbilical hernias so they never stretch out the muscle from pregnancies.
In tummy tuck surgery, the rectus muscles can be sewn together down the middle to tighten them like a bowstring. In reality, the rectus muscles are not really sewn together but the fascia that contains them is. This is why the official name for this portion of the tummy tuck is known as rectus fascial plication. By sewing the fascia together, the muscles are securely held closer together by permanent sutures. The manipulation of these muscles is what causes most of the pain from tummy tuck surgery. No other abdominal mucles are plicated since they will produce no significant benefits in changing the shape of the abdominal wall.
Not every tummy tuck requires rectus muscle tightening. It is only done if the examination prior to surgery demonstrates that a portion of one’s abdominal bulge is due to muscle looseness or laxity. A good examination with the patient standing and laying down can demonstrate whether muscle tightening is worth the effort and discomfort.
Dr. Barry Eppley
Indianapolis, Indiana