Diastasis Recti Surgery

A diastasis recti is a separation of the abdominal muscles. This happens when the rectus abdominis muscle separates more than 2.7 cm. It is most common in pregnant females and newborn babies, but can also happen to men. The doctor can find it by having the patient lie flat on his or her back and bend the knees upward while keeping the feet flat. The head is lifted to touch the chin to the chest and the doctor can feel the ridge. If a hernia is questioned, an ultrasound can be ordered. Diastasis recti is not an actual hernia and is not life-threatening but diastasis recti surgery is needed sometimes.

Who Has Diastasis Recti?

Pregnant women can get the condition due to the muscle stretching. It is most apparent after delivery of the baby during the postpartum period. A sign this is happening during pregnancy is appearance of bulges, a ridge in the middle of the abdomen, or the belly button forms into and “outie.” It is most common in pregnant women over age 35, twin pregnancy, or when the baby’s size is large.

Infant cases usually result from a slight defect in the middle of the rectus abdominis muscle that causes the abdominal tissue to slightly herniate forward. It may appear as a bubble or lump in between the breastbone and belly button.

When Is Diastasis Recti Surgery Needed?

Because diastasis recti is not life-threatening and not a hernia, it does not require surgical intervention. Doctors may have the patient attempt exercise first to bring the abdominal muscles back together. This includes heel slides, leg stretches, and pelvic tilts.

Exercise should aim to keep the core muscles tight and not allowing them to push outward. This can happen with planks or crunches, so these types of exercises should be avoided. It is important to not allow the abdominal muscles to push out or form a dome. This can make the condition worse.

Doctors can refer patients to physical therapy for exercise or they can easily be done at home. Physical therapy needs to be done for the full length of the recommendations because this condition takes quite a while to heal. If the condition does not improve with exercise, surgery may be considered.

For infants, the abdominis rectus muscles tend to continue to develop and close on their own over time. Doctors may refer babies and young children to physical therapy if the condition is severe. 

Figure 1: Infant Diastasis Recti

Babies and children can be watched carefully, but if an actual hernia develops due to the separation then they may be referred for surgery.

Surgical Intervention

If exercise does not work to correct the separation, surgery may be considered. Doctors can work together with the patient to make sure the condition is truly needed. In order for surgery to be considered, the separation must be larger than 2 cm. Keep in mind that surgery for this condition is considered cosmetic and most insurances will not pay for cosmetic surgery. There is also the factor of recovery time and pain from surgery.

Figure 2: Diastasis Recti

The Procedure

Surgery involves a major abdominal operation and is often called the “tummy tuck.” In medical terms it is known as abdominoplasty. The doctor may have to tighten up the muscles, remove some skin, and bring the muscles together. This may also involve moving the actual belly button to put it back in a more natural state. The surgical interventions depend on the needs of the patient and how much diastasis is involved. The doctor may be able to do the surgery laparoscopically without a major incision, but more involved surgeries may require an open abdominal surgery.

The recovery for laparoscopy may be a few weeks and fairly easy, but recovery for an open abdominal surgery can be six to eight weeks. The patient needs to plan to possibly take time off work. There is no heavy lifting allowed and exercise will be limited for the first six weeks. Complications can include bleeding, swelling, bruising, and possible infection. The scars should fade in about a year’s time. (See Figure 3)

Figure 3: Before and After Photos of Diastasis Recti Surgery

How Much Does a Diastasis Recti Surgery Cost?

Surgery for diastasis recti is often considered cosmetic and not covered by insurance. This is why it is important to try exercise programs and/or physical therapy before opting for the procedure. Tummy tucks can average around $5,500 for just the surgery. There are additional fees for the hospital, anesthesiologist, and medications. This can put the cost well over that. On average, the total cost can amount to well over $10,000.

On rare occasion, a diastasis recti can herniate in adults. This is most common in pregnant women that had congenital diastasis recti at birth that did not fully develop and close. If herniation does occur after pregnancy, surgery may be required and in this case the insurance will cover surgical repair of the condition.

Infants that require surgery for the condition due to hernia will most likely be covered under insurance as hernia surgery. It is important to always check with the health insurance for coverage prior to performing the surgery unless it is a medical emergency. Then authorization can be obtained after the surgery to avoid delays of a lifesaving procedure.

Choose a Doctor for Diastasis Recti Surgery Carefully

It is important to find a doctor who is experienced in diastasis recti surgery. Either a general surgeon or a plastic surgeon can do the repair or reconstruction of your abdominal wall muscles. It is important for doctors to have at least five years minimum training in this surgery. It is even better to find a doctor that has additional certification in working with the abdominal wall. Make sure to check if a mesh will be used in the repair that it is safe and approved. This is due to problems with mesh used in abdominal surgeries that can cause disability. 

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