Need to tighten the abdominal wall during a tummy tuck?

A tummy tuck is a pretty standard cosmetic procedure now. While liposuction will remove excess fat and tighten the skin to some extent, a tummy tuck ensures that all of the excess skin is removed. But there’s more than just the skin. There’s also the deeper abdominal wall which is made up of tough tissue called fascia, and muscles. This also plays a part in a tummy tuck. If you’ve had kids, the abdominal wall can stretch out so your surgeon may need to tighten the abdominal wall during your tummy tuck. Much like a corset is tight against a woman’s torso. The stretching out of the abdominal wall is called a rectus diastasis and the tightening of the diastase is called a rectus plication.

Do you need to tighten your abdominal wall during a tummy tuck?

During pregnancy, the abdomen stretches. Luckily, the skin recoils and tightens after delivery. The question is will it recoil and tighten enough. Additionally, will the deeper abdominal wall tighten or will you be left with a “pooch” or diastasis.

If the abdominal wall stretches out, exercise won’t necessarily fix it. You can work out your six-pack muscles but the “pooch” or diastasis isn’t a muscle problem. The tough tissue that makes up the abdominal wall, the fascia, encases the muscles. So while the muscles will get stronger with exercise, the surrounding fascia won’t tighten with exercise.

That’s where a tummy tuck comes in. Aside from removing excess skin and performing liposuction, a tummy tuck is also a great opportunity to tighten the abdominal wall via a rectus plication. This is done by inserting stitches into the fascia and tightening the abdominal wall like a corset as described here.

It’s not always clear looking at the patient’s abdominal wall during the operation whether they need tightening or not. The easiest way to tell is to determine if the 6-pack muscles are in the middle of the abdomen. If they are, that means the muscles are in the right place because the abdominal wall isn’t stretched out. If the 6-pack muscles are widely separated, then the muscles need to be brought back into the middle with tigtening described above.

So how do you tell if the muscles are in the middle? Stimulate them with electricity and see if they jump! Electrocautery, the instrument that helps stops bleeding during a procedure, can stimulate the muscles to jump so you know if they’re in the middle or spread out. Not sure what I mean? Watch the video below!