Dear Dr. Kim,

I don’t live in California, but I’m a regular reader of your blog and wanted to get your opinion on my upcoming tummy tuck. (I know you’d rather I just fly to San Francisco to see you, but I have two little kids and can’t get away for that long).

I have been on several tummy tuck consultations and have narrowed my choices down to two different plastic surgeons. But they are both saying slightly different things.

Background: I had my last baby about 20 months ago. I have lost all of the pregnancy weight and have a fairly flat stomach. I’m nearly six feet tall and weigh 140 pounds, and I was a competitive volleyball player through college. However, I do have extra skin around my navel and along the lower portion of my abdomen. Upon consultation, I was told I also have an umbilical hernia that needs to be repaired at the same time as the tummy tuck surgery.

Here is what the two doctors recommend:

Doc #1 – Fix the hernia. Tighten the skin, tighten the muscle, no lipo needed.

Doc #2 – Fix the hernia. Tighten the skin. No lipo needed. BUT, he says I have a flat abdomen and not that much muscle separation, so he doesn’t think we should tighten the muscle at all because it won’t change my outcome that much. By not tightening the muscles, I will save some money and have a quicker recovery. He says the trend is going toward less dissection.

So what do you think? Have you ever heard of a tummy tuck that does NOT tighten the muscles? If stitching the muscles will create even a slighter better result and/or keep my tummy looking better longer as I age, then the recovery time and the money are worth it to me. I’m already going to be having surgery, so why not tighten it all up? Or is just a skin tightening on some patients just as good?


Thin Mom With Extra Skin

Dear Thin Mom:

The rectus abdominus muscles are the “6-pack” muscles of your belly that are just to the right and left of the belly button.  They are connected when you’re born.

These muscles separate if you gain weight or get pregnant.  Basically, the “diastatis recti” is the midline, vertical separation of these rectus abdominus muscles.  This is the separation that occurs with pregnancy, and usually is corrected by sewing the muscles back together in the midline.

The thing is this –  in some women, the separation is minimal to non existent.  I have seen 2 female patients, who work out a ton, who have a visible 6 pack AFTER kids.  Granted, this is rare, but I’ve seen it for myself.

It’s far more typical for women to be overweight, and to have a slight separation of these muscles.  So, often you can’t “see” the diastasis, but you can “feel” it.  In your case, you are pretty thin, so you may have little separation that you can only feel or see in an operating room setting while your abdomen is opened up for surgery.

Also, this is why hernias occur so often after pregnancy.  Maybe a women has twins, or weak tissue, or just is unlucky. Whatever the reason, weight is gained during pregnancy and when the baby is delivered, a hole occurs in the abdominal wall, and the intra-abdominal contents (intestines) will want to occasionally pop through the hole.  This is a hernia, and it definitely sounds like you have this, and the hole needs to be corrected.

However, you may have literally little to no separation of your rectus abdominus muscles. In the operating room, your muscles may be still touching, or there may be separation of only 1 cm or less.  Usually in cases with little to no separation, most plastic surgeons would choose NOT to sew the left and right sides together, and would simply leave it alone.

However, you are right. If you want a super tight abdomen that can act as a trampoline for small carnival animals AND that you can bounce a quarter off of, then you would probably want even a 1-2 cm separation surgically sutured together.

Also, there’s the question of “what exactly is a diastasis”.  A bikini model in LA, a Real Housewife, or a former athlete like you may have much different expectations of abdominal tightness and loose skin versus someone who never had a tight stomach to begin with.

If you have any other questions, or want even more babble, please let me know. Best of luck on your upcoming surgery!


Roy Kim, M.D.


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