One of the operations I have always loved to do is a tummy tuck, (also known as an abdominoplasty). I really get a charge out of helping a mother restore the shape of her abdomen after she has brought one or more children into this world.
There have certainly been modifications over the years in how I perform an abdominoplasty. One of the most important of these has been the addition of liposuction which created the “lipoabdominoplasty”. Another great change has been to eliminate the need for drains, something that my patients are thrilled about.
Something that hasn’t changed is the importance of muscle repair of the abdominal wall in women who have had children*. With the muscle repair, we are changing the position of the rectus abdominis muscles which are often called the sit-up muscles. This is the muscle group responsible for the “six-pack” (or in my case, the keg). There are obvious benefits in terms of appearance, but what you may not realize is how much repairing these muscles improves quality of life. Let me explain…
Something’s gotta give.
Before pregnancy, these muscles are right next to one another running up and down the middle of the abdomen. The muscle coverings (the fascia), connects them in the midline. Think of this connection as being a “seam”, so to speak.
When a woman becomes pregnant, the abdomen must expand to accommodate the pregnant uterus. This is usually achieved by stretching the “seam” or the connection of the rectus abdominis muscles in the midline. In almost all women, there will be a separation of these muscles, which is known in medicalese as “rectus diastasis”.
Women who have a very short waistline generally have a greater separation and women with large pregnancies or with twins (or even triplets) will see an even greater difference. Still, this happens to almost all women during pregnancy. For women who were really happy with their tummies before children, this can really be an issue. It affects how your clothes fit, and the type of slacks or bathing suit you are comfortable wearing. And it can really affect how you feel about yourself.
Now, there are a very few lucky women who seem to avoid muscle separation after pregnancy. They are the ones with a longer torso who only gain a small amount of weight with pregnancy. They are quite physically fit. Also, most other women hate their guts! JK – well, not really.
It’s not just about how it looks.
For muscles to function optimally, they need to be in the right position. Since muscles only shorten (contract) or lengthen (relax), they work along a single vector or straight line. In terms of the rectus abdominis muscles, this means running straight up and down the middle of the abdomen. When there is a significant muscle separation, (the rectus diastasis I mentioned), the muscles move to the side and no longer contract as efficiently as they did before the babies came along. This affects abdominal core strength and function: the more the separation, the bigger the impact.
Another way this can show up is in the contour of the lower abdomen when these muscles are contracted. Instead of the abdomen flattening, like when you are doing a sit up, the lower abdomen may protrude or slightly bulge, unlike it did prior to pregnancy. Again, this is due to muscle position.
The better the anatomy, the better it functions.
The result of getting the muscles back in the proper position is that they work better ― something that patients can really feel. I have had many patients tell me how much better their workouts are, how much stronger they feel, and how much better their energy levels are.
As you can imagine, many women who have rectus diastasis have some level of lower back discomfort as a result. This, too, will be improved or even eliminated with muscle repair.
No amount of crunches will fix this.
Many people have asked what they can do with exercise to correct the changes in the muscle position. Why can’t you just exercise them back into position? The reason you cannot is that there is no way to narrow the stretched connection of these muscle with exercise. All you can do is strengthen the muscles, but they will still be separated.
This is your core.
The reason the muscle repair is so important is because of how much we use and depend upon our core muscles. They are involved in everything: from lifting, to sitting up, to breathing. Because we do use these muscles so much, the repair has a significant recovery. It’s really a “no pain, no gain” situation.
There is hope.
So, if you are a mother who has had the wonderful experience of bringing another life into this world and are working hard to get your tummy back to where it was, but not quite getting there ― fear not! This is something that can be very successfully corrected with a tummy tuck. Once you are through the recovery, you will look and feel great.
See you poolside,
David B. Reath, MD
*Note: When I am talking about muscle repair, I am referring to what is done for women who have had children because these are the women who have had changes in their muscles. So this doesn’t really apply to women who have not had children, or to men – although they can still get a great result from a tummy tuck.Tummy Tuck
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