Diastasis recti surgery in Paris

Abdominal diastasis recti is defined by an abnormal gap between the rectus abdominis muscles, resulting in a loosening of the abdomen and a distension (or bulging) of the belly. A diastasis repair, potentially combined with an abdominoplasty, addresses this functional and aesthetic discomfort and helps restore a more balanced body contour.

What does abdominal diastasis recti surgery involve?

The treatment of abdominal diastasis (or diastasis recti) is an abdominal surgical procedure that brings the rectus abdominis muscles closer together. This procedure addresses a loosening of the rectus abdominis muscles located above and below the navel.

By moving abnormally apart from the midline where they meet, these long parallel bands of muscle leave behind a round, distended belly (a « pregnant look »). Whereas the rectus abdominis muscles are normally very close together (less than 1 centimetre), people with abdominal diastasis instead have a linea alba that can range from 1 to 10 centimetres (a diastasis is generally diagnosed for real from a gap of 2 cm).

Beyond causing the abdomen to bulge, this separation leaves a space into which certain organs can slip, increasing the risk of complications and abdominal pain.

What are the causes and symptoms of abdominal diastasis recti?

Diastasis of the abdominal wall can stem from several factors, including:

pregnancy: weight gain and the expansion of the uterus can cause the abdominal muscles to stretch too much. The diastasis is then well hidden during pregnancy but becomes visible postpartum. Multiple pregnancies and twin pregnancies increase the risk of diastasis;
rapid, significant weight gain that stretches the skin tissue, or conversely a sudden weight loss that does not allow the skin to retract gradually;
ageing: with age, the abdominal muscles can loosen and lead to a progressive separation of the rectus abdominis;
lifting heavy loads due to demanding jobs or to repeated, poorly controlled sport (abdominal movements in particular);
a chronic cough caused by a lung condition, which can lead to repeated contraction of the rectus abdominis;
a sedentary lifestyle, which undermines muscle tone and can cause muscle slackening. This is especially the case for pregnant women, whose movements are limited.

The symptoms of abdominal diastasis recti: a bloated, distended belly

The most characteristic sign of abdominal diastasis is a bloated belly that cannot be explained by weight gain or fat accumulation: the abdominal wall, stretched along the linea alba, no longer holds the organs in place properly, hence this persistent central bulge (a « pregnant look ») that is often more pronounced at the end of the day or on exertion. Alongside this bloated belly, diastasis frequently adds other symptoms:

a vertical ridge in the middle of the belly that appears when you contract the abdominal muscles (when getting up from a lying position, for example);
a loosening and weakness of the abdominal wall, with a feeling of poor core support;
back, lower-back or pelvic pain linked to the loss of spinal support;
sometimes digestive discomfort (bloating, discomfort) or continence problems when the pelvic floor is also affected.

How do you know if you have abdominal diastasis recti?

A simple test can raise the suspicion of a diastasis before the consultation. Lying on your back, knees bent, place your fingers flat just above the navel then lift your head and shoulders slightly to contract the abdominal muscles: if you feel your fingers sink into a soft groove between two ridges of muscle, it may be a diastasis. A gap of about two finger-widths (i.e. from 2 cm) above, at the level of, or below the navel points towards the diagnosis, which will be confirmed by the surgeon using an ultrasound or an MRI of the abdominal wall.

Abdominal diastasis recti treatment: for which patients?

While it mainly affects women postpartum (after childbirth), abdominal diastasis can also be diagnosed in both sexes when it is a functional diastasis (strong, repeated intra-abdominal pressure).

More generally, surgery for diastasis of the abdominal wall is intended for patients who mainly present 2 types of abnormality, sometimes occurring together:

bulging of the abdomen and a loosening of the abdominal wall, causing aesthetic discomfort (a pregnant appearance) as well as mobility problems, particularly when playing sport;
abdominal, back, lower-back or pelvic pain that may even cause umbilical hernias, intestinal discomfort (bloating) or even incontinence problems.

The aim of abdominal diastasis repair is then to tighten the rectus abdominis muscles and restore tone to a linea alba that has become distended. Postpartum diastasis is very common and often resolves spontaneously: a Norwegian study published in the British Journal of Sports Medicine (Sperstad et al., 2016) followed 300 first-time mothers and observed a diastasis in 60 % of women six weeks after childbirth, then in 45 % at six months and still 33 % at one year. It is when the gap persists beyond this first year, despite physiotherapy, that diastasis surgery makes full sense.

How abdominal diastasis recti surgery is performed

Abdominal diastasis surgery takes place in a clinic under general anaesthesia and generally lasts between 2 and 3 hours depending on the technique used.

Before the procedure

Abdominal diastasis surgery is preceded by at least one consultation with the surgeon, who diagnoses the separation of the abdominal muscles. In particular, the surgeon measures the muscle gap at the level of the linea alba by performing an ultrasound or an MRI of the abdominal wall. These examinations are also an opportunity to detect a potential hernia (umbilical hernia or hernia of the linea alba) in order to treat it during the procedure or to schedule a procedure prior to the abdominal surgery. In consultation with the patient, the surgeon may also decide, if necessary and for a better result, to combine the operation with liposuction of the hips, a mini abdominoplasty, or even a full abdominoplasty.

A consultation with an anaesthetist will also be required at the latest 48 hours before the procedure. Stopping smoking (for healing), aspirin and certain anti-inflammatory medications is necessary in the weeks before the procedure. Finally, the surgeon may recommend some weight loss before the procedure.

How diastasis repair is carried out

Abdominal diastasis surgery in Paris can be performed mainly using 2 techniques.

Abdominoplasty with diastasis repair

This is the most frequently used method. The operation begins with a long horizontal suture at the level of the pubis, in the natural skin fold so that the scar is as inconspicuous as possible. A circular incision can also be made around the navel when there is a significant excess of skin to redrape. The surgeon then lifts the skin and the abdominal fat in order to expose the sheath of the rectus abdominis muscles (anterior aponeurosis). The surgeon can then begin tightening the rectus abdominis (plication of the diastasis) by placing sutures to bring them closer together and re-tension the linea alba.

Where appropriate, the surgeon may then carry out the repair of the hernia and the repositioning of the navel. An abdominoplasty can finally be performed when necessary, with liposuction of the excess fat and a downward redraping of the skin to re-tension it.

At the end of the procedure, the incisions are closed and the sutures are made with absorbable threads. A compression dressing is applied and drains may be placed to evacuate fluids. The patient generally spends 1 to 2 nights at the clinic before going home.

Laparoscopy

This alternative technique is increasingly used when there is little excess skin. It involves making fine incisions over the area to be treated so that thin surgical instruments can be inserted, allowing the muscles to be plicated from the inside using a directional camera.

The rectus abdominis muscles are then brought closer together while preserving their functional independence (MISAR technique) and the linea alba is reconstructed. This method is less invasive, with finer scars, but it cannot treat a significant excess of skin. It can generally be performed on an outpatient basis.

Recovery after abdominal diastasis recti treatment

Recovery from abdominal diastasis surgery can be relatively significant, especially if an abdominoplasty or liposuction is required. Any pain felt can be relieved by taking painkillers. Swelling and bruising can also occur but disappear naturally after a few weeks.

The patient must also wear an abdominal compression garment for a period of 4 to 8 weeks to consolidate the results of the procedure. When excess skin remains after the muscles have been re-tensioned, it may need to be treated specifically; we cover the options in our article on loose belly skin and crepey skin.

A fairly long social withdrawal of 2 to 4 weeks should be expected, with at least 15 days off work. Lifting heavy loads is prohibited for at least 1 month and up to 3 months depending on the extent of the operation performed.

Abdominal diastasis recti: before & after results

The before & after results of abdominal diastasis surgery reveal a firmer, more toned belly, allowing for improved posture, greater mobility, better breathing and a reduction in back and abdominal pain. These aesthetic and functional improvements are accompanied by a positive change in self-image. In patients who combine several after-effects of pregnancy, diastasis repair is also often part of a more comprehensive approach to post-pregnancy reconstructive body surgery (mommy makeover). The patient then regains self-confidence thanks to a more harmonious, even body contour.

The before & after results of abdominal diastasis are definitively visible between 6 and 12 months after the procedure, once the swelling has completely subsided.
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Frequently asked questions

How do you know if you have abdominal diastasis recti?+

A simple test can raise the suspicion of one : lying on your back, knees bent, place your fingers flat just above the navel, then lift your head and shoulders slightly. If your fingers sink into a soft groove between the two bands of muscle, it may be a diastasis. A gap of about two finger-widths (i.e. from 2 cm) points towards the diagnosis, which will be confirmed by the surgeon using an ultrasound or an MRI of the abdominal wall.

Is a bloated belly always a sign of diastasis?+

No : a bloated belly can also come from excess fat, bloating or simple skin laxity. Diastasis is distinguished by a central bulge that persists despite a stable weight and that becomes more pronounced when you contract the abdominal muscles, sometimes with a vertical ridge in the middle of the belly. Only a clinical examination, supplemented by imaging, can tell them apart.

Can a diastasis close on its own without surgery?+

In a large proportion of postpartum cases, the gap narrows spontaneously during the first year and abdominal and pelvic-floor rehabilitation supervised by a physiotherapist is enough to restore good core support. Surgery is only considered when the diastasis persists beyond one year despite well-conducted rehabilitation, or when it is accompanied by excess skin, a hernia or marked functional discomfort.

When should abdominal diastasis recti be operated on?+

We generally wait until the abdominal wall has had time to recover : at least one year after childbirth and after a period of rehabilitation, and ideally once the plan to have children is complete, since a new pregnancy can reopen the gap. Surgery is then indicated if the diastasis remains symptomatic or aesthetically unsatisfactory.

Can abdominal diastasis recti surgery be covered by French national health insurance?+

As a procedure with an aesthetic purpose, diastasis repair is not reimbursed by French national health insurance. Partial reimbursement may nevertheless be obtained when it is combined with the treatment of a hernia, or when an abdominal apron covers the pubis and justifies a functional abdominoplasty. These criteria are assessed on a case-by-case basis ; the surgeon will tell you whether your situation may qualify for insurance coverage.

Is diastasis repair possible right after pregnancy?+

No. Diastasis mainly becomes apparent postpartum, i.e. 4 to 6 weeks after childbirth. It is advisable to wait at least 6 months after pregnancy, to allow time for rehabilitation and to confirm the diagnosis once the abdominal wall has stabilised.

How long does it take for the results of diastasis repair to become visible?+

The belly already looks flatter and more toned within the first few weeks, but the final result is judged once the swelling has completely subsided : it generally takes 6 to 12 months after the procedure to fully assess the body contour.

Abdominal diastasis recti: surgical treatment in Paris

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