Tummy Tuck and Rectus Plication: A Guide to Flatter Abs

Are you fit but your stomach sticks out? A tummy tuck, or abdominoplasty, is one of the most effective procedures for achieving a flatter, firmer abdomen. While many people are familiar with the removal of excess skin and fat that occurs during a tummy tuck, fewer understand the important role that a procedure called rectus plication plays in addressing a protruding belly, particularly for patients with muscle separation.

As a board-certified plastic surgeon, I frequently perform rectus plication during tummy tucks. The procedure addresses a condition called diastasis recti, where the abdominal muscles (rectus abdominis) separate, often as a result of pregnancy or significant weight fluctuations. In this blog, I’ll explain what rectus plication is, why it’s commonly included in tummy tuck procedures, and the key benefits it offers to patients seeking to restore their abdominal contour.

What is rectus plication?

Rectus plication refers to the surgical repair and tightening of the rectus abdominis muscles, which run vertically along the front of your abdomen. These muscles can become stretched and separated —a condition known as diastasis recti — which is especially common after pregnancy or significant weight changes.

When these muscles are weakened or separated, it can lead to a protruding abdomen, even in people who are otherwise fit or at their ideal weight.

During a tummy tuck, rectus plication involves suturing the separated muscles back together, restoring their strength and tightening the abdominal wall. This step is essential for creating a smooth, toned, and more aesthetically pleasing midsection.

Why is rectus plication important during a tummy tuck?

Many patients seeking a tummy tuck don’t realize that loose or separated abdominal muscles are often a significant contributor to their abdominal bulge. Addressing this muscle separation through rectus plication helps correct the underlying structural issues that cannot be resolved through diet or exercise alone.

Key reasons why rectus plication is important:

1. Restores core strength: Diastasis recti weakens the core, which can result in poor posture, back pain and difficulty with certain physical activities. By bringing the muscles back together, rectus plication improves core strength and stability, which can make daily activities easier and enhance overall physical function.

1. Flattens the abdomen: Without addressing the muscle separation, removing excess skin and fat alone may not achieve a completely flat abdomen. Rectus plication tightens the underlying muscle structure, helping to create a firmer, flatter abdominal contour.

1. Improves posture: Weak or separated abdominal muscles can cause an imbalance in the core, leading to poor posture and even chronic back pain. Tightening the abdominal muscles through plication can help improve your posture and alleviate the strain on your lower back.

1. Enhances long-term results: The inclusion of rectus plication in a tummy tuck provides more durable, long-term results. Without muscle repair, patients may continue to experience abdominal bulging or a loss of contour over time, even after a standard tummy tuck. By addressing both the skin and muscle layers, rectus plication ensures that your results will last longer and remain aesthetically pleasing.

What happens during rectus plication?

During a tummy tuck, rectus plication is performed after the excess skin and fat are removed. Here’s an overview of how the process works:

1. Abdominal exposure: After making the incision (usually along the lower abdomen, just above the pubic area), the surgeon lifts the skin and fatty tissue away from the underlying muscles, exposing the rectus abdominis.

1. Suturing the muscles: The separated or weakened muscles are brought back together using either strong dissolvable permanent sutures, or a combination of both, in a layered technique, creating a tighter and stronger abdominal wall. This reestablishes the muscles in their proper position.

1. Skin redraping: Once the muscles are sutured and tightened, the skin is pulled down over the abdomen, and any excess is removed. The incision is then closed, often with careful attention to maintaining a low, concealed scar.

The result is a flatter, more toned abdomen that not only looks better but also functions more effectively.

What are the advantages of doing a rectus plication during a tummy tuck?

Rectus plication offers numerous benefits, both aesthetic and functional. Here are some of the top advantages:

1. Restoration of a toned abdominal appearance: By repairing the underlying muscle structure, rectus plication ensures that your tummy tuck results look more natural and balanced. The procedure helps eliminate the bulging appearance caused by diastasis recti, giving you a flatter, smoother abdomen.

2. Improved core stability and strength: A strong core is essential for maintaining good posture, balance and overall physical health. Patients often report feeling stronger and more stable after the procedure, as the reconnected muscles provide better support for the spine and pelvis.

3. Relief from back pain: Many patients with diastasis recti experience chronic lower back pain due to the strain on their core muscles. Rectus plication can help alleviate this discomfort by restoring core strength and improving posture, which reduces the pressure on the back.

4. Enhanced confidence and body contour: Patients who undergo a tummy tuck with rectus plication often feel more confident in their appearance. Whether you’ve experienced changes from pregnancy or weight loss, the procedure helps restore a youthful, toned abdominal contour that aligns with your goals.

5. Long-lasting results

A tummy tuck that includes rectus plication tends to offer longer-lasting results compared to one that focuses solely on skin and fat removal. By addressing the deeper structural issues, you’re ensuring that the foundation of your abdomen is strong and more resistant to future sagging or bulging.

Is rectus plication right for you?

Rectus plication is ideal for patients who have diastasis recti, weakened abdominal muscles, or a persistent bulging appearance despite being at a healthy weight. If your abdomen sticks out due to pregnancy, weight fluctuations or aging, this procedure can be a game-changer.

During your consultation, we will assess the condition of your abdominal muscles and determine whether rectus plication is necessary as part of your tummy tuck. Together, we’ll create a customized surgical plan that meets your needs and delivers the best possible results.

Conclusion

A tummy tuck is more than just skin deep. By incorporating rectus plication into the procedure, we can correct muscle separation, improve core strength, and provide a more comprehensive solution to abdominal contour issues. If you’re considering a tummy tuck and want to learn more about how rectus plication can benefit you, I invite you to schedule a consultation with one of Ochsner Health’s board-certified plastic and reconstructive surgeons. Let’s work together to achieve the flatter, stronger and more confident look you deserve!