How High Up Do We Go When Repairing Diastasis in a Tummy Tuck?

Replying to a great question from a follower: when we put the abdominal muscles back together during a tummy tuck, how high up the abdomen does that repair actually go?

Short answer: as high as we possibly can. Here's the longer version, and a few related things every tummy tuck patient should know.

Before the repair, this is the setup we're addressing:

• The rectus abdominis muscles ("six-pack" muscles) run vertically from your pubic bone at the bottom up to your rib margin at the top
• Normally they sit close together with a thin band of fascia between them
• After pregnancy, significant weight gain, or other stretching of the abdominal wall, those muscles get pulled apart
• The white space between them in cross-section diagrams = diastasis recti

That gap doesn't fix itself. No amount of crunches or core work closes a true diastasis — only a surgical repair physically brings the muscles back together.

When we repair diastasis during a tummy tuck:

• We use a big, heavy-duty suture
• We suture each side of the rectus muscle to the other side, edge to edge
• We start at the pubic symphysis (your pubic bone) at the bottom
• We sew all the way up to the rib margin at the top

We go as high as we possibly can. The rib cage is essentially the upper limit of how far our reach extends through a tummy tuck incision — and that's exactly where we stop.

It's worth saying clearly: it is extremely rare to open a tummy tuck and not find diastasis.

Even patients who:

• Have never been pregnant
• Have always exercised
• Have a relatively flat abdomen externally

…almost always have some degree of separation that becomes obvious once we lift the skin and look at the muscles directly. That's why diastasis repair is essentially a built-in part of any proper abdominoplasty.

You will always get a flatter contour by repairing the muscles than by leaving them apart, even if the diastasis seemed minor on the outside.

Here's something I tell every tummy tuck patient: a flat abdomen is not just about the rectus muscles.

Patients with a significant diastasis very often also have:

• Weak obliques (the side muscles that wrap around your waist)
• A weak transversus abdominis (the deep core muscle that acts like a corset)

Even after a perfect rectus repair, if the rest of your core is weak, your abdomen won't function — or look — the way you want long-term. Which leads to the next critical point.

Once the swelling settles and your surgeon clears you, core rehabilitation is essential. Not optional.

You need to work your core after a tummy tuck for three reasons:

1. Strength — your core hasn't been functioning properly for years (sometimes decades) before the repair
2. Balance and posture — your trunk stability depends on a working core
3. Flat contour — strong obliques and transverse abdominis are what keep the abdomen looking flat from all angles, not just front-on

Skipping core work after a tummy tuck is like getting a beautiful kitchen renovation and then never turning on the appliances. We did the structural part. You have to do the conditioning part.

Quick PSA on something I'm seeing in patients more and more often:

Wearing your post-op garment or faja for too long.

I've now seen patients who have been wearing their garments for:

• 6 months
• 1 year
• 18 months and beyond

What happens is the opposite of what they're hoping for:

• The garment provides constant external core support
• Over time, the actual core muscles weaken because they don't have to work
• When the patient takes the garment off, the abdomen looks rounder and softer
• They put the garment back on, the cycle continues, and they become essentially dependent on it

A garment is a post-op tool, not a lifestyle. You should not need to wear it forever to look the way you want.

Generally speaking, a faja or compression garment should be needed for the first several weeks to a few months after surgery, depending on what your surgeon recommends. After that, you should be:

• Out of the garment
• Working on your core
• Letting your body do the work of keeping you flat

When we repair diastasis during a tummy tuck, we go all the way from your pubic bone to your rib margin — as high as we can possibly reach. It's almost always present, and repairing it is one of the things that actually delivers a flat contour.

But surgery is only half of the equation. The other half is:

• Core rehabilitation after you heal
• Not relying on a faja as a permanent crutch

Do both, and you'll get the result we're working so hard to give you in the operating room.