A case study by Dr Dilip Gahanakari

Amy is a 38-year-old, otherwise fit and well lady, who is a physiotherapist by profession. No, she was not pregnant in this photo! However, she has had four beautiful children and decided on nohaving any more.

Since her pregnancies, Amy suffered from low backache and stress incontinence. As her job often involves physical strength and use of core muscles, Amy found it very difficult to cope with her symptoms.

She knew that she has nothing wrong with her spine or her bladder, yet she suffered from symptoms arising out of these. 

As a health professional herself, Amy was well aware that her rectus muscles in the front of her tummy had stretched so far wide apart, that no matter how hard she tried to ‘tone them up’ with regular gym activities, no improvement was noticed in her symptoms. 

She also had the bulge of her lower abdomen, which made her self-conscious – often because she ‘looked pregnant’, although she was less concerned about the bulge than she was that the back pain and incontinence would continue into her future and cause permanent effects.

Amy came to me for consultation in late 2018. It was obvious that Amy had post-pregnancy severe rectus diastasis, or in simple terms massive separation of the rectus muscles. In fact, my examination suggested 7cm of separation – through the almost thinned out middle part of the tummy, I could feel her bowel with my hand.

Unfortunately, Medicare changed the criteria in 2016 so the item number for tummy-tuck no longer covered surgical procedures for patients such as Amy. 

However, despite having had no help from Medicare or her private health insurance, Amy decided to go with my recommendation of an abdominoplasty or tummy-tuck procedure. She recovered relatively quickly after the procedure and says she has never been happier with her decision to have this procedure. Following is her photo at nine months post her tummy-tuck procedure.

The bulge is gone, but most importantly the back pain has totally disappeared, and the urinary stress incontinence is history.

Unfortunately, Amy is not alone in experiencing significant symptoms of low back pain and stress incontinence after pregnancies. 

The effect of abdominal distension on rectus muscles has been extensively studied in scientific literature. There are several studies which have focused on effect of pregnancy on rectus muscles separation and their effect on the abdominal wall muscle strength. Some have not even indicated improved abdominal muscle strength but inter-vertebral disc spaces following abdominoplasty surgery. Since Medicare pulled the plug on post-pregnancy diastasis correction and abdominoplasty in 2016, a group of nine plastic surgeons from all over Australia, including myself, undertook a prospective study to obtain Australian data. 

Dr Campbell from Canberra led this study which included 214 patients (one of largest studies of this kind in literature). Only the post-pregnancy women were included and the study was only focused on effect of abdominoplasty procedure on lower back pain and stress incontinence. 

Our study data, all from independent surgeons suggested that abdominoplasty does improve low back pain and stress incontinence. The study was published in the coveted Plastic Surgery Journal in 2018.

Unfortunately, Medicare has not changed the criteria yet and as we speak, further application is being submitted to Medicare for consideration, which includes case studies like Amy’s from other parts of Australia.

What is abdominoplasty?

Abdominoplasty is a surgical procedure – which has definite goals:

  1. To remove the excess fat and skin from the lower abdomen and 
  2. To correct the rectus muscles separation by their imbrication (bringing them together with strong sutures).

Scientific studies show that muscle separation beyond 3cm can cause abdominal wall muscle dysfunction. Of course, not all women who undergo pregnancy have rectus muscle separation. And not all women with rectus muscle separation from pregnancy have symptoms of back pain or incontinence either. Also separation of the rectus muscles is also seen in some men, and in some men and women after massive weight-loss. 

Abdominoplasty is commonly necessary after massive weight loss and in this scenario the focus is on removal of excess skin folds in the lower abdomen. Fortunately Medicare has still maintained rebates for this condition. 

Abdominoplasty is tailored to the patient’s condition – to conform to goals as mentioned above. It is often performed with liposuction, and I myself often do extensive lipo-suction (called ‘lipo-abdominoplasty’) to achieve better contouring of abdomen – while also removing excess skin and tightening the muscles. It is a major procedure needing anywhere between 2-4 hours of operating time and a general anesthetic. 

Abdominoplasty commonly involves a long scar from hip to hip – which can be positioned close to the bikini line. At least a one-night stay is recommended in the hospital, and post-operative prophylaxis against deep venous thrombosis (commonly daily injections of blood thinner) is advocated by most surgeons, including myself. 

The recovery period can vary, but the key to have quick recovery is to start moving very next day. The procedure like all surgical procedures is not without its risks. The risks include general risks of surgery and anesthetic and those related to surgical wound healing. Occasionally, because of use of blood thinners, post-operative bleeding or blood clots may occur and these may need another procedure. It is also important to support the abdomen with a strong Velcro binder for a period of 6-8 weeks. It is best performed by a trained Plastic Surgeon in an accredited hospital with inpatient care facility. The best results of abdominoplasty procedure are obtained in men and women with their BMI (body mass index) close to the ideal range. The better our patients prepare their body and mid before this procedure, the better results can be achieved.

For a free tummy tuck consultation with our surgical nurses, contact us using the form below or call 1300 007 300.

Any surgical or invasive procedure carries risks. Before proceeding, you should seek a second opinion from an appropriately qualified health practitioner.

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