WHAT IS A DIASTASTIS? WE TALK TO DOUBLE CERTIFIED PLASTIC SURGEON, DR. DANIEL CAREAGA, OF CAREAGA PLASTIC SURGERY FOR THE 411

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It’s hard to believe my abdominoplasty surgery for my diastasic is just two days away and as you can imagine, I’m equally excited and nervous for the procedure. I’m also equally excited for the recovery because it means I have no choice but to rest and literally, Netflix and chill and that sounds like a dream. Joking aside, it’s crucial to do your research and know what you’re signing up for when it comes to choosing a doctor, familiarizing yourself with the procedure, recovery, and making sure you have a good support system in place to help. I often get asked, ‘what’s a diastasis?’ And this usually comes after someone wrongly congratulates me for my ‘pregnancy’ or after asking me how far along I am. The answer is, I’m not pregnant, it’s my diastasis. To better understand what that means and what an abdominoplasty is (aka tummy tuck), I sat down with double certified plastic surgeon, Dr. Daniel Careaga, of Careaga Plastic Surgery, who will be performing the procedure on me on Thursday. From what causes a diastastis to how a tummy tuck is performed, Dr. Careaga is here to share his knowledge with you!

KB: First of all. I can’t begin to tell you how excited and nervous I am for my procedure. I know I’m in the best hands, but of course, there are some nerves! Is this common for a patient to be experiencing so many emotions before their ‘big day?’ 

DC: Absolutely, you have to understand that surgery for most people is a once-in-a-lifetime deal. More than half of my patients have never even been in an operating room. It’s my job to transfer my level of confidence and comfort with surgery to my patients to ease their anxiety.

 KB: I get a lot of questions on what a diastastis is, and to be honest, I had no idea what it was until a doctor told me that’s what I had. Can you explain what a diastatis recti is and how it fits into what you do? 

DC: An abdominal diastasis is a Separation of the abdominal muscles usually caused by pregnancy, massive weight loss and aging. The abs are four pairs of muscles that are held together in the midline through a thin line of connective tissue. This connective tissue stretches to accommodate a growing uterus.  Often the connective tissue shrinks back down after pregnancy but many times it stretches beyond its limit -sort of like a rubber band that has been stretched too much and the fibers begin to break.  This leaves an unsightly bulge throughout the entire abdomen that despite many boyfriends and husbands telling their wives that they just need to do more crunches will never go away because it is damaged connective tissue. The only effective treatment for an abdominal diastases is a tummy tuck where I create what we refer to as an internal corset to flatten and tighten the muscles.
KB: So it’s very common after pregnancy as well? I know mine got worse after my second, and I also have a hernia!  

DC: Pregnancy is definitely the number one cause of abdominal diastasis.  Since it is a weakening of the connective tissue it is not uncommon to find small hernias such as umbilical hernias as well. These are easy to repair at the same time as a tummy tuck.

KB: How do you correct that? Would exercise work?  

DC: I perform a two layer tightening of the abdominal muscles with a very strong permanent suture.  The reason I use permanent suture is because most sutures start to lose their strength at about 3 to 4 weeks and since connective tissue and muscle take longer periods of time to heal I like to make sure that the strength is going to be held together by the suture.

KB: Tell me a little bit about the abdominoplasty, or as we know it, the tummy tuck? How is it performed?  

DC: Abdominoplasty commonly referred to as a tummy tuck is an operation that is designed for somebody that is near their ideal body weight and has one or more of the following issues- muscle separation, fat accumulation along the lower abdomen and waist, loose damaged abdominal skin and stretch marks.  For me the most part of the procedure is when I’m marking my patient in pre-op.  I will have my patient stretch up on their lower abdomen while marking them. This mimics the stretch that the tummy tuck will be performing on them so that I can make sure that the scar will be placed nice and low hidden underneath the bikini line. The first step in a tummy tuck is to lift the skin off of the abdominal wall followed by a strong muscle tightening. I then set the patient up around 45° to mark all of the excess skin to be removed.  I remove all of the excess skin I bring the belly button out in its new position, close the incision meticulously and finally perform liposuction of the waist for definition.
KB: Who’s a good candidate for the tummy tuck? 

DC: The ideal candidate for a tummy tuck is somebody who is near their ideal body weight, is in a good state of health, is a non-smoker and has loose abdominal skin or muscle separation.

 KB: I’ve heard people say, it’s the same thing as getting lipo and it isn’t. At all. Can you explain that? 

DC: Many of my patients come in requesting liposuction thinking that a tummy tuck and liposuction or essentially interchangeable. It’s my responsibility to educate my patients on the fact that liposuction only corrects one problem which is excess fat. It does not correct loose skin or a separation in the abdominal muscles. Performing liposuction on somebody that has these issues is a set up for failure.

 KB: Now, I’ve got two kids, a husband, and a job so one of the first things I think about is, how soon will I be back up and running? What’s recovery like? Give it to us straight!  

DC: The recovery for a tummy tuck is actually not as bad as most patients think it’s going to be. Most patients can go back to work and drive within 10 to 14 days after surgery. I let people go back to the gym at one month and start out with low impact cardiovascular exercise and upper body weights. I let them progressed to lower body weights at two months and the only exception is no abdominal exercises for six months.
KB: What are some common questions or concerns you get asked when someone wants to come in for abdominoplasty? 

DC:  The most common concern I get in tummy tuck consultations are the patients that say, ‘I know I have loose skin and a separation in my abdominal muscles but I don’t want to scar so I’d like to do liposuction instead.’ Sometimes it’s a little easy to get carried away with the fun side of plastic surgery and not realize that when I examine the patient, I’m actually making a diagnosis and I need to choose the procedure that’s going to correct those diagnoses. so if a patient has loose skin or a separation of abdominal muscles and the surgeon is choosing to do a fat removal operation only, it is Impossible to obtain a good result.  

KB: I remember one of the questions I asked was, well, what happens if I decided I wanted to get pregnant? How would that affect my tummy tuck? 

DC: Ideally a tummy tuck should be performed on a woman who has completed her childbearing. There are times however when a patient has loose skin and separation of Abdominal muscles and may be planning children years down the road. In these patients a tummy tuck can be safely performed.  The fact that I do a tummy tuck will not increase their level of risk for future pregnancies and the majority of patients will have their skin and muscle shrink back down after the subsequent pregnancy
KB:  I’m asking this one for all the husbands out there because I know my husband wanted me to ask, when can we have sex? 

DC: There’s no absolute answer to this, really it’s just when my patient feels ready for it. I have found that this usually is at about three weeks after the tummy tuck.

 KB: One of the big qualities that I like about you as a surgeon, besides the fact that you’re double certified if you want to explain that, is that you will not operate on anyone that shows red flags and isn’t here for the right reasons? What do you mean by that? 

DC: In addition to the ideal candidate that we mention earlier for abdominoplasty, there are also psychological considerations. I need to know that my patients have reasonable expectations as to what can be obtained with any type of plastic surgery As well as be able to handle the stress of the surgery and a surgical recovery. The most important thing is that my patient is doing this for him or herself and nobody else. Plastic surgery is about self-confidence not about pleasing a partner.

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 KB: Any advise or words of wisdom for women or men who are contemplating this procedure? 

DC: Absolutely, I cannot stress enough to do your homework before your surgery. I cannot tell you how many patients I have seen over the years that come to me after they’ve had a failed operation or a complication and they tell me “Oh, I didn’t know that the surgeon that did my surgery was a gynecologist.”  Plastic surgery is a life-changing decision and as with any major decision should not be taken lightly and deserves to do your due diligence to make sure that you’re having your procedure done with the person that is going to give you the results you want and that you trust with your life.


* To book a consultation with Dr. Daniel Careaga, please call (305) 960-7511 and visit them at https://www.careagaplasticsurgery.com. Follow them on Instagram at @careagaplasticsurgery.