Mesh Repair of Rectus Diastasis for Abdominoplasty is Safer than Suture Plication

Abstract

Concerns regarding infection, extrusion, and pain have traditionally precluded the use of mesh to treat severe rectus diastasis during abdominoplasty in the United States. We describe a mesh abdominoplasty technique, and we hypothesize that the complication rate using mesh is greater than the complication rate of suture plication.

Methods: Inclusion criteria for mesh abdominoplasty were patients who (1) had retrorectus planar mesh for repair of rectus diastasis, (2) did not have concurrent ventral hernia, and (3) underwent skin tailoring. Patients who underwent rectus plication with suture, and met criteria 2 and 3 above were included in a sample of consecutive standard abdominoplasty patients. The primary endpoint was surgical site occurrence at any time after surgery, as determined with review of their office and hospital medical records. Secondary endpoints included surgical site infection, revision rates, postoperative course, and aesthetics assessed with their last set of office photographs.

Results: Surgical site occurrence rate was 0% of the 40 patients in the mesh group and 19% of the 37 patients in the standard group (P = 0.005); rates of soft-tissue revision were 23% in the mesh group and 27% in the standard group (P = 0.84). As to aesthetics, the mesh abdominoplasty patients had mean statistically lower preoperative scores in comparison with the standard plication group (65.8 ± 11.6 versus 70.3 ± 11.4, P = 0.0013). The mesh group had a statistical improvement to 75.9 ± 12.6 (P < 0.0001), whereas the standard plication group improved to 82.5 ± 11.4 (P < 0.0001).

Conclusions: Retrorectus mesh placement in a cohort of patients with severe rectus diastasis had a complication rate lower than that seen in a cohort of patients with less severe rectus diastasis, therefore negating our original hypothesis. This was done without compromising aesthetic improvement.

Fig. 1.

Illustrations of coronal and anteroposterior views showing width of mesh, retrorectus placement, and approximate locations of interrupted trans-rectus sutures to secure mesh.

Fig. 2.

Intraoperative photograph of mesh abdominoplasty patient. Photograph highlights author’s technique of tacking the anterior rectus sheath to the retrorectus mesh to accentuate the central midline depression.

Fig. 3.

Patient example: Preoperative (A–C) and 12-month postoperative (D–F) photographs of mesh abdominoplasty patient.

Fig. 4.

Patient example: Preoperative (A–C) and 10-month postoperative (D–F) photographs of a mesh abdominoplasty patient with a vertical skin incision. Vertical skin incision was indicated in this patient because she underwent removal of painful umbilical mesh at the time of her abdominoplasty procedures.