Should You Get Diastasis Recti Repair Surgery?

If you’ve looked in the mirror postpartum and wondered why you still have an alien belly that pokes out in the middle, you might have diastasis recti, or a stretching of the abdominal cavity.

At least 60% of women experience an abdominal separation 6 weeks after giving birth, and 30% still have it one year postpartum.

If you do have diastasis recti or think you might, please go and read my post here first, which includes:

What is diastasis recti
How to test if you have diastasis recti
What you can do about your abdominal separation
Tested and proven programs and resources

I’ll go ahead and recap my own story for you here so you can see that surgery was never my first choice, but a last resort. This is not something to be taken lightly.

Why I Chose Diastasis Recti Surgery Repair

I had my first baby in 2014, and started actively trying to heal a 4-finger-width gap one year later with online programs and in-person physical therapy. I reached a point where I was highly functional and not in pain, but still had a 4-finger gap (although it was not as deep or long, other important measurement criteria).

After having my second baby in 2018, the gap was at least 8 fingers wide. I knew how to engage my deep core muscles, avoided doming, and worked with a pelvic floor therapist, another physical therapist, and tried a chiropractor.

By this point, I was used to seeing my stomach poke out, but my upper back hurt on a daily basis. I would be in such pain by the end of the day that I had to make dinnertime easier to prep because it was painful to stand by that point in the evening. I only considered surgery as an option only because I felt like I had actively tried everything else under the sun over the past 5 years.

Plastic Surgery for Diastasis Recti

I first went to my primary care doctor to get a referral for a surgeon, simply to have a consult and explore my options. He referred me to two clinics in town, both of which only did hernia repairs. They suggested I see a plastic surgeon.

“Plastic surgeon?” I recoiled at the thought.

While it would have been nice to have a flat stomach again and not have to worry about people asking me if I was pregnant, I did not want to be seen as doing this for vain reasons. And plus, plastic surgery is not covered by insurance. It turns out that in most cases, diastasis recti repair is not covered by most insurance in general. They will cover a hernia repair, but that’s around 10% of the cost, or so it was for my own case.

If I was a male, they would cover the surgery cost. Because women only get these kinds of surgeries to look better, not feel better, or at least that seems to be the prevailing thought. Something needs to change there.

I asked around and found a reputable plastic surgeon in town who did this repair, which is actually just a “tummy tuck.” Once again, I felt embarrassed to even ask about this. But the office was so incredibly accommodating and understanding of all my questions and concerns.

But, what if…?

No, it would not cost as much as I imagined (no liposuction reduces the cost too).

No, recovery time is not as long as I thought.

Yes, it is still possible to get pregnant afterwards.

I wasn’t ready to close the door on more kids, but I also thought it wouldn’t be wise to get pregnant with my body’s state of pain.

Around the same time, my husband had to spend a few thousand dollars to get his car fixed. He encouraged me to do what I needed to get my body fixed: “That’s just a car. But this is your body. It’s your health.”

I felt like surgery was my last option. After we chatted about the details, we decided it feasible for us as a family. We planned what the surgery would cost, and how much care I would need afterwards in addition to childcare. My youngest was 15 months at the time. I wouldn’t be able to pick her up for the first two weeks let alone take care of myself very well, so we enlisted the help of extended family members who thankfully stepped in to volunteer.

Addressing Vanity

Even after we got all of the details ironed out, I still had my reservations.

I hate to admit this, but when I drove up for my consult at the plastic surgeon’s office, I kept looking over my shoulder looking out for any Christians who might see and judge. But the truth was that I was judging myself. Since I’ve grown up to be independent, and a personal trainer who trains other people how to strengthen their own cores, I felt like a failure in not being able to fix myself. It was humbling.

But after I got home from that consult, I wrote down in my prayer journal, “Should I get this surgery?” The answer I received was, “It’s not going to devalue you. I’m looking at your heart.” That was freedom for me. The Lord knew that I thought this surgery was going to make me less of a person because I was spending a lot of time and money to change my body that He made. I had a lot of guilt over that, but He reminded me that “Man looks at the outward appearance, but the Lord looks on the heart” (1 Samuel 16:7).

Looking Back, Would I Still Have Had Diastasis Recti Surgery Repair?

But after I was committed, I started to get really nervous when the office asked me to provide a living will. I had never undergone a surgery that serious, and I had to make sure this would be worth it.

In my prayers, I started doing visualization exercises as I teach in our Joyful Health Course and I feel like that helped me shift from a mindset of fear to one of possibility.

Instead of dwelling on all the things that could go wrong, I focused on the facts that I knew, trusted the professionals, and thought about how my life could be different after the surgery.

Writing this a year out of surgery, I can say I am still glad I had the surgery. I will be honest and say that my back still hurts so it did not “fix” me, but I do feel more normal (except for a scar that runs between my hip bones). But I know that it did pull my core back together and I feel more “put together" and my core feels way stronger.

Side note: If you are itching for before and after pictures, since I did this for restorative reasons, I won’t post pictures here. :)

And I wouldn’t recommend this surgery lightly. It was incredibly painful and took a lot of time, energy, and money not just from me but from our extended family who needed to help with recovery.

And did I say it was painful? I’ve had two babies (one naturally) and post-surgery was worse!

Let me emphasize that I am writing from a personal perspective, and what is right for me will not be the answer for you. I only hope to share my experience to give you more information if you are considering this option.

Is Diastasis Recti Repair Surgery Right for You?

For many women, diastasis recti will resolve naturally or with mindful core engagement and regular strengthening exercises as taught by a certified professional like a women’s health physical therapist. Generally, if your diastasis recti is two finger widths apart you can manage it pretty well by avoiding doming and taking care of your core.

For others, diastasis recti does not go away, even with concerted effort. There are a lot of wonderful programs out there, but none are a “guaranteed fix.”

There is still no right answer, no one-size-fits-all, no diastasis fix or blueprint or “just adhere do this program and you’ll be healed like me” before and after pictures for every single situation.

If you’re at all considering surgery after you have exhausted all other options, this is what you can expect. The procedure is called an “abdominoplasty” or, more informally known as a “tummy tuck.”

How does a tummy tuck help diastasis recti?

During the procedure, they sew the abdominal muscles together, then pull the skin down tight over the top. My skin was stretched so tight I now have new stretch marks! You’ll also get a new belly button. I was happy to see my outie go, but if you’re particularly fond of yours, you might want to keep that in mind. Here’s an animation video of the procedure so you know exactly what will happen.

Diastasis Recti Repair Surgery might be right for you if:

You’ve been to a women’s health physical therapist. I’ve done plenty of online programs (I’ve listed my favorite resources in this post), but I always recommend every single postpartum woman to get an appointment with a women’s healthy physical therapist. They will help you restore your core and pelvic floor in ways no online expert can. Sometimes you need a hands-on expert to show you where you are tight, to massage out scar tissue, and show you how to engage and release in all the right ways.
You’ve adhered to physical therapy guidelines: Physical therapy exercises can feel monotonous, but try them out consistently to gain expected results before moving on to another option.
You have reduced nutritional factors that might cause bloating: Since the abdominal muscles are not there to retain bloating, your stomach may look even bigger when eating foods that cause distension, like high-sodium foods or ones that your gut may not agree with. This can increase intraabdominal pressure and could worsen the diastasis recti.
You’re at least a year postpartum. Let your body heal. My physical therapist also recommended that I wait a few months after I was done nursing to let my hormones get back to normal to see if that helped my connective tissue.
Your diastasis recti is causing you considerable pain on a daily basis. Let me tell you, surgery is not a walk in the park. It is incredibly painful for the first few days, and inconvenient as a mom for the first few weeks until you are strong enough to lift your kids. My stomach was also too tight to even hang from a pull-up bar comfortably until a year later.
You don’t plan on getting pregnant again. I agonized about the decision of whether or not to have more kids. I thought this surgery ensured I would never be able to get pregnant, but my plastic surgeon reported that women were still able to get pregnant after their tummy tuck. So I knew I wasn’t closing the door on a baby entering the world through my womb. Your stomach will certainly stretch and you might have to get the procedure done again, so it’s a good idea to be fairly certain that you are not planning on having any more children.
You’re financially able. Most tummy tucks run on average $10,000, but mine was much less since I didn’t need any liposuction. Try a free consult with a trusted surgeon and see what they offer (I saw Dr. Pittman in Athens, GA). Unfortunately, most of these procedures are not covered by insurance. But I have heard of some women getting their procedure covered, so it’s worth a shot. Call your insurance, ask your primary care doctor to get you a referral, check with your physical therapist, and make appointments to get free consults to see for yourself.
You’re vocationally able. You’ll need to secure day and night help for the first three days, you can’t drive for the first 7-10 days, and you’ll need someone to take you to post-op appointments. You won’t be able to pick up anything over 5 pounds for the first 2 weeks, and it’s not recommended for you to return to exercise for the first few months. As a mom of a six-year-old, 15-month-old, personal trainer and fitness instructor, my vocation is physically demanding. For the first four days, my dad and stepmom watched our toddler, my mom came to help take care of me and my 6-year-old, and my husband helped me at night. Then my in-laws watched the girls for a full week, and I took three weeks off training. I wasn’t able to confidently work my core again for another 4 months.
You’re spiritually at peace with the decision. For some, getting plastic surgery can feel like a vain pursuit, one that says, “Hey, God who made me, I don’t like my body, so I’m going to someone else to get it fixed.” If you struggle with body image, I have a great resource for you here. After talking with God and getting past all the labels, I embraced this surgery as a gift I could receive rather than something I needed to change my body to be happy. I encourage you to go to God in prayer and have that conversation. I recommend writing down your questions in a journal for clarification, and prayerfully waiting for an answer.