Effect of abdominoplasty with transverse plication on rectus diastasis

Transverse plication (TP) abdominoplasty has gained popularity in recent years, as it is the keystone step of the TULUA procedure. This technique can achieve excellent contour results and reduce complications. However, the effect of TP on diastasis recti abdominis (DRA) remains uncertain. This study is the first specific research designed to investigate the effect of TP on the inter-recti distance (IRD). Two different strategies were defined for this purpose. The first is a prospective self-controlled case series study with ultrasound evaluation on 16 consecutive post-bariatric patients; the second is based on cadaveric surgery on three specimens. The average IRD reduction after TP in the study was 0.6 cm and 0.7 cm for the two defined measurement points (representing 26% and 28% of the preoperative IRD, respectively). The reduction in IRD after TP was statistically significant. The mean IRD reduction after TP in the three cadaveric specimens was 0.7 cm (25% of the preoperative IRD). If DRA is defined as 2 cm at any IRD point, TP abdominoplasty can correct DRA when the preoperative inter-recti distance is less than 2.5 cm, or between 2.5 and 3 cm in the absence of visceral fat obesity. In conclusion, although TP abdominoplasty reduces IRD, we recommend longitudinal plication abdominoplasty (either isolated or combined with transverse plication) when the IRD exceeds 3 cm, is between 2.5 and 3 cm in the presence of visceral fat obesity, or when complete approximation of the medial edges of the rectus abdominis is desired.