Tummy Tuck (Abdominoplasty) is an operation designed to improve the contour and shape of the abdomen. Often pregnancy or significant weight gain can stretch not only the skin of the abdomen but also the muscle layer as well. A typical abdominoplasty not only removes the excess skin but also tightens the abdominal wall in those cases when it is necessary. Commonly, we perform some limited liposuction of the abdomen along with the abdominoplasty to further improve the contour and ensure that there is smooth transition from the abdominal flap that has been brought down to the pubic area along the incision line.

Muscle tightening is sometimes not necessary if there has been no significant muscle stretch and the patient has exercised and redeveloped good abdominal muscle tone. Unfortunately, in many cases there has been some stretch of the linea alba. This is a strip of nonmuscle containing tissue that runs down the midline from the bottom of the breastbone to the top of the pubic bone. It runs between the two rectus muscles that comprise the “six-pack” seen on body builders. Similarly to skin, there is no amount of exercise that will tighten the linea alba. Thus the only choice here is to surgically tighten (plicate) this layer during an abdominoplasty.

Tightening of the abdominal muscle layer also allows the surgeon to correct any abdominal wall defects such a hernia. This is a valuable procedure in that hernias may enlarge with time and more importantly a hernia may lead to a serious surgical (and possibly life threatening) emergency if the intestines become trapped in the hernia sac.

I would recommend that you go ahead and have the muscle layer repaired in the situation described here. First, the hernia should be addressed for the reasons cited above. Secondly, skipping this step will significantly reduce the quality of the result that you will get from a tummy tuck. Muscle tightening will flatten the stomach giving a very aesthetic result. Tightening the muscle layer offers no significant increase in surgical risk or complications and you still will need to recover from the surgery with or without muscle tightening. I wouldn’t let the modest increase in recovery from the muscle tightening sway me away from having it done. You’ll get a much better result and I think that in the long run you’ll be much happier with your surgery instead of opting for a half result.