After pregnancy, many women have diastasis recti. It is a surgical repair of the muscles that is nearly never covered by insurance for women, but is frequently covered for males. It causes the women who are affected a great deal of physical pain.
Is diastasis recti repair considered cosmetic?
The surgical treatments panniculectomy and abdominoplasty are discussed in this text, as well as when they are regarded medically required, not medically necessary, and cosmetic.
Procedures are considered medically necessary in this article if there is a severe functional impairment AND the procedure can be reasonably expected to improve that impairment.
Procedures are deemed cosmetic in this article when they are designed to change a physical appearance that would be considered within normal human anatomic variation. Cosmetic services are sometimes defined as those whose primary goal is to maintain or improve one’s looks.
- For those who match the following requirements, a panniculectomy is considered medically necessary:
- The panniculus hangs below the pubis (as evidenced by pictures); and
- for a period of three months, there are documented recurrent or chronic rashes, infections, cellulitis, or non-healing ulcers that do not respond to conventional treatment (such as dressing changes; topical, oral, or systemic antibiotics, corticosteroids, or antifungals); or
- There has been observed difficulty ambulating and interfering with daily activities;
- notwithstanding significant* weight loss that has been steady for at least 3 months or well-documented attempts at weight loss (medically supervised diet or bariatric surgery) that have failed; and
- If the person has undergone bariatric surgery, he or she must be at least 18 months post-op or have maintained a stable weight for at least three months.
*Significant weight loss is determined by the individual’s clinical conditions and may be noted if the person:
- Has lost at least 40% of the excess body weight that existed before to the individual’s weight loss program or surgical intervention.
- When needed for exposure in unusual conditions, a panniculectomy is regarded medically necessary as an adjuvant to a medically necessary procedure.
- When the above conditions aren’t met, a panniculectomy isn’t regarded medically required.
- Unless the conditions above are met, panniculectomy is not deemed medically required as an adjuvant to other medically necessary surgeries, such as hysterectomy or incisional or ventral hernia repair.
- For the treatment of back discomfort, a panniculectomy or abdominoplasty, with or without diastasis recti correction, is not regarded medically required.
- When done to remove extra abdominal fat, liposuction is considered aesthetic rather than medically required.
- When extra skin or fat is removed along with or without tightening of the underlying muscles, abdominoplasty is deemed cosmetic and not medically required.
- PI Blomfield, T Le, DG Allen, and RS Planner. A beneficial method for obese patients undergoing gynecological surgery is panniculectomy. Gynecol Oncol, vol. 70, no. 1, pp. 80-86, 1998.
- Surgical therapy of incisional hernia. Br J Surg. 2002; 89(5):534-545. Cassar K, Munro A.
- MR Coriddi, PF Koltz, R Chen, and JA Gusenoff. Changes in quality of life and functional status after abdominal contouring in those who have lost a lot of weight. 2011; 128(2):520-526 in Plast Reconstr Surg.
- JP Fischer, CT Tuggle, AM Wes, and SJ Lovach. An investigation of the ACS-NSQIP database found that concurrent panniculectomy with open ventral hernia repair carries a higher risk than ventral hernia repair. 67(5):693-701 in J Plast Recontr Aesthet Surg.
- KC Harth, JA Blatnik, and MJ Rosen. Is panniculectomy beneficial in the treatment of massive ventral hernias in morbidly obese patients? 201(3):396-400 in American Journal of Surgery, 2011.
- Panniculectomy during gynecologic surgery in morbidly obese individuals. Hopkins MP, Shriner AM, Parker MG, Scott L. Am J Obstet Gynecol, 182(6), 1502-1505, 2000.
- Ventral hernia repair with concomitant panniculectomy, Hughes KC. Ann Surg., 62(8), 678-681, 1996.
- BB Massenburg, P Sanati-Mehrizy, EM Jablonka, and PJ Taub. Abdominoplasty readmission risk factors and poor outcomes 2015; 136(5):968-977 in Plast Reconstr Surg.
- A. Matarasso, S. G. Wallach, M. Rankin, and R. D. Galiano. A review of early and late reoperative surgery for secondary abdominal contour surgery. 115(2):627-632 in Plast Reconstr Surg, 2005.
- Abdominal surgery in individuals with extreme morbid obesity, Matory WE, O’Sullivan J, Fudem G, Dunn R. 1994; 94(7):976-987 in Plast Reconstr Surg.
- FX Nahas, SM Augusto, and C Ghelfond Is it necessary to correct diastasis recti? 1997; 21(4):285-289 in Aesth Plas Surg.
- Panniculectomy in morbidly obese gynecologic oncology patients. Pearl ML, Valea FA, Disilvestro PA, Chalas E. Int J Surg Investig, 2(1), 59-64, 2000.
- Panniculectomy to enable gynecologic surgery in morbidly obese women, Obstet Gynecol. 1999 94(4):528-531. Powell JL. Panniculectomy to assist gynecologic surgery in morbidly obese women, Obstet Gynecol. 1999 94(4):528-531.
- Perioperative care of the post-gastric-bypass patient presenting for body contour surgery. Rubin JP, Nguyen V, Schwentker A. 31(4):601-610 in Clin Plast Surg, 2004.
- T. Staalesen, M. F. Olsén, and A. Elander. The impact of abdominoplasty and rectus fascia plication on post-bariatric surgery patients’ health-related quality of life. 136(6):750e-761e in Plast Reconstr Surg, 2015.
- H. Buchwald; Panel of the Consensus Conference. Bariatric surgery for morbid obesity: health implications for patients, health professionals, and third-party payers, according to a consensus conference statement. 2005; 1(3):371-381 in Surg Obes Relat Dis.
- The National Institutes of Health (NIH) is a federal agency that researches The National Heart, Lung, and Blood Institute is a federal agency that studies the heart, lungs, and blood. Calculate your BMI. Visit https://www.nhlbi.nih.gov/health/educational/lose wt/BMI/bmicalc.htm for more information. On the 28th of December, 2020, I was able to get a hold of some information
- The National Library of Medicine is a government-run medical library. Diastasis recti is a medical term that refers to a separation of the abdominal muscles. http://www.nlm.nih.gov/medlineplus/ency/article/001602.htm is a good place to start. On the 28th of December, 2020, I was able to get a hold of some information
Review by the Medical Policy and Technology Assessment Committee (MPTAC). In the Description section, I updated the MN definition text. Discussion/General Information, References, and Website sections have all been updated. The Coding part has been restructured.
Review of the MPTAC. The first draft of the document. SURG.00048 Panniculectomy and Abdominoplasty’s content has been moved to a new clinical utilization management guideline paper with the same name. (1) changed bullet “A” to state that liposuction is considered aesthetic and not medically required when done to remove excess abdominal fat; (2) revised bullet “C” by eliminating the phrases “for all indications.”
How much is surgery for diastasis recti?
The loose, sagging skin between your belly button and the pubic area is tightened during a stomach tuck. However, based on your needs and preferences, the breadth of the process may differ. If you’ve ever pondered a little belly tuck, you’ve probably wondered, “How much does a mini tummy tuck cost?”
In 2019, the average cost of a small stomach tuck was $6,092, according to the American Society of Plastic Surgeons. However, everything appears to be getting more expensive as the cost of living rises. Â As a result, it’s likely that this number has risen in recent months. There are also extra costs associated with the process. This puts the price between $3,000 and $15,000. When investigating a belly tuck, keep these prices and expenses in mind.
Are tummy tucks covered by insurance?
- After decreasing weight, panniculectomies and tummy tucks are done to remove extra skin around the lower stomach.
- A panniculectomy is considered a medical need after a large amount of weight loss, but a stomach tuck is a cosmetic treatment.
Safety
- Pain and numbness are common side effects of both surgeries. Scarring is also a possibility, though it will fade over several months.
- Infection, severe pain and numbness, and bleeding are all rare consequences.
Convenience
- Both treatments are invasive surgeries that necessitate extensive planning and post-operative care.
- Finding a board-certified surgeon with substantial experience in each treatment is critical.
Cost
- A panniculectomy is more expensive than a stomach tuck, although medical insurance generally covers treatment. The price tag can range from $8,000 to $15,000, without including anesthesia and other fees.
- The cost of a belly tuck is less, but it is not covered by insurance. The average cost of this elective treatment is $6,200.
Efficacy
- Tummy tucks and panniculectomies have equal success rates. The objective is to decrease weight prior to surgery, as weight maintenance is critical to the success of your treatment.
Can you get lipo if you have diastasis recti?
The abdominis rectus muscles are divided into two portions, right and left, that are normally separated by a finger’s breadth.
The abdominal muscles are pushed out by the expanding uterus during pregnancy, and this force of expansion, combined with hormonal changes, causes the two sides to split, resulting in a pooched abdominal appearance.
Due to the power of the pushing, women may develop diastasis recti during birth.
Unfortunately, there is no foolproof method of preventing diastasis recti. Women with firmer, stronger stomach muscles before pregnancy are thought to have a lower risk; nonetheless, even those with “six-pack abs” can have issues with this illness.
How Does Tummy Tuck Surgery Correct Diastasis Recti?
Tummy tuck surgery simulates an internal corset by removing extra skin and fat and tightening loose or divided abdominal muscles (diastasis recti).
Your plastic surgeon will fix this issue by rebuilding and repositioning the abdominal muscles, similar to a “internal girdle,” during this treatment.
The only option to fix moderate to severe diastasis recti is to have a tummy tuck.
Can Liposuction Correct Diastasis Recti?
Despite the fact that diastasis recti appears to be excess fat, liposuction will not help.
Liposuction is a procedure that eliminates extra fatty deposits from the abdomen but does not tighten the skin or abdominal muscles.
Liposuction can be used in conjunction with a stomach tuck to improve the belt line by removing fat from the hips.
When is diastasis recti severe?
You can detect if you have diastasis recti by looking at your abdomen: Lie down on your back, legs bent, and feet flat on the floor. Place your hand palm down, fingers pointing toward your toes, over your belly button. Gently press your fingers into your navel area, then elevate your head slowly, bringing your chin to your chest. The rectus abdominis contracts as a result of this.
A diastasis occurs when the muscles contract and there is a gap of at least two finger widths between them. A severe gap is defined as four or five fingers wide. Because the spacing may be wider in different spots, repeat the procedure below and above your belly button.
Does CT scan show diastasis recti?
CT scans or ultrasonography can be used to investigate diastasis recti. For measuring the separation of the rectus muscles, both approaches are reliable. CT scans have the advantage of employing bone ridges for measuring and can also reveal other hernias that are present.
Does insurance cover hernia surgery?
Most insurance companies will fund hernia surgery if it is judged medically necessary. In order for your insurers or Medicare to cover your surgery or Medicare, you may need to give documentation of pain or discomfort. The following are some of the signs and symptoms: Bulging in the area of a hernia.