Eliminating a bulging belly is an essential part of a tummy tuck. The bulging of the belly has been termed diastasis recti and describes the stretching out of both the abdominal muscles as well as the ligaments that connect the muscles together.
The major muscle group of the abdomen includes the rectus muscles that are aligned in two vertical columns that are connected by a vertical ligament called the linea alba.
Stretching out of the linea alba will result in a bulging belly that can be eliminated with a tummy tuck. Stretching out of the linea alba is directly related to an increase in intra-abdominal volumes that result in increased pressure against the abdominal wall.
In addition to stretching out of the linea alba, the rectus muscles themselves can also stretch out and literally thin out. The bulging of the belly involving both the rectus muscles and linea alba stretching comprise diastasis recti.
Eliminating a bulging belly with a tummy tuck involves directly tightening the linea alba centrally, thereby bringing the two vertical columns of rectus muscles together. The tightening of the linea alba is achieved with a running stitching technique that extends from the rib cage down to the pubic region.
This stitching technique is performed much like a corset. Since the belly button needs to be kept uncovered for later reinsetting, the corset must be seen as two independent runs one above and another below the belly button.
Independent tightening of the bulging belly allows for differential tightening of the abdominal wall above and below the belly button. This is critical in female patients who should be tightened more aggressively above the belly button than below the belly button to create a gentle concave upper abdominal contour and a gentle convex lower abdominal contour.
Eliminating a bulging belly with a tummy tuck is required when patients demonstrate an abdominal contour that looks like they are bloated. Patients can be demonstrated the improvement that will be achieved with a diastasis recti repair by having them stick out and then sucking in their bellies.
Most women inherently suck in their abs to make their silhouette look better, but after their diastasis recti repair they will always look sucked in even when they are relaxed.
Please see this 72-year-old female status post complex ventral hernia repair, umbilical insetting, and trimming of redundant abdominal skin.