Rectus muscle diastasis in males: primary indication for endoscopically assisted abdominoplasty

Endoscopic techniques through umbilical and mons pubis ports have provided a method to plicate rectus muscle diastasis without skin resection. Limited or no skin excision is performed. Major series have included only women. The criteria for patient selection for endoscopic abdominoplasty include a protuberant abdomen caused by rectus muscle diastasis with minimal actual or potential skin laxity. There should not be significant intra-abdominal obesity. Extra-abdominal familial fat deposits may be part of the abdominal aesthetic deformity. In most women, rectus muscle diastasis because of pregnancy, obesity, or aging is associated with actual or potential skin laxity of the abdomen and lateral trunk. Endoscopic abdominoplasty in these women would produce mediocre early results and poor aging potential for the future. There are a limited number of women who are reasonable candidates for the endoscopic approach. In contrast, rectus muscle diastasis without skin laxity is a common finding in men older than 30 to 40 years of age. There may be a history of weight fluctuations, weightlifting, or full-excursion sit-up exercises, which may lead to progressive separation of the rectus muscles over time. Other etiologic factors include chronic or intermittent abdominal distension, advancing age, or familial weakness of the abdominal musculofascial tissues. Endoscopically assisted abdominoplasty was performed in four male patients with good to excellent results at 4 to 18 months. Minor complications occurred in half the patients but were successfully treated without re-operation. Men with prominent abdominal contours who are diet- and exercise-resistant should be examined both for familial fat deposits and for significant rectus muscle diastasis. Contouring of the male abdomen may be the primary indication for endoscopically assisted abdominoplasty.