Abdominoplasty: Dr Dona Publishes His New Technique for Repairing Abdominal Wall Muscles
Thu 1st Oct 2026
An Abdominoplasty addresses changes to the abdomen, including removing excess skin and tissue and, when needed, tightening the abdominal wall. Traditionally, this has involved addressing rectus abdominis separation (diastasis recti). However, Plastic and Reconstructive Surgeon Dr Eddy Dona has observed that, in some patients, abdominal wall laxity extends beyond the area between the rectus muscles.
Dr Dona has recently published a new technique involving a triple vertical row plication of the abdominal wall that incorporates a specialised suture configuration into the repair. The technique is designed for patients with more extensive abdominal wall laxity.
What Is Abdominal Wall Plication?
Your abdominal wall contains a layer of strong connective tissue that supports the abdominal muscles and helps maintain the abdomen’s structure. When this tissue stretches, the rectus muscles can separate.
This is commonly called diastasis recti, or rectus divarication. It basically means that your six-pack muscles separate.
During a Tummy Tuck (Abdominoplasty), abdominal wall plication can bring the separated tissues closer together and secure them with sutures.
However, if abdominal wall laxity isn’t limited to the central area, repairing only the central separation will not address all the laxity identified during surgery.
What Is the Importance of Repairing the Abdominal Wall Muscles?
The potential aesthetic outcome of repairing and tightening the abdominal wall is obvious – a tighter waistline. However, the potential functional outcomes of repairing the muscles are also extremely important. Impaired abdominal wall muscles can potentially contribute to the following problems:
- Reduced core strength
- Overarching of the lumbar spine
- Lower back pain
- Stress incontinence
- Altered posture and gait
- Gastrointestinal dysfunction
Given these potential issues, a surgeon should do everything possible to repair the abdominal wall muscles as fully as possible during an Abdominoplasty.
A Three-Row Approach to Abdominal Wall Repair
Dr Dona’s article describes a technique that uses three vertical rows of plication to address both central and lateral abdominal wall laxity.
The repair consists of:
- A central row to address rectus divarication
- A lateral row on each side to address lateral abdominal wall laxity – the oblique muscles
The two lateral rows use Dr Dona’s interlocking horizontal mattress (IHM) suture technique, while the central row uses a conventional two-layer plication.
This approach is not intended for every patient undergoing an Abdominoplasty, though. It is used only when assessment during surgery shows that abdominal wall laxity extends beyond the central rectus area.
If laxity is limited to diastasis recti, Dr Dona uses his conventional midline plication technique instead.
Why Does the Suture Technique Matter?
The sutures are what hold the repaired tissues together while the abdominal wall heals. Dr Dona’s article focuses particularly on the way the sutures are constructed, rather than simply where the abdominal wall is repaired.
Dr Dona originally developed and published the IHM suture construct for tendon repair in 2003. At the time, his research found that this technique had superior biomechanical properties compared with other commonly used techniques. Since his original publication, the IHM suture technique has been widely recognised as the technique of choice in flexor tendon repairs. It has also been adopted in other areas of the body due to its biomechanical properties.
The current article describes its application to abdominal wall repair for the first time.
In the triple vertical plication technique, the IHM construct is used in the two lateral rows. The central repair is performed separately using a conventional two-layer plication.
In addition to the triple vertical plication to maximise muscle repair and waistline tightening, Dr Dona also incorporates a biomechanically proven suture construct to optimise both functional and aesthetic outcomes.
What Did the Article Show?
Dr Dona retrospectively reviewed 10 patients who underwent Abdominoplasty using this technique between July and October 2025.
Eight patients underwent Standard Abdominoplasty and two underwent Circumferential (360) Abdominoplasty.
All 10 patients were followed for six months. In addition to the aesthetic outcomes demonstrated, the study reported an unremarkable postoperative course for all patients, with no complications attributed to the abdominal wall repair.
These findings demonstrate that the technique can be applied successfully in an appropriately chosen patient cohort.
Why Is This Article Important?
Abdominal wall plication has been used and refined for more than a century, with much of the development focusing on where and how much of the abdominal wall to repair.
Dr Dona’s article focuses on another part of the repair: how the sutures themselves are constructed.
This area has received comparatively little scientific investigation in abdominal wall surgery.
The article therefore provides a clinical description of a different approach to abdominal wall plication. Dr Dona also encourages surgeons to undertake further biomechanical and comparative research into the biomechanics of abdominal wall repair.
For patients, the important point is that abdominal wall repair can be tailored to the pattern of laxity present. Not every patient will require the same type or extent of plication.
Abdominal Wall Repair as Part of Your Tummy Tuck (Abdominoplasty)
An Abdominoplasty is tailored to your anatomy, including the amount and location of excess skin, the underlying abdominal wall and the extent of any muscle or fascial laxity.
If you require abdominal wall repair, the appropriate technique depends on your anatomy and Dr Dona’s assessment.
Dr Dona’s recently published article describes one approach to addressing abdominal wall laxity that extends beyond isolated rectus diastasis.
Read the Full Article
Dr Eddy Dona’s article, “Three-row vertical abdominal wall plication using interlocking horizontal mattress sutures in abdominoplasty,” was published in the European Journal of Plastic Surgery in September 2026.
The full open-access research paper is available from Springer Nature.
