From the Pen of Dr Taylor

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17 Sep 2018 | CAPS Clinic

New Hope for a Pain-free Post-Partum Life

By Dr Alastair Taylor (Bachelor of Medicine, Bachelor of Surgery | Fellow of the Royal Australasian College of Surgeons | MED0001401767)

All surgical procedures carry risks. Results vary and specific outcomes are not guaranteed. To learn more about the risks of aesthetic surgery visit

2022 Update

A Pain Free Post-Partum Life is Possible

In 2016 Medicare restricted the abdominoplasty item number to weight loss patients only. This disenfranchised a large population of Australian women suffering back pain and urinary incontinence after pregnancy. The exciting news is this decision has been reversed. This has been a triumph of evidence based medicine and a great example of how persistence can overcome.

The paper I published in PRS in 2018 was important and since then, there have been other publications reaching the same conclusion, that abdominoplasty works. The weight of this evidence has been enough for Medicare to change its mind and award an item number.

There are some conditions however. The item number is for relief of back pain and incontinence that has not responded to therapy. There must be a history of failed physiotherapy, osteopathy or other allied health. The youngest child must be one year old. There needs to be a demonstrated rectus diastasis of at least 3.5cm on ultrasound, reported from a radiology practice.

These are not difficult conditions to fulfil. I have seen so many deserving women over the last 6 years denied an operation because they can’t afford to pay the uninsured rate. They are the 50kg women with terrible back pain. They are not going to be able to lose 5 BMI points, they don’t have hanging aprons or fungal infections. The item number means they can use their health insurance to help pay for the operation which roughly cuts the cost in half. Gold level health insurance is required.

The item number is active as of July 2022. Abdominoplasty is back and it’s time to fix the back pain, the slumped posture, the incontinence and the poor core that is making everything you do more difficult.



The Functional Benefits of Abdominoplasty

I have always enjoyed performing abdominoplasties, gradually developing my technique since 1998.

As a plastic surgeon, I am always looking for changes in form and function, but I didn’t realise just how much function was restored until I was visited in 2011 by David Berg, from MoveHappy Physiotherapy.

He told me my post-op abdominoplasty patients were being discharged from his practice as their chronic low back pain and pelvic instability was cured by an abdominoplasty.

Indeed, my patients had been saying they were better, but I hadn’t asked specific questions about back pain and incontinence. So I started asking and the results were interesting.

Over half the patients I saw for abdominoplasty had suffered chronic lower back pain since pregnancy and this was often combined with stress incontinence. 

The back pain had a significant impact on life, it made mobility and exercise difficult. Even sitting in a chair or in the car for 2 hours was painful. The incontinence occurred on laughing and sneezing.

Six months after under-going an abdominoplasty, my patients were reporting all symptoms were pretty much gone. My female patients were telling me they felt stronger and healthier.

This was an important message but there was little evidence in the literature apart from case reports. If I was going to do a study, I would need numbers. Through the Australasian Society of Plastic Surgeons I recruited 8 other plastic surgeons to the study.

The Study

The premise was simple. All patients presenting for abdominoplasty were asked to fill in a validated research questionnaire on back pain and another on incontinence. The questionnaire was completed at three pivotal points; before the operation and then post-operatively at 6 weeks and 6 months afterwards.

By including all patients undergoing abdominoplasty it would give an indication as to the number of women suffering with functional symptoms. There was no modification of the operation to accommodate functional symptoms, it was a study of normal surgical practice.

The study ran from September 2014 to March 2016. There were 214 patients enrolled, with an average age of 42, average birth rate of 2.5 children, and an average BMI 26.3. Pre-surgery, 9% of patients had no back pain and 27.5% had no incontinence.

The Results

The post-operative results were remarkable.

  • The average back pain disability score pre-surgery was 21.8%, which translates to a moderate disability.
  • By 6 months post-operatively, the average disability score was 3.2%, an 85% improvement.
  • Pre-surgery the incontinence score was 6, post-surgery it was 1.6, a 73% improvement.

These results are statistically and clinically significant.

They show conclusively, abdominoplasty is a functional reconstructive operation for the woman suffering post pregnancy chronic back pain and incontinence.

Medicare, in 2016, restricted the abdominoplasty item number to only weight loss patients, citing a lack of evidence the operation was anything other than aesthetic. 

This large, prospective, multicentre Australian study is the evidence.

Medicare should now reconsider loosening the restriction to include women with chronic back pain and incontinence so they can reduce the large out of pocket expenses and claim this procedure on their health insurance.

Read more about the study on functional abdominoplasty here.

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