1. Examination in surgical office
Swiss Diamond Repair
The treatment for your rectus diastasis typically begins with an initial appointment at the ZweiChirurgen practice in Basel, Zurich, or Liestal. First, we assess your medical history thoroughly and perform a physical examination. Depending on your personal situation, additional tests such as ultrasound or CT scans may be necessary to better visualize the abdominal wall. These exams are crucial for planning the appropriate surgical technique. Afterwards, we discuss the results during a second appointment and create a treatment plan together. If your skin or tissue condition (e.g., excess skin, skin folds, or fatty tissue) requires additional correction, you will be referred to PD Dr. Osinga. There, you will have an in-depth consultation about the possible procedures for abdominal tightening (abdominoplasty) and whether your skin is suitable for use as a transplant in the procedure.
2.The TOR-concept (Training – Operation – Rehabilitation)
Swiss Diamond Repair
An important part of the “Swiss Diamond Repair” program is the training and physiotherapy before and after the surgery. The so-called TOR-Concept (Training – Operation – Rehabilitation) has been shown to be very helpful and effective in Scandinavian studies and is therefore an essential part of our treatment.
Before surgery (Training)
In the first part of the TOR concept, the goal is to train with special exercises for the deep core muscles for at least three months. Training starts with light weights to develop good coordination and strength. Then, exercises to activate the pelvic floor and the entire abdominal musculature follow, ensuring that tension in the abdominal area is created without improper movements. As the training progresses, the intensity increases with heavier and more challenging exercises. In addition to core exercises, our patients are guided to also do individual strength training with heavier weights and, if possible, endurance training such as cycling, jogging, or rowing. After about three to four months of training, the surgery (Swiss Diamond Repair) follows.
After surgery (Rehabilitation in the first month)
Directly after surgery, the rehabilitation phase begins already in the hospital as you receive instructions from highly qualified physiotherapists. Initially, focus is laid on flexibility exercises, particularly for the chest in all directions of movement. The abdomen is spared during exercises at first. Deep breathing exercises are also performed to strengthen the diaphragm and improve coordination between the pelvic floor muscles and core muscles.
After discharge from the hospital, the focus in the first four weeks is on resuming normal daily activities. Heavy loads (over 5 kg) and excessive stretching of the abdominal wall should be avoided. During the day, one should sit as little as possible. Starting from the third or fourth day, short walks of about 10-15 minutes can be taken. Over time, these can gradually increase to several walks per day with longer durations. However, no walk should exceed 45 minutes.
From the second week, rehabilitation training consists of breathing exercises and light movement exercises. The focus is on regaining a straight, upright posture and reducing any fear of movement. Our patients should perform five rehabilitation exercises daily, with each exercise lasting about two minutes.
After surgery (Rehabilitation starting from the second month)
In weeks 5 to 8, patients begin to increase their mobility in daily life, but without lifting heavy loads or overstretching the abdominal wall. As the sick leave typically ends at this point, our patients gradually increase their daily activities based on their work situation. Daily walks without time restrictions are now introduced. Cardiovascular training generally begins between weeks 6 and 8 when the wounds have fully healed.
The additional individual rehabilitation training consists of:
1. Breathing exercises, that consciously activate the pelvic floor muscles, abdominal muscles, and diaphragm.
2. Core-exercises, to regain control and stability, with particular attention to creating light tension in the abdominal area, engaging the rectus abdominal muscles.
3. General flexibility exercises, to achieve a neutral, upright posture.
4. Transitioning to light activation of the core, incorporating arm and leg movements in different body positions.
After surgery (Rehabilitation starting from the third month)
In weeks 9 to 12, the patient should continue to increase daily activities. The rehabilitation training focuses on rebuilding stability and strength in the core, emphasizing tension in the entire abdominal area and activation of the rectus abdominal muscles. Additionally, flexibility exercises for a neutral, upright posture and more challenging core exercises are introduced.
This includes, for example:
1. Exercises with longer levers and improved rotational control.
2. Various body positions such as lying on the back, side-lying, on all fours, and standing upright.
3. Familiar exercises like head lifts while lying on the back with a focus on breathing, leg lifts with a straight leg, and simultaneously lifting the opposite arm and leg (birddog).
Our patients should perform two to three exercises daily, each for two minutes in various positions. In addition, more intense cardiovascular training is introduced, starting with 15-20 minutes at a comfortable intensity. Every 2-3 sessions, the duration should be extended, and after 4-5 sessions, the intensity can be increased. The training volume is adjusted according to individual performance levels. At the end of this period, a full-body muscle strengthening program is introduced, using loads up to 50-55% of the maximum capacity. All exercises are performed with natural breathing, without excessive pressure on the abdominal area, and starting with a neutral body posture. Additionally, flexibility exercises for the chest area, hips, and pelvis, as well as general movements in all directions, are included.
After surgery (Rehabilitation from the fourth month)
In weeks 13 to 16, the focus is on fully returning the patients to their normal activities. The supportive abdominal brace is no longer needed. The rehabilitation exercises continue to focus on activating the pelvic floor muscles with deep breathing and strengthening the abdominal, diaphragm, and trunk muscles to rebuild strength and endurance. The exercises become more challenging and include longer levers and improved rotational control in different body positions. The patients should perform two to three exercises daily, each for two minutes, in various positions. Cardiovascular training begins with activities such as indoor cycling, cross-training, and uphill walking. Interval training with increasing intensity and duration is introduced. At the end of this phase, a full-body muscle strengthening program begins with advanced loading (up to 60% of the maximum) and flexibility exercises in all directions. The goal is to return the patients to the exercises they did before surgery, without overstretching the abdominal wall. From the 16th week onwards, more intense activities such as CrossFit, heavy lifting, running, swimming, yoga, tennis, and paddle can be resumed. The overarching goal is for the patients to return to a similar or higher performance level than before the surgery, six months after the operation.
Surgery and hospital stay
Swiss Diamond Repair
After all pre-surgical evaluations are completed consultation, imaging, surgical briefing), and you have completed the first part of the physiotherapy (TOR concept), surgery will be carried out. All surgeries take place at the Merian Iselin Klinik in Basel. On the day of the surgery, you will typically arrive at the hospital in the morning. If a “Swiss Diamond Repair” is planned, PD Dr. Osinga will draw necessary markings on your skin with you standing in a upright position right before anaesthesia. This is essential to achieve a good cosmetic result. Then, your abdominal wall surgeon from ZweiChirurgen and PD Dr. Osinga will perform the surgery together. The procedure will be carried out under general anesthesia, meaning you will be fully asleep throughout surgery. This typically takes around 3 hours. Upon completion, an abdominal brace will be placed over the dressing, and you will be positioned in a slightly bent posture. After surgery, you will spend some time in the recovery room, where you will gradually wake up from the anesthesia. During this time, your circulatory functions will be monitored, and any pain will be managed. Then, you will be transferred to your room, where you will continue to receive care. During this time, you will remain in the bent position. On the day of the surgery, there will be a first visit in the afternoon by the ZweiChirurgen team and PD Dr. Osinga. After that, daily rounds will be held in the morning by the entire team. As part of the TOR concept, physiotherapy exercises will begin on the first day after surgery, either in bed or nearby with highly qualified physiotherapists. During your hospital stay, you will be allowed to move freely, get up, and eat and drink normally.
