Background <p>Diastasis recti and midline abdominal wall hernias are frequently encountered in patients undergoing abdominoplasty, particularly postpartum women and individuals following significant weight loss. The associated musculoaponeurotic laxity results in functional abdominal wall weakness and contour deformities.</p> Methods <p>We describe a surgical technique combining abdominoplasty with midline fascial repair, performed without mesh reinforcement. The procedure utilizes a modified overlapping Mayo double-suturing method to restore midline strength and contour. This paper presents a 39-year single-surgeon experience, including long-term clinical outcomes.</p> Results <p>A total of 120 patients underwent the procedure between 1986 and 2021. All were discharged within 72 hours postoperatively and followed up regularly (range: 1–39 years). There were no recurrences of diastasis of rectus abdominis muscles (DRAM) or hernia and no cases of vascular compromise. Seromas occurred in 20% of cases and were successfully managed conservatively with drainage.</p> Conclusion <p>This combined approach allows for durable anatomical and aesthetic correction of abdominal wall defects without prosthetic materials. The long-term outcomes presented support the safety, effectiveness, and reproducibility of the technique in appropriately selected patients.</p> Level of Evidence IV <p>This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors <a href="http://www.springer.com/00266">www.springer.com/00266</a>.</p>