35f 5ft 2inch 114lbs. I have diastasis recti 5cm and umbilical hernia. What's the best surgical approach? (photos)

Question

35f 5ft 2inch 114lbs. I have diastasis recti 5cm and umbilical hernia. One consult said I could not have a true hernia repair with full abdominoplasty because it would compromise blood flow to umbilicus. He said that only umbilical float could facilitate both simultaneously. However my belly button already sits low but I don't have much excess skin. He did say there's would be some skin excess since he doesn't want to lower belly button too much. Is this a reasonable approach?

Earl Stephenson, Jr., MD, DDS, MBA · Answer

Thrifty 96679. 
Thank you for your excellent photo series. This is a common occurrence. Many plastic surgeons have a couple of approaches to deal with this. :

(1) Umbilical hernia repair by a  general surgeon as a separate procedure. 
Waiting six months and having a traditional full abdominoplasty with muscle plication. This ensures the circulation to the belly button can be maintained during your full abdominoplasty

(2)  Simultaneous umbilical hernia repair from an intraperitoneal (inside the belly) approach through a modest vertical incision in the belly button stalk. This can be done simultaneously with the general surgeon present or by the Plastic Surgeon alone . It is a bit risky, because it still can compromise the circulation to your bellybutton but definitely less risky to the belly button through a traditional umbilical hernia which completely divides the stalk at the base.

In my opinion, I don't believe an umbilical float is an approach that I would use for your situation because of what you mentioned your bellybutton is already low. Additionally, this doesn't avoid the hernia which needs repair.

It may be best to get a couple more consultations from Board Certified  Plastic Surgeon to get their recommendations on how they would approach your situation.

Best wishes,

ESJ,

#TruthAndTransformation

Jared Blau, MD · Answer

Thank you for the question. An umbilical hernia repair and diastasis recti correction can be performed as part of a tummy tuck, without floating the belly button. As you said, floating it will lower the position of the belly button and is not recommended.

Joel Patrick Maier, MD · Answer

You are a great candidate for an abdominoplasty with umbilical hernia
repair. This can be done simultaneously and, for many reasons advantageous.

Ramin Behmand, MD, FACS · Answer

You've asked an excellent question. The blood supply to the belly button comes from two sources: the surrounding skin of the abdomen and its stalk extending down into the abdomen. During a standalone umbilical hernia repair, typically performed by a general surgeon, an incision is made in the lower half of the belly button resembling a smiley face, and the stalk is cut to address the hernia with more ease. As a result, blood supply relies solely on the surrounding skin in the upper half of the belly button.

In contrast, when an umbilical hernia is repaired during a tummy tuck, the belly button is freed from the surrounding skin with a full-circle incision. Subsequently, its blood supply comes only from the stalk, which cannot be severed during the hernia repair. Most experienced plastic surgeons are proficient at separating the hernia sack from the belly button stalk, and repairing the hernia defect with sutures, while ensuring the blood supply remains intact. Then, repair of the rectus diastasis provides yet another layer of strong closure over the hernia repair. Essentially, this strong repair makes the need for mesh to reinforce the hernia repair unnecessary.

Despite your small size, you seem to have plenty of excess skin for a traditional tummy tuck. It would be best to avoid a floating tummy tuck because it will throw off your proportions. I recommend for you to have several consultations until you meet the surgeon who has the experience to comfortably move forward with this approach. Additionally, a drainless tummy tuck technique can be used, where the abdominal skin is tacked down with sutures. By doing so, you will avoid any possibility of the lower abdominal incision migrating up during healing due to tension from the upper abdominal skin.

Dr. B.

Gary M. Horndeski, MD · Answer

The technique I recommend is abdominoplasty with mesh reinforcement.  The mesh creates a more hourglass figure by compressing the abdominal wall resulting in early satiety and helps maintain a reduced weight.  The mesh goes from side to side and will correct the diastasis recti and umbilical hernia.

Best Wishes,

Gary Horndeski, M.D.

35f 5ft 2inch 114lbs. I have diastasis recti 5cm and umbilical hernia. What's the best surgical approach? (photos)

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Our mission is to create a world where every investment in modern beauty is Worth It.

35f 5ft 2inch 114lbs. I have diastasis recti 5cm and umbilical hernia. What's the best surgical approach? (photos)

Answers (9)

Answer: Hernia and Abdominoplasty: Common Occurence

Answer: Hernia and Abdominoplasty: Common Occurence

Answer: Absolutely possible

Answer: Absolutely possible

Answer: Umbo hernia

Answer: Umbo hernia

Recommended reading

Everything you need to know about Tummy Tuck

Answer: Standard Tummy Tuck with Umbilical Hernia Repair

Answer: Standard Tummy Tuck with Umbilical Hernia Repair

Answer: Abdminoplasty with mesh reinforcement

Answer: Abdminoplasty with mesh reinforcement

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Our mission is to create a world where every investment in modern beauty is Worth It.