Abdominoplasty & Hernia Repair for Stress Incontinence?

Question

I had Anterior & Posterior repair surgery 3 years ago for stress incontinence. My obgyn wants me to have it again along with a hysterectomy. I have a inguinal hernia and would like to know if I should have that repaired along with abdomnioplasty and if my insurance would cover it? Ive already meet my detuctible and need this some asap. Also should I go to a general surgeon or plastic surgeon? Thanks

J. Timothy Katzen, MD, FACS · Answer

Thank you for your question about combining abdominoplasty, hernia repair, and addressing stress incontinence. Based on your history of prior stress incontinence repair and an inguinal hernia, it is entirely possible to have both the hernia repair and abdominoplasty performed in the same surgical session. This approach could potentially improve both the structural integrity of your abdominal wall and your quality of life. Insurance coverage for a combined procedure often depends on the medical necessity of the hernia repair, so it’s essential to consult with your insurance provider and a board-certified plastic surgeon who is experienced in abdominal surgeries. If the procedures are deemed medically necessary, they may be partially covered, with you potentially paying the aesthetic portion out of pocket.

Regarding your choice of surgeon, a collaboration between a general surgeon for the hernia repair and a plastic surgeon for the abdominoplasty would be ideal. Many plastic surgeons (like myself) routinely perform hernia repairs during tummy tuck procedures, so a plastic surgeon experienced in combined surgeries may be able to handle both aspects. If a hysterectomy is also being considered, your ob-gyn and the other specialists can work together to coordinate your care, maximizing safety and minimizing the number of surgeries you undergo. It’s essential to thoroughly discuss all your concerns with your healthcare team to ensure the best outcomes for your health and cosmetic goals.

Sincerely,

Dr. Katzen

Gary M. Horndeski, MD · Answer

If you are going to have a hysterectomy then I do not recommend doing an abdominoplasty. It can lead to pulmonary embolism. However, you can have your hysterectomy, stress incontinence as well as your inguinal hernia repaired at the same time. Once this has been completed you can then have the abdominoplasty.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

John LoMonaco, MD, FACS · Answer

So....that might be a lot of surgery.

One important factor is of the hyst requires an open approach or if it can be done vaginally.  If you have large fibroids an open approach might be needed.

This would add a LOT to your recovery and downtime especially the first few days.  The other procedures can also add a lot of time to the overall procedure that is not always desirable.

An appropriate inpatient setting would really be needed for you to get the best care.

Christian Arroyo, MD · Answer

There are definitely benefits to having an abdominoplasty other than a smaller waist and tighter abdomen!! This is a great question!! Having an abdominoplasty will definitely help with stress incontinence because it will assist in strengthening your core muscles which in turn help to strengthen your entire abdominal area along with pelvic floor. It is unlikely that insurance will cover this procedure because it is considered a cosmetic procedure. You can however submit this for preauthorization to see if they will cover it. This procedure should be performed by a plastic surgery as it is a specialized procedure. Best of luck!

Camille Cash, MD · Answer

From the description of the procedures that you need and want it is better to have them addressed in two stages.  Complete the medically necessary procedure for the stress incontinence, hysterectomy, and inguinal hernia.  Once you are fully healed from those you can return for a tummy tuck.  Your Ob/Gyn and/or a general surgeon will handle the first procedures.  A board certified plastic surgeon is recommended for the second stage.

Connie Hiers, MD, FACS · Answer

It will be too risky to try and do all the surgeries at the same time. If your plastic surgeon agrees to repair the inguinal hernia and agrees to take insurance for doing this, then perhaps it could be done together. However, some insurance companies will not cover a hernia repair if done at the same time as a cosmetic procedure. If your plastic surgery will not repair the hernia, a general surgeon could go first and repair the hernia and then the plastic surgeon could do the tummy tuck. Otherwise, consider a general surgeon repairing the hernia and your ob/gyn doing the stress incontinence repair with the hysterectomy. Once healed, then have the tummy tuck.  The gyn surgery will and the hernia can potentially stir up bacteria.  Check with your insurance first to see what could be combined together.

Mats Hagstrom, MD (license on probation) · Answer

You don’t really post any particular plastic surgery questions.
The tummy tuck is not going to be covered by medical insurance. It is a cosmetic procedure.
I suggest avoiding having anybody other than a board-certified plastic surgeon Do a tummy tuck for you. Inguinal hernias are best done by general surgeons.
Considered consulting with a female urologist for complex incontinence repair.
Best,
Mats Hagstrom, MD

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