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

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.

Hi, thank you for sharing your question. The answer will depend on the size of the hernia. Small hernias can be repaired without compromising the vascular supply, however, larger hernias may require a more complex procedure. One option is the umbilical float but given that you feel your belly button is already too low, you may choose another option. A formal evaluation would be needed to determine your choices.

Hello Thrifty96679 in Marlton,

Thank you for your question regarding the best surgical approach for your diastasis recti and umbilical hernia. After reviewing your history and the photos you provided, it's clear that you are facing a complex issue that needs a thoughtful surgical plan.

Given your description, the umbilical float technique indeed seems to be a viable option for you. This method is particularly advantageous in cases where there is not an excess of skin and the belly button already sits low, as it allows for the correction of the hernia and diastasis without needing to relocate the belly button significantly. The umbilical float technique will enable the belly button to be repositioned slightly without detaching it completely, which helps maintain adequate blood supply and reduces the risk of complications.

Moreover, the use of mesh, approximately 8” x 10” in size, is recommended to reinforce the weakened abdominal wall. This approach not only supports the area but also reduces the likelihood of recurrence. The mesh acts as a scaffold, allowing your body's tissue to integrate with it over time, which can provide a durable solution to your abdominal wall weakness.

It's important to consider the potential for a small vertical scar from where the original belly button was repositioned, as this is sometimes unavoidable with the umbilical float technique. However, this is often a good trade-off for the comprehensive correction of both the hernia and the diastasis recti without compromising the function and aesthetic appearance of your abdomen.

As always, it's crucial to discuss all these details with your plastic surgeon, ensuring that you understand all the implications of the chosen surgical technique and how it fits into your specific anatomical and aesthetic needs.

Thank you for trusting in this process, and I wish you the best in your upcoming surgery and recovery.

Sincerely,

J. Timothy Katzen, MD, FASMBS, FICS
Plastic Surgeon

Dear Thrifty96679,
asmall umbilical hernia is something that can be fixed during a full tummy tuck procedure. I routinely repair these during my tummy tuck procedures. Not everyone feels comfortably repairing these however. A mini-tummy tuck does not reset the umbilicus which it looks like is what you needed to get the results you were looking for. If you are considering surgery, I would suggest you consult a board-certified plastic surgeon. Only after a thorough examination, you will get more information and recommendations.
Daniel Barrett, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

An umbilical float abdominoplasty is an option for patients that do not have significant excess skin. This prevents an incision from being placed around the umbilicus. But as you have mentioned, it lowers the umbilicus, sometimes too much. An umbilical hernia can be repaired with a full abdominoplasty. With this procedure, as much skin as needed can be removed. You may have a small vertical scar from you umbilicus in the lower abdomen. I would have a few consultations as a thorough exam can help guide you to the best options.

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

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

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.

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.

If you want your insurance to cover the hernia repair, have this done first using the scope to assist in the repair. Six months later, have the tummy tuck and you should do well. However, I have repaired small hernias at the time of the tummy tuck with usually no problems. There is some extra risk to the umbilicus when this is done. I am not a fan of the floating umbilicus because it is often out of place.