Hybrid abdominoplasty for full diastasis and hernia repair
Patients with skin looseness above the belly button, or significant overall skin looseness, will typically require a full tummy tuck or some version of it.
Patients who only need a minimal amount of skin removed, and no fascia tightened typically benefit from a mini-tummy tuck. The mini tummy tuck is especially suited for patients who need a nice scar revision of their C-section scar overlap. Doing a mini tuck in a patient with fascial looseness all the way above and below the belly button will often result in a bulge in the upper abdomen from the untightened fascia. The procedure is simply not best for a patient that needs their fascia tightened.
For patients who have fascial looseness and miimal loose skin, we typically recommend the Hybrid tummy tuck (R), which is a full tightening of the fascia through a small lower abdominal incision. It is not necessary to make a hip to hip incision in such patients to obtain an excellent result. Special instruments are required for this procedure, including an endoscope and special retractors.
There are many in between versions of the main subtypes above, and every patient's procedure should be customized to their anatomy and needs.
A belly button hernia can be repaired with any of the above procedures through a separate incision around the belly button.
Plastic surgeons typically view hernias differently than general surgeons, and prefer to plicate them away rather than use sheets of mesh without a plication.
Mini tummy tuck can avoid the umbilical scar
For individuals who have a significant diastasis or separation of the sit-up muscles after pregnancy, and only a modest amount of skin laxity, the tummy tuck can be modified to avoid the scar around the belly button. This can as well reduce the tendency to over pull the abdominal skin and produce unnatural contours. The tummy tuck can be altered to leave the umbilicus on the skin as the tunnel in made to tighten the abdominal muscles. The exact location is marked and the umbilicus attached again in the same natural location on the repaired abdominal wall, and the minimal skin excess removed at a level near the standard c-section scar. This may work very well for the goals you have in mind. Your opinion of the result you want should count the most.
Best of luck!
Tummy tucks, twins, muscle issues
As everyone will tell you, there is no way to tell what is best for you without seeing you and examining you. That being said, let's consider your situation.
It is very common for women to underestimate the amount of skin that needs to be removed to get a good result from a tummy tuck. And, it is very unusual for a mother of twins to get by without a full tummy tuck. So, it's a pretty good bet that you will need this. This will allow the best repair of your rectus diastasis, repair of any hernia, and best contouring of the shape of your abdomen.
In this operation, you retain your normal belly button, but it is place higher on the abdominal wall as the skin is pulled down. The end result is that the belly button stays at about the same level in your abdomen. There will be a scar around it, but you will not have to have a new one reconstructed.
This may or may not be what your plastic surgeon is recommending to you. So, it may be good to have another chat with him/her. But, the tummy tuck is a great operation. And if you have had twins, this probably what you need..
Best of luck,
While I obviously have not examined you, I would find it very hard to believe that after twins, you need anything less than a full tummy tuck. Just lean forward and see if you don't have a handful of bunchy skin in the lower abdomen. If you do, anything less than a full TT will do. If you aren't sure, get another consultation or 2 with qualified plastic surgeons.
A full abdominoplasty will correct hernia and diastasis without any fake hole.
1) There is a lot of misunderstanding about abdominoplasties. Without examining you, I predict you need a "full" tummy tuck.
2) To repair the hernia and the diastasis, the surgeon needs ACCESS. So the skin has to be lifted. Your own belly button is left in its original position.
3) After the repairs, the abdominal skin is pulled down around the belly button, and the excess skin is removed. After twins, you almost certainly have more excess skin than you think, but, of course, I have not examined you.
4) Finally, a little incision is made, and your original belly button is brought out.
5) Most women are very happy with this approach.
Mini versus full tummy tuck (abdominoplasty)
Certainly this can be performed if you make your request clear to your surgeon. To some degree you are discussing the difference between a full and a mini-tummy tuck or marriage abdominoplasty.
You can do what you are suggesting but it depends on multiple factors. First, the surgeon needs to be able to get to the areas that need to be corrected, i.e. the hernia and the diastasis recti. Second,the surgeon will need to have the room to do the repairs. Third, when the repairs are done the actual skin excess will be much greater than what you see now.
Under these circumstances the surgeon may need to detach the belly button from the surrounding skin to accomplich the task. Alternatively he may try a "floating belly button" or just do a mini tummy tuck.
There are several options and you and your surgeon should explore the positives and negatives of each.
Sounds like you need another opinion
If you had a child, you have plenty of skin to remove. Our surgery gets rid of the extra skin and moves the belly button -- because all of the skin below it is removed. You have more skin than you think.
Diastasis recti repair with minimally extra skin
I think and him misunderstood one another. There are a LOT of options out there. But they may not apply to you.
Not all Tummy Tucks are alike. The procedure BEST suited for you would depend on:
- extent of muscle separation (diastasis - which is NOT a hernia)
- extent of skin laxity (it MAY look like one inch BUT it may be much more).
If you just had a little pooch of extra tummy skin with NO muscle separation - then all you would need is a "mini-" Tummy tuck done as you described - remove the looseness through a just longer than C section scar. (This could also be used if the muscle separation was limited to just under the belly button).
BUT - is your muscle separation extended, as most women does after pregnancy, ABOVE the umbilicus, the umbilicus would need to be separated to allow the identification of the separation and bringing it together - to flatten your tummy. In so doing, the overlying skin is released revealing a LOT more loose skin than you thought - this is the reason for doing a "full" abdominoplasty.
It is VERY RARE for a woman to present with little to no skin looseness AND a long muscle separation. Under such circumstances one would have to consider repair of the separation with no umbilical re-creation after the removal of the minimal amount of skin at the bottom.