Will a Tummy Tuck Help with Hernia Repair?

Question

I am in need of 4th hernia surgery. I am meshed from breast bone to navel, then navel down. Can a tummy tuck be performed along with the hernia repair?
	
	I am overweight by approx. 50 lbs and have a lot of bulk below and to the left of the navel where the hernia is. I've been told the mesh is intact, but the muscle wall is torn again.

	My surgeon is sending me to a plastic surgeon for his opinion on whether a tummy tuck will help this situation or if he has any other suggestions. I am in a lot of pain most of the time in the hernia area. I am wearing a binder to help hold my bowel in and have had to push the bowel back in on numerous occasions as it wouldn't reduce on its own. Can a tummy tuck be done to reduce the pressure on the hernia and the hernia repaired with a chance of not tearing again?

	The surgeon gave me a 50% or less chance of it staying fixed, but this was before the plastic surgeon option was considered. I'm wondering if the insurance company will help pay for the tummy tuck since this will be the 4th hernia surgery they'll be paying for. I'm at my wits end and so very tired of being in pain. I'm unable to do much that is very physical without being in a lot of pain for a week afterwards. I love to garden, but I really pay for it these days in pain. Thanks in advance for any information. In Pain In OK!

Nick Slenkovich, MD · Answer

From you description of multiple recurrent abdominal hernias and being 50 lbs overweight, weight loss is probably the surest way to increase your chances of success with another hernia repair operation.
As previously mentioned, complex hernia repairs do benefit from collaboration with a plastic surgeon that has expertise in these procedures. In your case, an abdominal wall reconstructive procedure may be needed. Complex procedures such as "Component Separation" and reconstruction of the abdominal wall are performed by a subset of plastic surgeons.
A significant focus of my practice is performing plastic surgery on patients that have lost "massive" amounts of weight--often 70 to 100 lbs or more. Some of these patients have had recurrent and multiple hernias, and in no case have I had to resort to using mesh or a complex abdominal wall reconstructive procedure.
For a significantly overweight patient, weight loss leads to loss of intra-abdominal fat, which "loosens" the abdominal wall. The net result is that hernia repair becomes much simpler after weight loss, and therefore the anticipated rate of hernia recurrence decreases significantly as well.
Here is an example of a patient that had multiple large and recurrent abdominal hernias. She is a 52 yo that previously was 100 lbs overweight. She underwent a gastric bypass procedure and presented a normal weight, but with significant excess skin and laxity of her tissus. All of her hernia were repaired easily without mesh, and we were simultaneously able to get significant body contour improvements by performing a lower body lift.

J. Timothy Katzen, MD, FACS · Answer

Thank you for your question regarding if a tummy tuck will help with your hernia repair. It sounds like you're dealing with a lot, and I'm sorry to hear about your pain. It's certainly possible to combine a tummy tuck with hernia repair, especially if you have excess skin and tissue in the area. However, it's important to consult with both your general surgeon and a plastic surgeon to determine the best course of action for your specific situation.

Losing weight before surgery is generally recommended to optimize results and reduce the risk of complications. That said, if you're unable to lose additional weight and your surgeons believe that a tummy tuck could help alleviate some of the pressure on the hernia, it may be worth considering.

As for insurance coverage, it's best to check with your provider to see what they will cover. Insurance companies vary in their policies regarding coverage for cosmetic procedures like tummy tucks, especially when combined with other surgeries.

Ultimately, your healthcare team will work with you to develop a treatment plan that addresses your concerns and helps improve your quality of life. Stay strong, and I hope you find relief from your pain soon.

Sincerely,
Dr. Katzen

Otto Joseph Placik, MD · Answer

Without weight loss it is likely that your 4th surgery will undoubtedly result in a 5th surgery. I agree that you would, at this point most likely benefit from a "separation of parts" repair of your anterior abdominal wall. Understand that this is pulling out all the stops to repair your hernia and could result in a final cure to your problem but why would you jeopardize this by remaining at your current weight which is the most probable cause of your previous herniorrahphy failures?

Brent Moelleken, MD · Answer

It is likely that a tummy tuck would be very helpful for your problem.
However, the complexity and risk of your surgery is relatively high.  It will likely be necessary to go into the abdomen, which has a unique set of risks.
Complex hernia surgeries are best accomplished with a combination of a general surgeon and a plastic surgeon, each using their unique expertise.
Also, surgery such as this should generally be performed in a hospital setting.
It is also best to be at an ideal weight, if at all possible, before proceeding.

Steven Wallach, MD · Answer

Certainly a tummy tuck and hernia repair can be done at the same time. If you have a complicated hernia( which it sounds like you do), you may need a components separation to release the abdominal musculature laterally to reduce the tension on the repair.

Pat Pazmino, MD, FACS · Answer

Tummy tucks are a very popular and effective way to contour the abdomen. This surgery is routinely performed in conjunction with other surgeries such as a hernia repair or gynecologic procedures. If the size of the hernia is small or if the hernia does not require mesh repair, your plastic surgeon may choose to repair the hernia himself. Your best bet is to work at a board-certified plastic surgeon who has a great deal of experience in abdominoplasty, body contouring, and correction of defects such as hernias.

	To learn more about tummy tucks, see photos, and help you decide which one is best for you, please visit us at the link below:

Peter E. Johnson, MD · Answer

Abdominoplasty, or tummy tuck, gives exposure to the entire abdomen and is an excellent approach to hernia repair. Often hernia repair is a planned part of the abdominoplasty procedure and it is typical to repair an umbilical hernia from pregnancy,  a small ventral, or incisional hernia from gastric bypass procedures, as the abdominplasty is performed.Hernias are also encountered "incidentally" or in other words are discovered at the time of the abdminoplasty and are repaired along with repair of the muscle layer or diastasis as is frequently done in tummy tuck procedures.  If diagnosed before abdominoplasty, insurance coverage may be available for the hernia portion of the procedure. Incidental hernias encountered will usually be denied coverage after the fact.Keep in mind that hernia repairs and tummy tuck are separate procedures with distinct goals. Though there are times that the procedures will compliment one another, there are times that they may not. With your history of many failed hernia repairs, you are best to take a first things first approach and seek an expert in restoring the strength in the abdomen through a sound and successful hernia repair, and leave abdominplasty for another day.Best of luck.

Lisa Cassileth, MD, FACS · Answer

Dear in Pain,
It sounds like the best thing for you is a great hernia repair. In your case, if your hernia is in the vertical midline, then your anterior rectus sheath should be separated from your rectus muscle on both sides and the mesh can be re-placed from the lateral rectus sheath on one side to the lateral rectus sheath on the other side.
If the mesh is placed correctly (on tension), then the medial rectus sheath of the left and right side will sit right next to each other after the mesh placement. Then, the rectus sheath can be closed primarily. This is part of a hernia repair called "component separation," which many general surgeons do know how to perform and a few plastic surgeons.
My description is a little technical, sorry, I usually draw this part for patients. You can have a tummy tuck at the same time, but it won't lower your chance of recurrence.
Finally, you will be better off losing the weight first, as I am sure you know!
Good luck!

William B. Rosenblatt, MD · Answer

The first thing you need to do is lose those extra 50 pounds. You are doing yourself a disservice by being overweight. 
Once you have lost the weight, then a combined approach by a plastic surgeon and a general surgeon might help you.

Robin T.W. Yuan, MD · Answer

I think it is imperative to determine why you are in need of a fourth hernia repair. If you had reputable surgeons operate on you, you need to determine what would be different this next time around that would make success more likely. Your weight, especially if much of it is intra-abdominal, may be the culprit and therefore until your solve this part of the puzzle, your hernia will continue to present problems.
If it is determined that something different can be proposed to solve the hernia issue, and this is part of the value of having a plastic surgeon involved, then you can look at the value of doing a simultaneous abdominoplasty. Now you have to distinguish between one type of abdominoplasty and another. There has to be a reason to do more surgery. If you do not solve the hernia problem, which is a musculo-fascial problem, adding a skin-fat abdominoplasty may simply add risk and not any long-term benefits. Your situation is more of a reconstructive dilemma and that takes precedence over the cosmetic aspects of the abdominoplasty. An abdominoplasty that tightens the skin will not prevent a recurrence of your hernia.

Will a Tummy Tuck Help with Hernia Repair?

Answers (12)