Panniculectomy/tummy tuck with abdominal hernia history - what can I do?

Question

I’ve had multiple incisional hernia repairs in my lifetime following surgical procedures (stomach stapling, gall bladder removal, gastric bypass all done with a full opening of my belly, and about 3 hernia repairs to the incisional wall.) I have a significant pannus now and am thinking about having it removed but am unsure as to how my previous surgical history will impact the choice of surgery and if this can even be attempted. Suggestions?

Zoran Potparic, MD · Answer

It should be a priority to improve strenght of your abdominal wall. A very complex surgery, involving multiple abdominal muscles and mash (component separation) may be needed to improve strenght of your abdomen; panniculectomy may be a part of that surgey. In person consultation with a board certified plastic surgeon with expertise in this technique, is recommended. Goof luck.

Randal Haworth, MD, FACS · Answer

The presence of previous incisional hernias and surgical repairs can significantly impact the surgical options and techniques for panniculectomy. The surgeon will evaluate factors such as the location and extent of the hernias, the integrity of the abdominal wall, the presence of scar tissue, and the overall condition of the tissues in the area.

In some cases, it may be necessary to perform a comprehensive abdominal wall reconstruction rather than a straightforward panniculectomy. This procedure involves addressing the weakened abdominal wall and repairing any hernias or areas of weakness before proceeding with the panniculectomy. Additional techniques such as mesh reinforcement or component separation may be utilized to achieve optimal outcomes and reduce the risk of recurrent hernias.

During a consultation with a surgeon, make sure to provide them with a detailed medical history, including your previous surgical procedures, hernia repairs, and any relevant imaging or surgical reports. They will conduct a thorough examination and may recommend additional tests or imaging studies to assess the abdominal wall integrity accurately.

I hope this helps,
best of luck !

J. Timothy Katzen, MD, FACS · Answer

Dear ElaineBell,

Your history of multiple incisional hernia repairs, coupled with your significant weight loss surgeries, certainly adds complexity to your surgical profile. However, it's encouraging to know that a panniculectomy or tummy tuck can still be successfully performed in patients with similar surgical histories.

The incision for a tummy tuck or panniculectomy is typically made in a way that allows for the removal of excess skin and fat while also providing access to the underlying abdominal structures. This approach means that during your procedure, your plastic surgeon can carefully examine the abdominal wall for any additional hernias or weaknesses that might not be immediately apparent.

If your plastic surgeon is also experienced in general surgery—or if there is a collaborative approach with a general surgeon—they can address any hernias discovered during the procedure. This dual expertise is particularly beneficial because it allows for the concurrent repair of hernias while also enhancing the abdominal contour. The comprehensive approach ensures not just the aesthetic improvement of the abdomen but also strengthens and repairs the underlying structural issues, offering a more durable result and potentially reducing the risk of future hernias.

Here are a few suggestions as you consider moving forward:

Detailed Consultation: It’s crucial to have a thorough consultation with a board-certified plastic surgeon, ideally one with extensive experience in post-weight loss body contouring and hernia repairs. Sharing your full surgical history, concerns, and aesthetic goals will help tailor the approach to your needs.

Medical Clearance and Evaluations: Given your history, pre-operative evaluations and possibly imaging studies might be recommended to assess the current state of your abdominal wall and plan the surgery effectively.

Consider a Multidisciplinary Team: If your plastic surgeon suggests, a team approach involving a general surgeon might be recommended, especially if there’s a significant likelihood of encountering complex hernias that require specialized repair techniques.

Post-Operative Care Plan: Discuss the post-operative care plan in detail, including recovery expectations, activity restrictions, and follow-up schedules to monitor your healing and the integrity of the hernia repair.

Your proactive approach in seeking information and considering surgery to improve your quality of life and body image is commendable. With the right surgical plan and team, achieving a successful outcome that addresses both the aesthetic and functional aspects of your abdomen is entirely possible.

Sincerely,

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

Gary M. Horndeski, MD · Answer

The fact that you have dealt with previous hernias is not relevant. At the time of surgery, the surgeon can raise up the pannus and if he feels necessary, he can reinforce the entire abdominal wall with mesh and cut out the pannus at the same time.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Camille Cash, MD · Answer

I encourage you to begin by visiting with a board certified plastic surgeon near you for a consultation.  Here you will learn about the tummy tuck and be examined.  Your surgeon will also review your medical history to determine if you are a candidate for the procedure.

Panniculectomy/tummy tuck with abdominal hernia history - what can I do?

Answers (5)

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