Muscle repair and hernia repair both added charges with DIEP flap surgery?

Typically if a surgeon sees a hernia at the time of a DIEP flap, they would repair it or ask a general surgeon to assist with this repair. Hernia repairs are covered under insurance. However, surgeons vary in their opinion on additional abdominal muscle repair at the time of DIEP flap. Additional muscle repair can place too much tension on the surgical site and may not always be possible. This is something that you can discuss with your specific surgeon or it may be something that your surgeon decides at the time of surgery based on your anatomy.

Hi JBis,
There should not be an extra charge for performing diastasis repair or hernia repair during DIEP flap surgery. I would consider this a red flag if your surgeon is trying to charge you for this! It does not add a significant amount of time to the surgery, and although DIEP flap is reconstruction, ultimately the aesthetics are super important. Make sure you check out your surgeon's before and afters and ensure they value the aesthetics of your reconstruction, consider it 'all included' in DIEP flap surgery, and are not charging extra to do the basics..

Hi JBis,
The DIEP flap splits the rectus abdominis muscle vertically, along the line of its fibers. As such, the repair of the rectus muscle is inherent to the DIEP procedure. If you question is related to repair of upper abdominal rectus diastases, that is performed at surgeon's discretion, and consideration of your baseline anatomy.
With regards to hernia repair, small hernias like umbilical hernias can commonly be identified and repaired during DIEP flap reconstruction (if your surgeon performs preoperative imaging, they may identify the hernia on that imaging study). Larger ventral or postsurgical hernias could be identified in advance, and may require a preemptive procedure with a general surgeon to be repaired.
These are excellent questions to discuss with your surgeon prior to your DIEP procedure.
Hope this helps.
Best,Christopher Pannucci, MD MSBoard Certified Plastic SurgeonPlastic Surgery NorthwestSpokane, Washington

A hernia may need to be fixed during your surgery as this is an actual defect in the abdominal wall fascia. The DIEP procedure further weakens the fascia by incising through it in order to retrieve the blood vessels. Therefore, the hernia repair may be necessary and may results in additional charges since it is billed separately. Rectus diastasis repair, in which the separation of the abdominal muscles is performed (but the fascia remains intact), is typically not performed during a DIEP flap reconstruction. These are not performed together because, among the risk of other things, the risk of blood clots or venous thromboembolis (VTE). If your surgeon does decide to pursue this, it may result in an additional charge.

I always repair the muscle fascia with underlay mesh and almost always perform a rectus plication of the rectus abdominis muscles above the belly button. I get insurance approval for the repair if I can and only charge insurance if it is approved. I never charge patients.

Usually muscle/small hernia repair can be done at the same time of DIEP surgery, but should be discussed with your surgeon beforehand.  I do muscle repair work as part of the DIEP procedure.  Best wishes!

An in person evaluation will be needed to properly answer your question.  Also, we can assist you with verification of insurance coverage to determine your out of pocket expenses.  Consult with a plastic surgeon in your area to discuss your options.