My Obgyn Says I Have Abdominal Hernia & Diastasis Recti? (photo)

Question

Baby #2 is 18 months old The hernia is painful. Doc wants to do a small incision through my belly button and thinks that he could sew up most of my diastasis at the same time. Should I have my obgyn do it or look into plastic surgeons? Will this create loose skin? Will I ruin this surgery if I have another baby?Do I have enough skin to do a mini or full tummy tuck? Getting insur to pay? I truly appreciate anyone who takes the time to answer my questions& provides any other info I should consider.

Dana Goldberg, MD · Answer

If you think you might have more children, I would wait for a tummy tuck because any further stretching of the skin or muscles could ruin your result. You could have the hernia repair done to address your pain. I don't think that repairing a diasthasis through an incision by your bellybutton will work as well as a tummy tuck, but if you're going to have more children, it will improve things for now.

	If you're done having children, then I would have a board certified plastic surgeon perform a tummy tuck and hernia repair at the same time. It's hard to tell whether a mini or full would be better without an exam, but it looks like a mini would be adequate to address the looseness.

	In either scenario, your insurance would likely cover the hernia, but you would be billed separately for the cosmetic portion of the surgery.

Jourdan Gottlieb, MD · Answer

First question is whether or not you are planning additional pregnancies. If so, I would suggest only repairing the hernia, and it may be wisest to see a general surgeon for that.

	As a rule it is not a great idea or fix a significant diastasis without doing a TT-- as the muscle edges are drawn to the midline, the skin sometimes buckles and results in an unsatisfying outcome. 

	If no more pregnancies are planned, I would see a plastic surgeon for evaluation to consider whether a tummy tuck is in order.

	All the best.

Craig Harrison, MD · Answer

I cannot see evidence of a hernia. I suggest that you see a plastic surgeon for another opinion and have someone examine you for evidence of a hernia. I would get your hernia fixed first and would not consider abdominal recontouring until your are done with your pregnancies Best wishes

Morgan E. Norris, III, MD, FACS · Answer

I would agree with Dr. Saltz's comments.  See a board certified plastic surgeon before you do anything. A careful assessment must be done to determine what your problems are. 

	If you are found to have a hernia, where abdominal contents are slipping in and out, then a general surgeon may need to be consulted to repair this for you.  A hernia has the potential to pose a life threatening emergency. Get the hernia repaired before any cosmetic surgery is done to your abdomen.

	The diastasis between your rectus muscles on the other hand,  is a normal process from pregnancy.  The diastasis may allow your abdomen to bulge, but your abdominal contents are well contained, therefore, it is NOT a hernia.

	If you plan on more children, I would recommend that you hold off on the rectus diastasis repair and have that dealt with later during your abdominoplasty by a board certified plastic surgeon.

	Good luck.

Lori H. Saltz, MD (retired) · Answer

You have lots of issue and questions so bear with me for a full answer here:

	First lets differentiate a diastasis recti from a hernia.  Your rectus abdominus muscles are up and down muscles on either side of your belly button.  They are covered by a thin but strong layer of tissue called a fascia that comes together between the muscles.  During pregnancy this central fascia gets pulled wider creating a space between the muscles that your internal organs can push out against.  When you do a crunch it can really dome up between the muscles.  This is a diastasis.  Exercise does not correct it and it looks like what you have.  Now a hernia on the other hand means there must be a hole in that fascia and the internal contents of your abdomen (usually the fat around your organs called the omentum) is pushing out through it.  Most often you can push on it and the contents goes back into the abdominal cavity and you can feel the hole in the fascia especially when you are lying down.  Most often these are small and occur in the belly button or very near it or in the upper midline of the abdomen.

	Without a physical exam it is hard to say whether you have a hernia or not, but I would not take the word of your OB/GYN or allow him to fix it.  I would see a board certified plastic surgeon if you have any thoughts about an abdominoplasty.  Most mothers get better results with full TT rather than minis, but a full exam is needed.  That would include a full repair of the diastasis and hernia if you truly have one.  I have had several patients have more children after a TT and one had twins!  Only a plastic surgeon is trained to evaluate and correct all the things you are concerned about.  Learn about all of your options, not just the one your OB might want to try his hand at.

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