Fixing Post Pregnancy Belly After Hernia Repair?

Question

I had my child 4 years ago and was left like this what can I do? No diet or exercise has worked. My belly is hard and I don't know why. What do you recommend? I'm afraid of a Tummy Tuck. I just had a hernia repair surgery 2 weeks ago. How long do I have to wait to get another surgery to fix my tummy? My hernia doctor told me my muscles tore and open and got weak that's why I still look pregnant and bloated.

J. Timothy Katzen, MD, FACS · Answer

Thank you for your question regarding your post-pregnancy belly after hernia repair. Based on your description and photos, it sounds like your abdominal muscles have separated (a condition known as rectus diastasis) and no amount of diet or exercise is able to correct it. This is a common issue for many women after pregnancy, and it often requires surgical intervention.

A tummy tuck (abdominoplasty) would be the most effective way to address your concerns. It not only removes excess skin and fat but also tightens the abdominal muscles, which can restore a flatter and more toned appearance. While you mentioned being afraid of a tummy tuck, it is important to know that many patients in your situation experience life-changing results from this procedure, and it can help improve both the appearance and function of your abdominal muscles.

Since you’ve just had hernia repair surgery two weeks ago, you’ll need to allow your body adequate time to heal before undergoing another surgery. Most plastic surgeons recommend waiting 3 to 6 months after a hernia repair to ensure your body is fully recovered before considering a tummy tuck. This gives your tissues enough time to heal and lowers the risk of complications.

If you're not ready for a full tummy tuck, you could also discuss the option of a mini tummy tuck with your plastic surgeon. This is less invasive but still addresses the lower abdomen, although it may not provide the muscle tightening you need.

Please consult with a board-certified plastic surgeon to discuss your options. They can help you determine the best approach and timeframe for achieving your desired results.

Sincerely,
Dr. Katzen

Richard J. Bruneteau, MD · Answer

It’s not unusual for women to develop redundant saggy skin,
weakened abdominal muscles, diastasis recti, stretch marks and fat accumulation
following pregnancy. In many cases these problems are refractory to diet and
exercise and for this reason correction usually requires abdominoplasty
surgery.Although
it’s impossible to make a specific recommendation without a physical
examination, your history and pictures suggest the presence of significant skin
sag with associated laxity of the abdominal wall muscles. Under these
circumstances, correction will usually require a full abdominoplasty with
muscle tightening. This
procedure should be delayed for at least three to six months. This delay will
allow adequate time for additional weight loss and further recovery from your
hernia repair.Unfortunately
abdominoplasty is the only treatment option that can effectively address this
problem. It’s therefore important to consult a board certified plastic surgeon
with experience performing this type of surgery. This surgeon should be able to
formulate a treatment plan that addresses both your anatomic findings and
aesthetic goals.

Leila Kasrai, MD, FRCSC · Answer

The most common reason is laxity of the abdominal fascia or weakness/separation of the abdominal muscles. Another reason is that some people store fat around internal organs and the only solution would be weight loss followed by a tummy tuck. Without examining you it is difficult to say how much of an improvement you would get with surgery alone.

Raffy Karamanoukian, MD, FACS · Answer

An abdominoplasty procedure is the gold standard for improvement of the abdominal bulge in the picture. Patients benefit from having the excess skin and muscle removed as well as tightening of the abdominal muscles and fascia that are stretched after pregnancy or with age.

Otto Joseph Placik, MD · Answer

Your surgeon is correct.
If surgery is out of the question, try a course of Core strengthening exercise using a Pilates or Yoga technique under the close supervision of a qualified trainer or instructor.
Surgery is likely to yield a 7-9 result on a scale of 1-10 whereas non-surgical methods are only likely to yield a result of 2-5. However, exercise is always a good idea and should you decide to proceed with surgery at a later date, it will only enhance the result.

David Shafer, MD, FACS · Answer

You can be helped considerably with an abodminoplasty. However, since you just had hernia surgery, the best option is to wait several months for your body to heal from the procedure. For other people considering the procedure, if you have a hernia, it is often possible to have the procedures done at the same time. Since you have already had the hernia repaired, then the best option now is to wait.

Brent Moelleken, MD · Answer

Your best results will be from losing weight, then having a tummy tuck.
A hard abdomen indicates fat inside the abdomen, which cannot be reached by liposuction.  However, tightening of the fascia does help by tightening the deep layer and therefore reducing the abdominal bulge.
You can have a full tummy tuck and will see a significant improvement, but this will not give your best results.  Your best results will be a combination of a tummy tuck and weight loss.

John LoMonaco, MD, FACS · Answer

I agree with Dr Rand.  You probably have more of an "apple" shaped figure than a "pear" shape, and the success of a hernia repair and especially a tummy tuck will be very minimal if you still have the abdominal fat.
This type of fat also has adverse health consequences and weight loss will not only get you looking better but will imporve your health.

Peter E. Johnson, MD · Answer

The laxity in the abdomen after pregnancy can have several causes, among which are loss of muscular tone, a stretch of the tissues, and a separation of the sit-up muscles in the abdomen, called a diastasis. We see the greatest loss of tone in our patients who have undergone infertility treatments and carry multiple babies. Generally, the abdominal tone will adjust itself as well as can be expected by six months, so we recommend the repairs and that tummy tuck wait at least this time to see the best results. Healing takes time as well after abdominal surgery, or after a hernia repair at which time the tissue can be stiff and the scar immature, and again it is best to wait six months to consider tummy tuck.Concerning your photo in particular, it is difficult to determine if the issue is laxity alone, or a combination of abdominal fat that will respond to diet and exercise. To help sort this out you can lie perfectly flat on your back and see if your abdomen will will become flat, or at best even fall in somewhat (concave). If you remain full and round (convex) there is internal abdominal fat pushing out which will resist any repair and weight loss is the key. Also while flat you can check the 'outside' fat as well by pinching the skin as it folds below the belly button, as this will represent twice the thickness of the fat under the skin. One half inch is all you need!If weight is an issue, the good news is that you have six months to begin on a program which will lead to better health and a more enjoyable life. Check with your doctor as to how you should progress after the hernia repair.Best of luck,peterejohnsonmd

Sirish Maddali, MD · Answer

Given the one picture, it is actually difficult to say what is right for you. The most important thing is that surgery is NOT recommended in the near future. You just had a hernia repair 2 weeks ago and need to give your tissues time to heal. I would not even consider surgery for at least 6 months and maybe even up to a year. It also appears that you may have intraabdominal fat (fat that is inside the abdomen, around your organs), which is not removable by a tummy tuck or any other operation. It looks as though you really need to lose weight first. This can be accomplished through utilizing the services of a good trainer and nutritionist. After that, you should seek the advice of a good plastic surgeon. Good luck!

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