Can a Tummy Tuck Make an Existing Hiatel Hernia Worse After the Procedure?

While it is true that tightening the abdominal wall can increase your intraabdominal pressure which could potentially worsen your hiatal hernia symptoms, I am not sure that this explains why your symptoms have only started to worsen beginning 4 months postoperatively.  If the abdominal plication were solely to blame, your symptoms should have worsened fairly soon after the surgery. 

It is possible that early after a tummy tuck, the symptoms of a hiatal hernia could be worse (due to the increased pressure in the abdomen). I think it is much less likely to 4 months later as the pressure has usually improved by then.

Tightening the tissue of the abdomen shifts the contents of the abdomen and, yes, this could aggravate a hiatus hernia. It is possible that, when you have the incisional correction, a general surgeon could work on the hiatus hernia at the same time.