Umbilical Hernia Repair Recovery Versus Rectus Diastisis Repair and a Tummy Tuck?

I have an umbilical/epigrastric hernia, rectus diastasis and slight lower abdominal bulge and a bit of loose skin, no extra fat. I am extremely active every day lifting weights and doing cardio at the gym. Will my recovery be easier and shorter if I just fix the hernias now with mesh by a GP? In a year or two when my kids are older I can then fix the bulge and muscles with a tummy tuck by a PS. See photos attached.

Doctor Answers 9

Hernia repair, Tummy Tuck

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You are in great shape, congratulations.  This is also a scary situation when considering cosmetic surgery, because everything can be visible through the skin that is done below- including sutures and mesh.  There simply is no place to hide here!

I don't see your lower bulge.

I can't see your hernias on your pics, so I can't render an opinion on those either.

I can tell you that if you mean general practitioner, I would say NO!.  My strong advice to you is to get evaluated by a fully trained plastic surgeon and if needed, a general surgeon.  Mesh carries with it complications and you need a lot of information prior to deciding.  You may only get one shot at this.


Umbilical hernia repair

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It is common for me to repair umbilical hernias at the same time I perform a tummy tuck.  It is necessary to be conservative with the repair because the blood supply to the umbilicus.  Since I am there anyway, however, I advise most patients to have the hernia repair at the same time as the tummy tuck. Good luck.

David Stoker, MD
Los Angeles Plastic Surgeon
4.8 out of 5 stars 62 reviews

Diastasis repair vs Tummy Tuck?

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This is a great question, and one that I am glad you are asking before you have any procedure performed.  There are multiple ways to improve the abdominal area after weight loss, pregnancy, or just aging, and if you ask 5 surgeons you will get 4 answers.  This is because there is no one perfect procedure for everyone. 

 However, in your case I don't see the need to have anything done. Surgery will only make unnecessary scars and will not improve much else on you.  That  said, nothing takes the place of a good examination by a board certified plastic surgeon. Let someone evaluate you personally and then if needed, that plastic surgeon can repair the hernia or diastasis, whichever is needed.  Hope this helps, Erez Sternberg, MD (Jacksonville, FL).

Erez Sternberg, MD
Jacksonville Plastic Surgeon
4.9 out of 5 stars 33 reviews

Hernia repair with abdominoplasty

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It's been a long lime since my general surgery residency (20 + years!) so make sure you take this advice knowing that I may not be up to date on hernia repair by general surgeons..  If your hernias bother you and they can be repaired via laparoscopy and mesh from the inside, go for it.  If your general surgeon would need to do a vertical incision and an incision through your umbilicus (this is the way they were done when I was doing general surgery), I would have a plastic surgeon fix the hernias through a bikini line incision.  Because you have very little extra skin,  he/she may need to leave a short vertical component of incision in the lower abdomen but it will not leave a vertical scar in your midriff area or a horizontal scar through your umbilicus.  If I were you, I would put on a little weight.  You really look too lean to me.  Just my opinion. 

If your hernias don't bother you, I would do nothing at this point. 

Lisa Lynn Sowder, MD
Seattle Plastic Surgeon
5.0 out of 5 stars 77 reviews

Umbilical hernia repair vs. tummy tuck?

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Thanks for including the photos; they really make a difference in advice in your particular case--you are so thin and fit (but with virtually no fat layer to "hide" any visible parts of surgery, such as mesh, sutures, or residual bulges), that my recommendations are different than if I did not have these photos.

I am leaning with my colleagues who suggest that you don't really "need" a tummy tuck. I can't examine your abdomen or hernias, but based on your description and photos, let's assume you have a small protruding belly button that indicates an umbilical hernia. Let's also assume that there are no other hernias, and that the "bit" of loose skin and slight lower abdominal bulge are as minimal as they appear to be.

Here's a slightly different "twist" of a recommendation.

Being a fully-trained and Board-certified general surgeon (although I have not re-certified since I have not practiced as a general surgeon, instead completing additional training in plastic surgery and becoming ABPS-certified), I would be concerned that a general surgeon may not be as adept at using a tiny incision to repair your umbilical hernia, which is all that it appears is required. It would not be incorrect to utilize a larger omega-shaped scar for full access to the hernia, use mesh, and sew it all up, possibly with staples or cross-hatch marks for the skin. This would be a "standard" general surgical approach where time and efficiency are valued more than precision and cosmesis of the result. Nothing wrong with this, but once the scar is there it can NEVER be removed.

So how about a different approach?

Rather, ask a fully-trained plastic surgeon (often with full training and certification as a general surgeon, as I and many of my colleagues have taken this route to plastic surgery) performing your umbilical hernia repair via a tiny hidden incision (mesh is still possible, though probably not necessary for a small, first-time hernia repair) that leaves a nearly invisible scar. No big scar, no cross-hatch marks, no palpable mesh or suture knots! At the same surgery, if you wish, your chosen plastic surgeon could perform a mini-abdominoplasty to address the minimal bulge and small amount of excess skin. Muscle plication could be performed via the shorter suprapubic incision, and a small ellipse of excess skin removed. Voila, all concerns dealt with in an efficient, skillful manner by one expert surgical specialist. This can be done now, if your umbilical hernia is symptomatic, or if not, when you are ready to take care of all your issues at one operation, one time off, and lower total cost.

If you have read other of my answers on this site, you know I am generally not a fan of "mini" tummy tucks (or "mini" anything, for that matter, as they generally over-promise and under-deliver for their cost). But I also believe that each and every operation should be tailored to the individual patient's needs, and this may well be a good situation for just such an operation!

Best wishes! Dr. Tholen

Richard H. Tholen, MD, FACS
Minneapolis Plastic Surgeon
4.9 out of 5 stars 263 reviews

Approaching issues of the abdominal wall

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You have not stated it you have seen a general surgeon and a plastic surgeon. If you have not, it would be to your benefit to see both then you can make a more informed decision based on the information. Without examining you and obtaining more of your history, it would only be conjecture in determining what course of action would be best for you.

Steven Turkeltaub, MD
Scottsdale Plastic Surgeon
4.7 out of 5 stars 33 reviews

Have it all done at once.

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If the umbilical hernia is not bothering you, then i would have the plastic surgeon repair it when the tummy tuck is performed.  This will be much easier on you an will be done properly.

Miguel Delgado, MD
San Francisco Plastic Surgeon
4.8 out of 5 stars 81 reviews

Tummy Tuck with Hernia Repair

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Based on your pictures, I'm not sure you need a tummy tuck - you look great. Consider having the hernia repair by a general surgeon for now.

Karol A. Gutowski, MD, FACS
Chicago Plastic Surgeon
4.9 out of 5 stars 76 reviews

Umbilical Hernia Repair or Tummy Tuck?

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Thank you for the question and pictures.

Giving you advice  without examining you in person and/or discussing your goals is not ideal.

However, based on limited information  I think you may be better off undergoing repair of the hernia without tummy tuck surgery. This recommendation is made based on your description, viewing pictures,  and after  considering the pros/cons  of each procedure as well as the potential risks and complications associated with each procedure.

I hope this helps.

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.