I have diastasis recti and an umbilical hernia that developed post-partum. I am 5'3" and weigh 98 pounds. I am planning abdominoplasty with hernia repair. I saw a surgeon who said that a vertical incision would give the best results for the abdominoplasty because there is not much skin to work wit. Is it possible to correct this without cutting vertically down the abdomen?
Is a Vertical Incision Required for Repair of Diastasis Recti with Umbilical Hernia?
Doctor Answers 18
A board certified plastic surgeon would use tummy tuck incision
This is what a tummy tuck or abdominoplasty is for; plication or sewing together of the diastasis (and any hernias) and redraping/resection of the skin and umbilicus to give back the youthful/straight abdomen. One thing to consider is if you are going to have more children...Then you may wish to defer definitive repair until your childbearing is complete. Also, are you having any symptoms from the hernia (pain, hard lumps in hernia that are hard to reduce). That would also have a bearing on how quickly all these issues are addressed. Good luck, and do not get a vertical incision.
Vertical incision for abdominoplasty
Scars of abdominoplasty are the result of what you are trying to achieve and this is in part a function of your anatomy. The repair of the diastasis does not require a vertical skin incision because the muscle can be accessed through a more imperceptible horizontal incision. The issue with removal of skin is a bit more involved. With pregnancy, the abdominal skin is stretched centrifugally. A removing skin in one dimension requires a scar at a right-angle to this dimension. That is, to remove skin vertically requires a horizontal scar. If you have excessive skin in the horizontal dimension, then it requires a vertical scar. However skin that is used to close the wound can be recruited that is tighter in that dimension so the skin that is loose in the horizontal dimension can be replaced by skin that is tighter.This reduces the need for excising excess skin. The design of the abdominoplasty is important to take all this into account and this is in part dependent on what will make you happy as a final result.
I advocate a complete customization of each procedure for each patient to take all individual concerns into consideration. Without examining or consulting with you I cannot give you a recommendation, but I suspect that with the right planning, you will probably be happy with just a horizontal scar but the location will be important.
Best incision for abdomen with minimal extra skin and umbilical hernia
It is not necessary to have a vertical scar to repair your umbilical hernia.
If you undergo a tummy tuck to remove extra skin, the incision will be horizontal. Most plastic surgeons will repair the umbilical hernia at the time of the tummy tuck.
You may be a candidate for a limited incision tummy tuck.
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A vertical Tummy Tuck incision may not be required for your hernia repair
Thank you for your question and photograph. A formal consultation and exam is required to to fully answer your question.
From your photographs however it appears that your umbilical hernia repair and tummy Tuck may be able to be done through a horizontal incision in the lower abdomen and not require a vertical incision.
Be sure to consult a plastic surgeon who is certified by the American Board of Plastic Surgery, experienced in tummy Tuck, and has an excellent reputation in your community. In my practice I operate with a general surgeon who does the hernia repair and I limited myself to the abdominoplasty.
Hide your horizontal incision
Looking at your picture, I believe you would be better treated with a standard transverse tummy tuck incision to repair your rectus diastasis. Your excess skin can be removed the the final scar placed in your bathing suit line thus avoiding a long vertical scar. I would urge you to get another opinion from a surgeon certified by the American Board of Plastic Surgery
No vertical scar needed
A vertical scar is not required and should be avoided in rectus repair with umbilical hernia. This procedure can be for through a low bikini incision. Even without a full tummy tuck an endoscopic can be used to assist in the procedure. Unless there is an existing vertical scar i would not use a vertical approach.
Vertical incision with abdominoplasty
Unless there is something else about your situation that we don't know, most Board Certified plastic surgeons should be able to repair your umbilical hernia, correct the rectus diastasis and remove your loose skin through a horizontal incision in your bikini line.
However, it is possible that the surgeon you saw meant that there may be a small vertical scar (between your pubic area and your belly button) in the skin where your belly button used to be after the loose skin is pulled down and a new opening is made for your belly button. If that is the case (which is likely based on your picture), then this type of scar tends to heal very well.
It may be a good idea to go back to your plastic surgeon and ask for a clarification on this.
No Vertical incision Tummy Tuck
I obviously have not examined you but by your picture I would not consider a vertical incision for your abdominoplasty. You would probably end up with standard horizontal incision with a small vertical closure of your old belly button site.
Do I need a vertical incision with my tummy tuck?
Looking at your picture, I would guess that you would not need a vertical incision and that you would see very nice improvement with a traditional low transverse abdominal incision. The main reason for the vertical incision is to address significant mid-abdominal laxity that simply cannot be addressed with the traditional incision. That being said, I generally reserve these incisions for my massive weight loss patients who present with not only significant excess skin but also poor tissue quality.
I hope that helps!