Tummy Tucks, Diastasis and Hernias by Dr. Ronald Schuster, Board Certified Plastic Surgeon in Baltimore, Maryland

Recently I have operated on a number of patients who have had hernias fixed at the same time as their tummy tuck. I thought I would take just a moment to discuss it. A hernia is basically a hole in the abdominal wall which can allow your “insides” (ie. intestines and internal fat) to poke out. Usually whatever “pokes out” is able to “slide back in”. On some occasions whatever poked out gets caught outside. When this happens it is called an incarcerated hernia and can become a surgical emergency. Imagine a rubber band wound too tightly around your finger! Fortunately this is not too common but that is why it is always best to fix a hernia electively. Hernias can be present at birth or develop later in life. The most common is the umbilical hernia because it develops in a natural area of weakness. These are easily fixed at the same time as the tummy tuck but can sometimes cause some delay in the healing of the belly button. Another type of hernia can occur from any previous abdominal surgery, like cesarean section, hysterectomy, appendectomy and unsuccessful repair of previous hernias. These are called incisional hernias and can sometimes be complicated. Hernia repairs are generally covered by most insurance plans.

Diastasis recti is different from hernias. A diastsis is simply the stretching of the thin connection between the two halves (right and left) of your tummy muscles. It usually occurs after pregnancy and especially after pregnancies with multiple births like twins and triplets. The thin connection becomes very stretched and is unable to shrink back after delivery. Even though it can be very thin there is not a “hole” and therefore does not have the same risks as a hernia. Unfortunately diastasis repair is generally not covered by insurance plans.

So what does this have to do with tummy tucks? It is important to look for hernias before a tummy tuck so that they can be properly fixed. I often will fix routine umbilical hernias myself. If the hernia is complicated I will arrange for a general surgeon to fix the hernia when I perform the tummy tuck. It is extremely important not to have liposuction performed without fixing the hernia first since the contents of the hernia could get injured by the liposuction procedure. Fortunately this is a very rare but preventable complication of tummy tuck surgery. I always wait until the end of the tummy tuck to perform any liposuction so that I can tell if there are any “silent” hernias lurking. It all starts with a good thorough examination at the time of your consultation.

Hope this helps to answer any questions. Don’t wait till next Spring to wish you would have gotten your tummy tuck before Summer! Schedule now for your consultation. Hope to see you soon.

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Dr. S