Tummy Tuck / Abdominoplasty : Hernias – Belly Button, Umbilical and Other Defects

West Chester, PA

A tummy tuck or abdominoplasty can simultaneously repair hernias of the belly button or abdomen. The tummy tuck operation is done to make the stomach flatter, thinner, and more attractive. It repairs the muscle weakness often coming from pregnancy, aging, or prior surgery. But the muscle area might have other problems like hernias of the belly button (umbilical hernia) or other muscle hernias. This educational writing will review these hernias and their simultaneous repair at the time of an abdominoplasty. This writing was done at the request of a patient from West Chester, PA – which is very close to my deluxe private cosmetic surgery center.

It’s important to first learn what a hernia is anatomically. It’s a weakness or hole in the muscle layer of the abdomen. This hole allows the abdominal contents to push out through this hole from “inside to outside.” Normally, the abdominal layer or fascia layer keeps the abdominal contents contained inside the abdominal cavity. Inside this cavity, we have intestines, the liver, the spleen, and abdominal fat. When we get a hernia or weakness, the abdominal contents can start to come out and can cause problems. These problems can include pain, intestinal blockage, or intestinal incarceration. Because of these problems, it is typically recommended that hernias are fixed or repaired. The timing of the repair is elective. This means it is not an emergency. They should be repaired in a timely fashion.

With this understanding of what a hernia actually is anatomically, I will now discuss its relevance to tummy tuck and abdominoplasty cosmetic surgery. There are many causes for the gradual development of muscle weakness and hernias of the abdomen. Pregnancy is the number one cause for most women. However, other causes are aging, weight loss and gain, other surgical operations, and congenital problems. What happens with pregnancy is the gradual pulling apart of the muscle layers. These muscles are called the Rectus Abdominus muscles. After delivery, the muscles often bounce back, but not always. Multiple babies and pregnancies can worsen the muscles, and the result can be severe weakness and an actual hernia.

A “belly button outie” is a classic example of a hernia. This is called an umbilical hernia or a belly button hernia. Other hernias of the abdomen are also possible. These have other names such as ventral, incisional, and inguinal. The most common hernia for woman who have had a pregnancy is the belly button hernia or hernias in the area around the navel.

An extremely important fact is that the muscle layer is weak after pregnancy from almost the top to bottom of the abdomen. This is from the rib cage to the pubic bone. It is called a Rectus Diastasis. The hernia is just the weakest area. The hernia is the place where there is a hole. But the weakness is much higher, lower, and extensive. This can not be over emphasized. Think of rolling out pizza dough. If you roll it out, it becomes thin. This is like the muscle layer after pregnancy. If the pizza dough gets too thin, it gets a hole. This hole is the hernia, and it’s the weakest part. But the entire area is weak, not just the area with the hole.

The general surgeon is the main doctor who fixes these hernias. The  exception to this fact is when a woman gets the hernia repaired with a tummy tuck. The general surgeon typically repairs these hernias with stitches or a small piece of mesh. Some belly button hernias require just a stitch or two in the muscle layer. It’s an easy out-patient operation for most. But when this is done, nothing is done to the rest of the weak abdominal muscles. The weakness above and below the hernia are not medically risky, so it is left alone. The general surgeon is not a cosmetic surgeon, so they don’t care about the appearance of the stomach beyond the hernia. They aren’t involved in things like stretch marks, loose skin, and extra fat. Sometimes the belly button hernia can be fixed by a general surgeon and it can fix the hernia, but it can make the surrounding area look worse. This happens because pressure pushes out in the surrounding weak muscles.

In my opinion, the best repair of these hernias for many woman is a tummy tuck. Why? Because the abdominal muscle repair will fix the hernia and repair the entire muscle weakness from top to bottom. The separation of the muscles is called a Rectus Diastasis. I repair this and the hernia with the “California Corset”. I repair the muscle from the rib cage to the pubic bone in two layers. The repair is imbricated, which means the second layer is done on top of the first. This pushes the first repair below and gives, in my opinion, a more secure repair. The “California Corset” repair can give many women the extra flat appearance and definition of the muscle that they have lost. Some woman will get a sculpted stomach that they have only dreamed about.

I once gave a lecture in California to general surgeons in a medical conference on this topic. I trained in California, and this is how I came up with the name for the extra tight muscle repair. The title of the medical lecture was “The Best Repair of an Umbilical Hernia is an Abdominoplasty.” General surgeons fix umbilical hernias commonly. They use a few stitches or a piece of mesh. It fixes the problem very well, but it leaves the rest of the abdomen weak. It fixes an inch of the muscles, but it does nothing to the other 14 inches of the muscles.  I said it “tongue-in-cheek” to the general surgeons, so as to not upset my colleagues. They are not trained in cosmetic aspects. The truth is that my “California Corset” tummy tuck muscle repair is a much more secure repair that is going to make more people happy.  Of coarse, the tummy tuck gets rid of loose skin and extra fat, so these are also huge factors that make the woman much happier.

If you have an umbilical hernia or other muscle weakness in your abdomen, and you are concerned about the overall appearance of your stomach, I recommend you consider a tummy tuck. The muscle repair will take care of the hernia in a very secure, comprehensive, and extensive manner. The surgery can also give you an extra flat and sculpted stomach. Please come in for a consultation, so I can review your procedure personally with you.