Hernia Repair And Mini Tummy Tuck

Mini-Abdominoplasty with Hernia Repair A hernia occurs when an organ or other tissue protrudes through a defect in the abdominal wall. If a hernia gets stuck, it can cause a lot of discomfort and anguish. It is possible to restore strength to the compromised area of your abdomen through hernia surgery.

Mini tummy tuck surgery is a cosmetic procedure that targets the area below the belly button, the hips, and the buttocks in order to tighten excess skin. It also works to reduce the visibility of stretch marks. This article will explain what each treatment is, how it is administered, and how much it can set you back if you decide to go through with either surgery.

You may find it hard to access the right information on the internet, so we are here to help you in the following article, providing the best and updated information on Hernia repair and mini tummy tuck, hernia and tummy tuck surgery recovery time. Read on to learn more, tummy tuck with hernia repair cost.

Hernia Repair And Mini Tummy Tuck

The objectives of abdominal hernia repair are to restore the structural integrity of the abdominal wall. Current techniques include primary closure, staged repair and the use of prosthetic materials. Techniques for mini-abdominoplasty include the use of the transverse lower abdominal incision and the resection of excess skin. We report a case of epigastric hernia repair through a transverse lower abdominal incision with the resection of excess of skin. Our purpose is to evaluate the results of the procedure by incorporating these aspects into an epigastric hernia repair, we found out that the procedures are made safer and the results are improved. Proper indication and details of the technique are described.

Epigastric hernia is a type of abdominal wall hernias due to a weakness, gap or opening in the muscles or tendons of the upper abdominal wall, on the alba line between the umbilicus and the xiphoid process. The hernial sac content is usually properitoneal fat, vascular structures and, uncommonly, abdominal viscera. This results in a bulge of intra-abdominal contents and pain or discomfort. Epigastric hernias are usually occult in obese patients, and their symptoms may mimic peptic ulcer or gallbladder disease.^1,2 Epigastric hernia is quite uncommon and represents 0.5–5% of all hernias. There is a male predominance with a male to female ration of at least 3:1, diagnosis usually occurs in the third to fifth decade. Defects of the fascia may vary in diameter from several centimeters to only a few millimeters. The larger ones usually readily reducible, whereas the smaller often became in-carcerated. Multiple fascial defects are present in between 20% and 25% of individuals. Clinically, the majority of epigastric hernias (75%) are asymptomatic.³

Vague upper abdominal pain and nausea associated with epigastric tenderness may be present. Common symptom of epigastric hernias is a painless epigastric swelling or bulge. Incarceration is common, especially in smaller hernias, but strangulation is unusual.⁴ Operative management aims at reposition of the hernia sac contents and direct closure of the hernial opening with a continuous suture. Due to high recurrence rates, tension-free hernia repair with mesh is becoming more common. The repair of umbilical and epigastric hernias still represents a challenge to surgeons. Even if is a common and relatively simple procedure, there is no exact protocol today on how the repair should be done. The purpose of epigastric hernia surgery is to repair the weakening area between rectus abdominis and put the hernial sac back into the abdomen. The best way to restore the anatomy of the abdominal wall in a tension free manner, is obtained by the placement of a polypropylene mesh. The Mayo technique and its alterations could not stand the test of time and it shows a recurrence rate of 20% and higher.⁵ Although there is no consensus opinion, the anatomic repair without tension and without an artificial enlargement of the defect is clearly the new trend in hernia repair techniques.⁶ In 1987 Lichtenstein⁷ reported on 6321 cases of inguinal herniorraphy with a tension free repair, and in 1994 Stuart⁸ reemphasized that special importance in his editorial in the Lancet. A newer study from Brancato⁹ and coworkers in Italy also states the advantage of a tension-free prosthetic repair in 16 patients with epigastric hernia; in their work no recurrence has been recorded. They found the technique simple, safe and absolutely effective, allowing immediate rehabilitation with a low rate of complications (Figs. 1–5).

Fig. 1

Psillakis’ technique for detaching the navel.

Fig. 2

A polypropylene mesh is positioned over the posterior fascia of recti abdominis.

Fig. 3

Anterior fascia of recti abdominis is plicated using 2/0 vicryl.

Fig. 4

Pre-operatory picture: laxity of the lower part of the abdomen allows us to perform a mini-abdominoplasty technique in combination to the repair of the epigastric hernia.

Fig. 5

Post-operatory picture of the patient 3 months after surgery.

Small epigastric hernias is usually not a medical emergency and can be healed without surgery. When the symptoms are frequent and the problem affects the quality of life of the patient, surgery is the solution. The traditional approach to incisional hernia repair usually involves a surgical approach via the vertical scar. In young woman midline vertical scar is not well accepted. They would rather prefer not to be operated instead of having such a visible scar. An approach via a low transverse incision may be considered. Techniques developed for the surgical approach to mini-abdominoplasty include the use of the transverse lower abdominal incision and the resection of excess skin above the navel. The laparoscopic access was not the first choice because it did not allow the resection of the excess of skin. We report a case of epigastric hernia repair through a transverse lower abdominal incision with the resection of excess of skin.

2. Presentation of case

A 37 year-old female patient was diagnosed an epigastric hernia with a little diastasis recti. Patient’s symptoms were sense of discomfort, bloat, sometimes associated with dull pain increasing with cough. She had a mild laxity of the skin in the lower part of the abdomen and the position of the navel was 16 cm from the pubic symphysis. She refused classic approach to surgical hernia repair due to the visible midline vertical scar. The general surgeon asked the cooperation of a plastic surgeon who found another technique reliable to solve the functional problem with an esthetic approach combining the hernia repair with a mini-abdominoplasty hiding the scar in the bikini zone. The miniabdominoplasty technique was chosen in accord to the abdominolipoplasty classification system proposed by Mejia JA and Castellanos C¹⁰ and categorized as a type II.

Preoperatory marking was done following the type II abdominoplasty described by Pontes R.¹¹ because the patient had such criteria in fact this technique is suitable for females with high position of the navel. The patient was placed in the supine position with the “break” in the table at the patient’s waist. A standard abdominoplasty incision was used. The lower abdominal incision was first demarcated in the pubic area 6 cm above the anterior vulvar cleft. The incision was made, the flap was elevated, hemostasis was done to avoid any bleeding. The umbilicus was detached from its aponeurotic implantation to prepare the access to the epigastric hernia. The dissection was made cranially creating a subcutaneous tunnel in the midline. Care was taken to elevate the skin flaps only as far as necessary to define the hernial defect and to find surrounding fascia of good quality. The hernia was situated 4 cm beneath the xiphoid process. This area lacks important perforator vessels, and the tunnel was wide enough to expose the medial borders of the rectus muscles. The pannus was raised to the costal margins taking care to avoid undermining laterally to preserve the intercostal perforators to the flap. The navel was released from its insertion on the aponeurosis and left attached to the flap, as described by Psillakis¹² in his paper. This technique allowed us to get to the hernial area to repair the gap. Alba line was opened and the hernial defect was identified, isolated and was safely reduced. It clinically contained only omentum. The edges were dissected to free the hernial sac and identify an intact facial edge. The hernia was reduced and the posterior fascia of rectus abdominis was dissected from its adjacent structures. A polypropylene mesh was placed over the posterior rectus fascia to prevent the recurrence of the hernia. The muscles were sutured together and the anatomy of abdominal wall was restored. A little plication of recti abdominis was made. The navel was reattached 2.5 cm below its original position maintaining 13.5 cm from the pubic symphysis, using a 3/0 absorbable suture. The excess of skin was sectioned after marking the cranial border of the flap with the Pitanguy marker. 4/0 Vicryl was used for subcutaneous sutures and 4/0 monocryl for the intradermal suture.

3. Discussion

Epigastric hernia repair through a mini-abdominoplasty incision is a reliable method to approach an abdominal wall defect with an esthetic procedure. The use of the mini-abdominoplasty approach isolates the incision from the hernial defect and repair. This technique is safe, with a low risk of postoperative complications. We found a little difficult to access to the epigastric area through the subcutaneous tunnel, but, when the defect is not too big to repair and the flaps are elevated till the xiphoid process, then it is easy to prepare the posterior fascia and to inset the polypropylene mesh.

• •laxity of the skin in the lower part of the abdomen.
• •high position of the navel.
• •patients refusing midline vertical scar.

Hernia And Tummy Tuck Surgery Recovery Time

There are many reasons a person may choose to have a tummy tuck procedure, or abdominoplasty. Those who may consider having a tummy tuck include:

• women who have loose skin or abdominal sagging after pregnancy
• people who have excess skin after weight loss
• individuals with a protruding abdomen despite losing weight

Regardless of the reason, a person needs to follow all postsurgical instructions to avoid infection or other complications.

In this article, we provide tips for recovery from a tummy tuck. We also examine how long recovery takes and what to expect following a tummy tuck procedure.

How long does recovery take? 

Typically, a person can expect to feel themselves again around 8 weeks after surgery.

According to the American Board of Cosmetic Surgery (ABCS), tummy tucks are an outpatient procedure for most individuals, meaning they can go home the same day.

Recovery time from a tummy tuck procedure will vary, depending on factors such as:

• the type of tummy tuck
• the age of the recipient
• postsurgical care
• general health of the person

People should discuss their recovery timeline with their surgeon who can give an estimate that they will base on the individual’s situation.

Stages of recovery

A person should discuss recovery time before the procedure. According to the American Society of Plastic Surgeons, a person should ask their surgeon:

• how to bathe after the procedure
• when to remove their bandages
• when to return to normal activities
• when to return for follow-up care
• what drugs they must take after the procedure

Asking these questions can help a person prepare and take the right steps for the smoothest recovery possible.

Recovery timeline

Immediately following the procedure, a person can expect to go to a recovery room. A healthcare professional will monitor them and check the incision.

During recovery in the hospital, they will receive instructions on:

• recovery time
• how to care for the incision
• when to expect to resume normal activity

When a person is free to leave the hospital, they will need someone there to take them home. Doctors do not recommend they drive themselves home after surgery.

There may be drainage tubes that need emptying, and the individual will have to record the amount of fluid draining from their wound each day.

At home, a person should make sure they have someone to help them for the first few days, as their mobility will be limited. They may experience tightness around their tummy and only be able to walk hunched over for a week or two.

Initially, they can expect the incision to feel sore. They will likely need to lie in bed at an angle and may also have trouble with:

• standing
• lifting objects
• general movement

Many people take up to a month off work, particularly if their occupation is physically demanding.

After a tummy tuck, an individual may need help caring for young children for several weeks to months. They should also avoid exercise for the first several weeks until a doctor gives them the all-clear.

However, a person can typically return to activities, such as driving, within 1 to 2 weeks and gradually do more everyday tasks as time passes.

Finally, a tummy tuck scar will likely feel sore or tight for several weeks to months following surgery. The visibility of the scar will slowly fade.

Factors affecting recovery time

Recovery time after a tummy tuck can vary. Some common factors that impact this include:

• type of tummy tuck
• age
• postsurgery care
• general health

The types of tummy tuck include:

• Mini tummy tuck. This procedure has the shortest recovery time and minimal scarring.
• Classic or full tummy tuck. The scar will stretch from hip to hip, and recovery will take longer, but a person should be able to hide the scar under their bathing suit.
• Extended tummy tuck. This tummy tuck creates the largest scar. The scar may be visible under bathing suits and takes the longest time to heal.

It can be helpful to take steps to avoid constipation after surgery, as some pain medications can slow down the bowels. Straining to have a bowel movement will cause discomfort.

Tips for recovery 

During recovery from a tummy tuck, people need plenty of rest and must follow all of their doctor’s recovery instructions.

They will need to carry out daily maintenance of their incision and drainage tubes. Typically, daily maintenance includes:

• keeping the incision site clean and dry
• changing the bandage daily
• taking any prescribed antibiotics
• applying topical creams at the incision site

A person will likely have a supportive wrap, binder, or compression garment for their abdomen to prevent swelling and reduce discomfort.

Following a tummy tuck, they should avoid smoking and drinking alcohol for at least 3 months. Tobacco and alcohol can negatively affect healing.

Also, they should:

• avoid lifting heavy objects, including small children
• temporarily stop exercising until told otherwise
• take time off from physically demanding work

Side effects of surgery 

After surgery, a person may have limited mobility and experience some pain. Typically, the surgeon will prescribe pain relief medication.

The incision will also typically feel tight, causing a pulling sensation on standing or moving.

Finally, a person will find they can no longer do some of their normal activities immediately following the procedure. However, they can return to activities slowly as they start to recover.

When can you resume certain activities?

How soon a person can return to their normal activities will vary.

The ABCS suggest the following guidelines:

• up to 2 to 3 weeks for tasks such as cooking, driving, and shopping
• around 2 to 4 weeks to return to work

However, it is not uncommon to take up to 2 months before a person can return to their normal activities.

Summary

Full recovery from a tummy tuck — also called an abdominoplasty — can take several months. During recovery, a person should follow all postsurgical instructions and advice, including:

• avoiding lifting anything heavy
• keeping the incision clean
• taking time to return to normal activities

They should talk to their surgeon before the procedure about what to expect in their individual case.

Tummy Tuck With Hernia Repair Cost

It seems like every year, the cost of living increases. But unless you change jobs or get lucky when landing an employer, wages remain stagnant. At The Institute of Aesthetic Surgery in Celebration, FL, we offer affordable cosmetic procedures, so you don’t have to worry about questions like how much is a tummy tuck cost in 2020. 

But just because you don’t have to worry about it doesn’t mean you can’t be curious. We understand that cost is a significant factor when deciding to pursue a procedure and who to choose as your service provider. That’s why, today, we’re talking about how much is a tummy tuck cost in 2020 and several other things you might be wondering.

How Much Is a Tummy Tuck in 2020?

One of the most common questions we get regarding tummy tuck cost is “how much is a tummy tuck cost.” Unfortunately, this is a really hard question to answer because there are so many factors that affect the price. We can’t tell you right now how much your tummy tuck will be. But for the sake of transparency, we can discuss some of the factors to give you a ballpark figure:

The Extent of the Procedure

Sometimes, all a tummy tuck involves is tightening the loose, sagging skin below your navel. But the scope of the procedure can be a lot greater depending on your needs. In fact, this procedure is so customizable that there are three different names for it: a full (traditional), mini, or extended tummy tuck.

A mini tummy tuck only addresses loose skin and excess skin and fat beneath your navel. On average, this procedure costs between four and five thousand dollars. A traditional tummy tuck may cost you between eight and 10 thousand dollars, and an extended tummy tuck can cost you up to $20,000.

The Volume of Fat Removed

When we say the extent of your procedure affects the cost, we’re talking about a few things. First, we’re talking about how many things are being done, such as fat removal, excess skin removal, skin tightening and lifting, muscle tightening, muscle reshaping, or muscle repairing.

The more services you have provided during your procedure, the more expensive your procedure will be. But you don’t just have to consider how many things are being done. You also have to consider how much work is being done. If we have to remove so much fat we are required to perform liposuction, for example, your procedure will cost more.

The Size of the Area

If we’re just tightening loose skin and removing fat from your lower abdomen, your procedure won’t cost very much. However, in the case of a full tummy tuck, the scope of the procedure includes both your lower and upper abdomen. Extended tummy tucks cost the most because they also cover the sides and back.

The Type of Anesthesia Used

The type of anesthesia and the dosage you receive are two other significant factors that will affect how much your procedure costs. The larger your required dosage is, the more expensive it will be. The appropriate dosage for your needs will depend on how long your procedure takes and how much you weigh.

Regarding the type of anesthesia, general anesthesia is usually more expensive than local anesthesia. This takes into account that local anesthesia is usually administered with a sedative so you can sleep through your procedure. General anesthesia may cost you between $425 and $1,800. Local anesthesia may cost you between $500 and $3,500.

The Number of Procedures Performed

Sometimes, lifting and tightening your stomach skin isn’t enough to achieve your ideal aesthetic. In such cases, you may be a good candidate for another procedure, such as liposuction. Liposuction is a fat removal procedure designed to contour an ideal body by removing excess fat via suction.

Lipo is an ideal complement to a tummy tuck because it can remove more excess fat than a tummy tuck can. As a standalone procedure, liposuction usually costs around $3,500. However, if you combine liposuction with your tummy tuck, you can save money on both procedures. Other factors that can change the cost of liposuction include the technique used and the number of areas sculpted.

Where Liposuction Can Be Performed

Liposuction can be performed virtually anywhere. It is usually used to remove excess fat from larger regions of the body, such as the back, upper or lower abdomen, sides, hips, buttocks, or chest. However, due to incredible advances in tools and techniques, it can be used to sculpt smaller parts of the body, such as the thighs, underarms, knees, chin, or neck.

Your Health Insurance

Most people think of a tummy tuck as a cosmetic procedure. In some cases, that’s accurate. But other times, a tummy tuck is considered a medical procedure. In such cases, your health insurance provider may cover the cost of your procedure and all associated fees and medications.

You may pay nothing out of pocket for your procedure. Or, if you’re having your procedure early in the year, you may pay your deductible and a small copay for your prescription antibiotics and analgesics. If your health insurance provider requires you to pay upfront and be reimbursed, apply for a CareCredit credit card so you don’t have to pay anything upfront.

How Is a Tummy Tuck Considered a Medical Procedure?

There are several ways a tummy tuck could be considered a medical procedure. However, it is important to note that it’s usually full tummy tucks that are considered a medical necessity rather than mini tummy tucks. Among the potential medical benefits of a full tummy tuck are facilitated weight loss, improvement of stress urinary incontinence, repair for ventral hernias, and less back pain.

Weight Loss and Weight Maintenance

Your health insurance provider may come to the conclusion that your tummy tuck is medically necessary if you have undergone a bariatric procedure and you have a significant amount of excess skin. This excess skin can get in the way of your legs while you are exercising, cause you pain, and prevent you from losing more weight or maintaining your current weight.

Since bariatric procedures are usually only for individuals who are suffering from a weight-related illness, there’s a good chance your health insurance provider will want you to be as successful as possible on your weight loss journey. If you gain the weight back, you will get sick again and lose your quality of life.

Stress Urinary Incontinence Treatment

Stress urinary incontinence is a type of medical condition common in women who have given vaginal birth. It is caused by a weak pelvic floor and characterized by the leakage of urine when the bladder is “stressed.” Examples of activities that can stress your bladder include coughing, sneezing, running, jumping, and laughing.

During a full tummy tuck, your pelvic region can be restructured to strengthen the pelvic floor and better support your bladder. As a result, you will find that your stress urinary incontinence-related accidents do not reoccur unless you tear your muscles during childbirth in the future or suffer some other sort of trauma to your pelvic region.

Back Pain Treatment

There are types of back pain and many potential causes of back pain. One type of back pain is muscular back pain, and one potential cause of this type of back pain is weak muscles. Your lower back muscles and the muscles supporting your spine may become weak due to chronic poor posture or a traumatic injury, such as a motor vehicle accident.

Unfortunately, it’s hard to maintain proper posture when your back hurts. Weak muscles may or may not start due to poor posture, but poor posture definitely perpetuates the painful cycle. Undergoing a tummy tuck to tighten your loose abdominal muscles may be your only option to ease back pain and improve posture.

Ventral Hernia Correction

Ventral hernias are another condition that often occurs due to childbirth. This condition is characterized by one of your intestines penetrating the wall of your stomach. If you don’t have this corrected during your tummy tuck, you will need to undergo a different medical procedure and pay for anesthesia and all sorts of fees a second time.

How Else Can I Sculpt My Ideal Body?

At The Institute of Aesthetic Surgery, we offer several body contouring procedures and treatments. To discover the perfect combination of aesthetic procedures and treatments, we welcome you to come in for a complimentary consultation. This provides us with an opportunity to examine the physical structure of your body and skin.

You have the opportunity to provide us with pictures of the look you want. Then, we can discuss together what your expectations are. Often, clients who are dissatisfied with the appearance of their abdomen are also concerned about their overall proportions. Some feel their chest is too large. Others feel their hips are disproportionately large.

Breast Reduction

If you are concerned about loose, sagging abdominal skin and breasts that are too large, you may be a good candidate for a tummy tuck and breast reduction. If you are concerned about excess fat in your breasts, we can remove excess fat via excision or liposuction, depending on the volume of fat you want to be removed.

If you are concerned about excess glandular tissue, we will remove that to make your breasts more proportional to your waist and hips. We can also remove excess skin tissue. We also offer male breast reduction to treat gynecomastia. Men who seek a tummy tuck and male breast reduction usually use liposuction to remove excess fat from their sides, too.

Breast Augmentation

Some women find that their breasts will look proportional to their waist and hips after they reduce the size of their abdomen. Others have always been confident about the size of their hips and buttocks and want to augment their breasts along with their tummy tuck to get the proportions they’ve always wanted.

The average cost of breast augmentation is between $3,800 and $12,000, depending on the type of anesthesia used, the technique used, the type of implant used, and how much volume is added to your breasts. Keep in mind that if you are satisfied with the size of one of your breasts but not the other, we can add volume to only one breast.