Mini Tummy Tuck and Hernia Repair

A mini tummy tuck is a great way to get rid of loose skin and excess fat after having a baby. It can also help you feel confident about your appearance, even if your body isn’t returning to its pre-pregnancy state as quickly as you’d like it to.

This procedure is less invasive than a full tummy tuck, so there’s less risk involved. But it’s still a major surgery that requires careful planning and preparation to ensure the best possible outcome. In this post, you’ll read about hernia after tummy tuck symptoms and tummy tuck with hernia repair cost.

Mini Tummy Tuck With Umbilical Hernia Repair

What is a mini tummy tuck?

A mini tummy tuck is a procedure designed to remove excess fat and tighten skin on the lower abdomen, hips and thighs. It’s usually performed in combination with other procedures, such as liposuction or breast augmentation surgery. The goal is to restore your body’s natural shape while giving it a youthful appearance without going overboard with aggressive surgical techniques that could leave scars or cause significant complications down the line.

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 a 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 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. 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.

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. 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 though it 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 hernia sac back into the abdomen. The best way to restore the anatomy of the abdominal wall in a tension free manner, is through the placement of a polypropylene mesh. The Mayo technique and its alterations could not stand the test of time and it show a recurrence rate of 20% or higher. Although there is no consensus opinion, anatomic repair without tension and without an artificial enlargement of the defect is clearly the new trend in hernia repair techniques. In 11987,Lichtenstein reported on 6321 cases of inguinal herniorraphy with a tension free repair, and in 1994 Stuart reemphasized that special importance in his editorial in the Lancet. A newer study from Brancato 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

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 not 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.

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 C and categorized as a type II.

Preoperative marking was done following the type II abdominoplasty described by Pontes R. 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. According to Psillakis’ description in his paper, the navel was unhooked from its insertion on the aponeurosis and left attached to the flap. This technique allowed us to get to the hernial area to repair the gap. The Alba line was opened and the hernial defect was identified, isolated and 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.

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.

We find this approach suitable for those people who need a surgical repair of an epigastric hernia and have such conditions:

• Laxity of the skin in the lower part of the abdomen.
• High position of the navel.
• Patients refused a midline vertical scar.

Roberto Grella M.D., Ph.D.: study design, writing the article. Sergio Razzano, M.D.: writing of the article, drawings. Rossella Lamberti, M.D.: analysis and interpretation of data. Trojaniello Biagio, M.D.: data collection and study design. Francesco D’Andrea, M.D.: final approval for the article to be published. Giovanni Francesco Nicoletti, M.D.: review of the article.

An abdominoplasty, or tummy tuck, is often viewed as a purely cosmetic procedure that can help you slim your waistline. While it is true that the surgery can give you a shapelier figure, the procedure can also be an opportunity to address certain medical conditions.

Board-certified plastic surgeon Dr. Lisa Hunsicker is skilled and experienced in body contouring procedures. She understands that every patient is unique, and she is very thorough in gathering the information she needs to make quality medical and aesthetic recommendations for you. With this foundation, Dr. Hunsicker delivers a high level of care and beautiful results.

Umbilical Hernia Repair with Mini Tummy Tuck

Umbilical hernia repair can be done with a tummy tuck procedure to achieve a more aesthetic midsection. An umbilical hernia may be congenital or may develop in adulthood as a result of multiple pregnancies, obesity, or other medical conditions. Generally, umbilical hernias in adults are the result of a weak abdominal wall, which can be tightened in a tummy tuck procedure.

Umbilical hernias appear as a bulge near your belly button. You may experience discomfort and pressure in your abdomen, and you may be self-conscious about the appearance of the hernia.

If you have additional concerns about your midsection, a tummy tuck procedure may be a good solution to both repair your umbilical hernia and address issues such as:

• Loose, sagging skin – Pregnancy and weight fluctuations can cause skin to lose elasticity. Skin folds can rub together and get irritated, and it can be difficult to look and feel your best in form-fitting clothes or beach wear.

• Diastasis recti (separated abdominal muscles) – This condition can occur as a result of pregnancy or significant weight fluctuations. When the abdominal muscles are stretched or torn, your stomach will protrude. Dr. Hunsicker can tighten and repair these muscles to firm and flatten your abdominal area.
• Excess fat – A tummy tuck procedure allows Dr. Hunsicker to remove stubborn fat from your abdominal area to slim your waistline.

Combining a Tummy Tuck with Umbilical Hernia Repair

If Dr. Hunsicker finds an umbilical hernia during your exam, she will refer you to a general surgeon to determine if it can be repaired during your tummy tuck procedure.  If your general surgeon finds that it is safe to combine the procedures, he or she will will be present at your tummy tuck surgery to perform the hernia repair.

The combined procedure begins with the tummy tuck incision, which is made around the navel and extends from hip to hip. The general surgeon will place the herniated tissue or organ behind the abdominal wall to repair the hernia. Dr. Hunsicker will tighten the weak or damaged abdominal muscles. She will also remove excess skin and fat and then place the skin and tissue to create a smoother, firmer abdomen. The final step is to close the incision.

Tummy Tuck With Hernia Repair Cost

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 provide 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 that 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.

Will Insurance Cover my Hernia Surgery and Tummy Tuck?

Abdominoplasty is generally not covered by insurance. We offer several financing options, including a deferred interest plan, so you can select a payment method that works for you.

Your insurance may cover your hernia repair if it is medically necessary.  The general surgeon’s office can assist in determining coverage for this procedure.

Hernia After Tummy Tuck Symptoms

Lump or protrusion in the abdomen at or near the site of a previous incision; the patient may be asked to stand and cough, which tends to make the hernia more pronounced.

• Nausea, vomiting, fever or rapid heart rate
• Pain in the abdomen, especially around the protrusion
• Previous surgeries, locations and outcomes