Occasionally, layers of the bowel can be caught up in the protrusion and this could be serious if it gets twisted or gangrenous in the hernia. Generally this situation is operated on by a general surgeon who places plastic mesh on the hole to prevent the protrusion. It fixes the hernia but not the problem that led to it in the first place. The muscular split (diastasis) remains following the repair along with the weakness (see Traditional Repair Diagram). I have seen many men and women who come to me following multiple failed hernia repairs, performed by well-qualified and very experienced general surgeons.
The very nature of the abdominoplasty surgery allows a more exposed repair which is stronger and more reliable than the traditional methods. Operative exposure of the abdominal wall during an abdominoplasty allows easy reduction of the hernia and the extending of the muscle repair from the chest to the pubis, removes the weak midline problem. With the tension shared equally down the abdomen in a muscle repair, no plastic mesh is required. Hernias can also protrude from the umbilicus (an “outy” belly button). This will need to be fixed at the time of the tummy tuck, as an “outy” belly button generally looks worse when the abdomen around it is flatter. Most of these hernias are small and are found incidentally during the operation.
Removing an umbilical hernia at the same time as the abdominoplasty can be tricky, as the blood supply to the remaining umbilicus can be affected by the hernia repair. Sometimes the umbilicus needs to be sacrificed and reconstructed with a skin graft. This should not be too much of a surprise during the procedure as generally a hernia of this size will be noticeable pre-operatively.