The operation is always under general anaesthetic and is performed as an in-patient procedure. The usual length of stay in hospital is 4-5 days.
The procedure is performed in three stages
1. The plastic surgeon will perform the skin incision and dissection of the abdominal wall just as it is done in an abdominoplasty. The skin incision extends from hip bone to hip bone or even a bit further. The skin and soft tissues are freed along the muscle fascia right until just below the rib cage. The navel is completely freed from the surrounding skin, but its stalk is left intact.
2. The abdominal/visceral surgeon will then take over and repair the hernia or abdominal wall defect, often using an absorbable or non-absorbable mesh.
3. The plastic surgeon will then estimate the amount of skin/fat excess by pulling the freed up skin and soft tissue downwards. The excess removed so the wounds can be closed without tension. The navel is brought out through a separate incision at its anatomically correct height and also sutured in. In some cases, especially in large umbilical hernias the navel must be removed.
Both the deep and superficial (skin) sutures are made from absorbable material and do not have to be removed.
Since the wound areas are usually quite large at least one or multiple drains will be placed into the wound through the skin during surgery. These prevent excess wound secretions and blood to accumulate inside the wound cavity, which may cause healing problems. The drains are removed once the output is minimal (usually when less than 30ml/24h).
A binder or compression garment must be worn for 4-6 weeks after surgery day and night.
You will be allowed and also encouraged to get out of bed and mobilize freely immediately after surgery. For the first few days it is recommended to do so slightly bent over. You will need to avoid any strain on your abdominal wall. This includes applying manual pressure on your abdomen when coughing and sneezing.
The dressings can usually be left intact after discharge until your first follow-up appointment. You may shower over the dressings, but should not bathe or swim until the wounds have healed.
Every day activities and light work (e.g. office work), including driving, can usually be resumed about 1-2 weeks after surgery. Lifting heavy objects weighing more than 5 kg (including children) and physical activities (sport) should be refrained from for at least 6 sometimes even 12 weeks.
Routine follow-up appointments with your surgeon will be at 1-2 weeks, 6 weeks, 3 months and 1 year after surgery.
As with every surgical procedure herna repair with abdominoplasty is associated with both anaesthetic and surgical risks. Preexisting conditions such as Diabetes, obesity, heart and blood vessel diseases, immune diseases and smoking significantly increase the risk of complications.
General complications of all surgical procedures include:
Bleeding/Hematoma, infection, thrombosis (including pulmonary embolism)
The most common surgical complications after herna repair with abdominoplasty are:
- delayed wound healing or wound breakdown
- unsightly or asymmetrical scars
- permanent numbness of the skin
- loosening of the muscle fascia repair/ recurrent bulging
- compromised blood supply to the navel, in extreme cases loss of the navel
- skin necrosis
- injury to intestine or other internal organs, adhesions
Do I need to stop my own medication prior to surgery?
Most medication can be continued normally. Some drugs such as blood thinners (e.g. Aspirin or Warfarin/Marcoumar) can increase the risk of postoperative bleeding and may need to be stopped or replaced before the procedure. We ask you to bring a complete list of all your medication and their dosages to your first consultation.
Does my GP need to perform or organize any special investigations or tests before surgery?
Before any surgery the surgical team including the anaesthetist will need to be aware of any preexisting conditions (especially cardiovascular or lung diseases) which may be associated with an increased anaesthetic risk. Previous abdominal surgery can also pose an increased risk of surgical complications and can have an impact on the surgical strategy and technique. In case of a suspected hernia a CT or ultrasound is usually recommended to assess its size and extent.
We ask you to provide as much detailed information on your past medical history as possible when you come for your preoperative consultation so we can coordinate any necessary tests with your GP.
Do I need to stop smoking before surgery?
We seriously recommend stopping all nicotine consumption, including smoking at least 6 weeks before any surgical procedure. One of the most common complications following any type of surgery is delayed wound healing or wound breakdown. The main cause of this is usually bad blood circulation to the skin and tissues in the operated area. Nicotine is a chemical substance, which causes blood vessels in the body to constrict (narrow). This lowers the blood circulation to the wound and significantly increases the risk of complications.
Why is it necessary to cut out and reposition the navel for an abdominoplasty?
In order to tighten the skin and soft tissues of the abdomen they must be pulled downwards. A full abdominoplasty usually involves removing most or all the skin and fatty tissue below the navel. If the navel were not repositioned it would come to lie just above your pubic area, which would look very strange.
What happens if my navel dies off?
The navel is actually merely a thick strand of scar tissue going from the skin down to the muscle fascia. It is a leftover from your umbilical chord and serves no function after birth. Especially in people with a very thick layer of fatty tissue this strand can be quite long so that when the navel is cut out from the skin around it and a large part of its blood supply is removed. The remaining blood supply running along the strand itself may then not be enough to keep it alive. In the rare occasion that the navel does die off completely it will have to be removed and the skin closed over it directly. If desired a new navel can be reconstructed at a later date.
Can the repair/tightening of the muscle fascia tear and is that dangerous?
When the fascia is tightened with sutures over a period of 6-12 weeks a strong scar is formed in that area. This scar is actually what holds the repair together long-term and not the sutures. Overexertion of the abdominal muscles in the first few weeks after surgery when the scar has not fully formed can lead to the sutures pulling out and the repair failing. This is certainly not dangerous and does not need any urgent treatment, however the cosmetic and functional outcome of the operation may be compromised.
What happens if I become pregnant after an abdominoplasty with tightening of the muscle fascia?
Carrying out a full term pregnancy is usually not a problem after an abdominoplasty as the tissues outside of where the fascia was tightened can stretch with the growing baby just as they would normally. We do however not recommend undergoing an abdominoplasty if you plan on having (more) children as the surgically tightened soft tissues will get stretched again and may reverse the cosmetic result.
Are there any activities I won’t be able to do after surgery?
It is usually recommended not to engage in any activities straining the upper body for 4-6 weeks after surgery. These include lifting heavy objects (greater than 20kg) and physical activities such as jogging. Once the healing period is over there are no restrictions.
I have had previous abdominal surgery and have a long scar on my abdomen. Can I still have an abdominoplasty?
This depends on the location and course of the scar. The surgical technique may have to be modified as not to risk extensive tissue necrosis. The decision whether or not it is possible at all would have to be made individually.
I have had a cesarean section. Can I still have an abdominoplasty?
Yes you can. The cesarean scar can be incorporated into the abdominoplasty skin incision so you won’t have any additional scars.
What happens when I develop a seroma?
A Seroma is a fairly common complication after any operation involving a large wound cavity. The seroma merely a collection of wound secretions and is not dangerous. It can however be quite uncomfortable and cumbersome. Small amounts of fluid can just be left alone until your body absorbs them by it self. Larger fluid collections may need to be drained with a needle. This can be done during a regular consultation and is usually painless. In some cases repeated drainages over a period of a couple of weeks are necessary until the fluid build up stops completely. Kompression garments or an abdominal binder can reduce the risk of seroma formation.
How long before I can go back to work after surgery?
This depends on your work. Light duties, such as office jobs can usually be resumed after about 2 weeks. Lifting heavy objects and activities that strain the abdominal muscles should be refrained from for at least 6 weeks.
Especially if you have small children it is important for you to plan and ensure enough support for their care other household chores during your recovery period.
Will I get a sick certificate for the time I am off work?
Will my health insurance cover the costs for the surgery?
The treatment of the herna will definitely be covered by your insurance provided it is clinically proven. The cover of the additional costs for involvement of a plastic surgeon to perform the abdominoplasty at the same time must be requested specifically prior to surgery.
Will my health insurance cover the costs of treatment if I develop any complications requiring medical treatment, hospitalization or even further surgery?
Yes, provided the complication is purely medical, e.g. an infection.
Corrections of aesthetic complications are not covered.