Hernia Repair and Tummy Tuck

I haven't even got my band yet, and I'm already thinking about future PS. I have a huge incisional hernia from three prior abdominal surgeries. The scar is all stretched out since it's hard to heal properly after three cuts in the exact same spot.

The hernia starts right under my belly button, and is about 6 inches long, and several inches wide. When I lie down on my back, the "innards" settle back into place, and it's like a gully down my tummy. Heck, if I could just get the hernia repaired, I'd lose several inches off my waist.

The hernia repair will be more successful if it's done when I'm close to goal weight.

Has anyone had a large hernia repaired along with a tummy tuck? Any pictures? How well did your insurance cover the tummy tuck portion?

Interesting that I ran across your post this morning. A friend and I work talking just yesterday on how usually a tummy tuck would be covered w/the hernia repair because you do have the hernia. Usually tummy tucks are considered cosmetic but w/the issue of the hernia it should be covered. I guess you will never know until you contact your insurance.
Good luck
Jennifer

Insurance coverage for this is a very compicated issue. Insurance will cover a hernia repair. Sometimes, insurance will also cover the removal of excess skin at the same time because the argument can be made that the apron of skin must be removed in order to allow the surgeon to repair the hernia......However, this is a panniculectomy, not an abdominoplasty.

A panniculectomy is removal of the excess skin, or "pannus", than hangs.
An abdominoplasty is removal of the excess skin, repair of muscles, and replacement of the belly button.

So, insurance should pay for the hernia repair and the time in the operating room to do this (about 1 hour). They might pay for a panniculectomy(reconstructive), but will not pay for an abdominoplasty (cosmetic). Because of the hernia repair, insurance shuold also pay for an overnight stay in the hospital.

Check with your insurance carrier about the specifics. Also check with your surgeon and do not be surprised if you have to pay some out of pocket. Oftentimes, the surgeon does not know if the insurance will pay for the procedure until after it is done. A pre-authorization is not a promise to pay, and insurance companies can "change their mind".

I told you it can be comlicated...

Dr. Schulman,

Thank you for the reply. Since my hernia is excessive in size, in my opinion, would it be more likely to be able to be corrected in a way that could be similar to a tummy tuck? Is there any phrasing that could be used to encourage "tightening up" during the hernia repair, and therefore getting the surgery covered by insurance?

The hernia is the result of three abdominal surgeries with mid-line incisions. The incision begins approximately 2 inches above my navel, takes a turn to the left to bypass the navel, and then continues down for approximately 8 inches. The scar above the navel is relatively normal (for a scar), but then the navel is canted upward, in a comma-shape.

Under the navel, the hernia bulges out, and is about three inches wide. The scar in this area has stretched out due to the hernia. When I lie on my back, and the intestines settle back into their semi-proper place, there is a gully on my abdomen that can get about 1/2 to 1 inch deep.

I have to place my hand against my lower abdomen when I sneeze or cough, or I will hurt.

I don't know if I would have enough excess skin for a panniculectomy, since most of the excess apppears to be just the bulging area of the hernia.

Thank you for any further thoughts.

What you describe is unfortunately very common in overweight people who have had multiple abdominal surgeries. It sounds to me that you would be a candidate for abdominal wall reconstruction with a component separation. During this procedure, an incision is made, and the hernia is repaired by moving some the muscles from the flanks, towards the center to close the hernia. Depending on the size, this can be done on both sides. The incision can be either through the midline (where your scar is) or through a tummy tuck incision, which might get rid of that midline scar at the same time. Commonly, extra skin is removed during this procedure. The abdominal wall is routinely made "tight" during this operation.

That being said......This is a large operation (but commonly performed by board certified plastic surgeons) and you might get a better aesthetic result (ie. tighter, flatter, thinner...) if you lose a large portion (if not all) of your weight before doing this. Because your hernia sounds large, there is actually LESS chance of any intestine getting incarcerated ("stuck") as compared to a small hernia with a narrow opening. This means that it is uncomfortable and unsightly...but not an urgent matter right now. If the bulge gets "stuck" and you can't push it back, or you have increased pain, or vomiting, then you should obviously see your doctor right away.

I hope this information helps.

Remember this is just my opinion based on the few details that you described and should never take the result of an actual consulation with your doctor.

Dr. Schulman, Again I want to thank you for the reply. I know that my weight has contributed to the hernia, and that's one of my big motivations for the Lap Band.

Your information will help so much when I lose this weight and start looking for a plastic surgeon.

have a wonderful day!