Umbilical or Belly Button hernias are common after pregnancy. During pregnancy the abdominal wall stretches in the midline to accommodate the growing baby. This can leave the abdominal wall with spreading in the midline which is referred to as a diastasis recti, and it can also stretch the umbilical ring which is a natural weakness in the abdominal wall. This stretching at the umbilicus can create a hole through which fat or abdominal contents can bulge through, also referred to as an umbilical hernia.
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- Previous surgery in this area, like a laparoscopy, also makes the area prone to weakness.
The danger in an umbilical hernia is that the hernia contents can get trapped in the hernia, called an incarceration, or squeezed, called a strangulation. These situations can lead to intestinal blockage and injury to the intestine, which may necessitate urgent and emergent surgery.
- Stretching of the abdominal skin and fat during pregnancy can also lead to excess wrinkled skin and the aforementioned diastasis recti, which are the main indications for abdominoplasty.
Ironically, umbilical hernias are encountered commonly during the initial consultation and examination for an abdominoplasty. Commonly, the umbilicus may appear stretched with a soft marble type mass in it, and/or it may appear to more of an “outy” than an “inny”. Sometimes, the fascial defect can be palpated, but often there is fat trapped in the umbilical hernia.
An umbilical hernia can be repaired safely during an abdominoplasty, if it is small and not a secondary hernia. The risk of repairing an umbilical hernia at the time of an abdominoplasty is injury to the blood supply to the umbilical skin.
- The umbilicus has three blood supplies and after incising around the umbilicus in the abdominoplasty, one if not two of the blood supplies are routinely severed. During the dissection of moderate to large umbilical hernias, the remaining blood supply may be injured leaving a belly button without any ability to survive.
The ramification is the loss of the umbilical skin, which ironically is how the umbilicus forms, but if the umbilicus does not survive it may jeopardize the underlying repair, which could lead to infection if mesh is used. Therefore, conservative umbilical hernia repairs with suture techniques can be performed, but larger repairs should be performed before any abdominoplasty procedure is performed.
- In an mini-abdominoplasty, the blood supply to the umbilicus is preserved and umbilical repairs can be performed without risk of umbilical issues.
Dr. Trussler in Austin Texas can discuss abdominal hernia repairs at the time of abdominoplasty during your consultation. An individualized and safe plan will be determined which can be incorporated into your abdominoplasty (Tummy tuck) surgery and recovery.
