Hernia and Abdomen Reconstruction in Boston


Helena O. Taylor MD, PHD, FACS & Stephen R. Sullivan MD, MPH, FACS

Named Among the Best Plastic Surgeons in Boston

We enjoy collaborating with our general surgery colleagues in the treatment of complicated abdominal wall defects and hernias. When a patient has had multiple prior surgeries, multiple scars, or other complicating factors we often perform surgery as a team, to minimize risk and maximize benefit.

Abdominal Wall Reconstruction, Tummy Tuck, and Hernia Repair

This young woman had a particularly complicated form of abdominoplasty (tummy tuck) and abdominal wall reconstruction due to a past history of multiple abdominal operations as a child. Preoperatively (left), she had extensive scaring, many hernias and no obvious umbilicus (belly button). Activities that many of us take for granted, such as swimming, summer time in a bathing suit, or form fitting clothing, were a source of fear or embarrassment.

Dr. Taylor and Dr. Sullivan made a plan for tummy tuck and complex abdominal reconstruction and placed tissue expanders (center), which they slowly inflated to stretch the skin. Several weeks later, the scarred skin was then removed, the hernias repaired, and the belly button reconstructed. Several months postoperatively (right) a normal appearance has been restored and her life has been changed with scars hidden below underwear lines. She can now enjoy summer months and swimming with friends with few people knowing about her operations.

Abdominal Reconstruction Boston

Abdominal Reconstruction At A Glance

WHAT ABDOMINAL RECONSTRUCTION DOES

  • Repairs hernias
  • Removes scars
  • Recreates contour
  • Removes excess tissue
  • Liposuction of fat

DURATION OF RESULT

Years

LENGTH OF PROCEDURE

3-4 hours

TYPES OF ANESTHESIA

General Anesthesia

RECOVERY

  • Comfortably at home

TIME OFF SCHOOL OR WORK

  • 7-14 days

TIME OFF ACTIVITIES

  • Activities of daily living – 1 day
  • Light exercise – walk the same day
  • Full exercise and contact sports – 6 weeks

Preoperative Abdominal Hernia

Hernia Repair Boston

Man with history of multiple abdominal operations and attempts at hernia repair by other surgeons who is left with recurrent ventral, incision and umbilical hernias, abdominal bulge, abdominal scars. Dr. Taylor, Dr. Sullivan and Dr. Gutweiler performed abdominal reconstruction.

Diastasis Recti

Diastasis recti refers to the separation of the vertical rectus muscles of the abdomen which most often happens with pregnancy, but can also occur with age and changes in weight. This widening of the space between the abdominal muscles can cause a bulge, and weakening of the core. Unlike a hernia however there is no true hole in the fascial layer, just a thinning and lateral migration. Diastasis repair plays an integral role in most tummy tuck or cosmetic abdominoplasty procedures, but may also be performed to reinforce a hernia repair. While we often feel that this muscular repositioning is a functional or reconstructive procedure, most (dare we say all) insurance carriers consider diastasis recti repair to be a cosmetic procedure.

Postoperative Abdominal Hernia

Same man shown above more than one year after after abdominal reconstruction with Dr. Taylor, Dr. Sullivan, and Dr. Gutweiler.

The hernia was repaired using a low transverse incision, the same approach used with an abdominoplasty or “tummy tuck”. The scar is hidden in the underwear line. This approach is used to improve exposure and improve safety and recovery. The hernia was repaired with mesh using the Rives-Stoppa technique, which has the lowest rate of hernia recurrence. Abdominal wall component separation is also used to repair the muscle layers. Finally, excess skin is removed.

Abdominal Reconstruction Boston
Hernia Repair Boston
Abdominal Reconstruction Boston

ABDOMINOPLASTY (Tummy Tuck) AFTERCARE INSTRUCTIONS

  • In the week before your operation:
    • Consider eating pineapple, it may help reduce bruising
    • Consider supplementing with Arnica montana, it may help reduce bruising
    • Complete household chores and prepare meals for the first few days of postoperative recovery
    • Follow preoperative instructions with eating, drinking, and medications
    • Order two compression garments specific to your size. The garments do not need to be expensive. Dr. Taylor and Dr. Sullivan can make some recommendations of garments that can be ordered from Amazon or online.
  • Postoperatively, get out of bed and walk (with assistance) every few hours after your operation to decrease the chance of postoperative problems such as blood clots.
  • Practice 15-20 deep breaths every hour to keep your lungs open.
  • After Tummy Tuck, it is important for you to have someone available to stay with you for the first 24-48 hours, as you may feel drowsy. You may require help the first few times you get out of bed.
  • You may need to walk slightly “stooped over” (bent at the hips) for a few days to release tension on the suture line. When in bed keep your head elevated about 30 degrees (two pillows under your head and back) with the knees slightly flexed (one pillow under your knees).
  • Please take your medications as directed by Dr. Taylor or Dr. Sullivan to manage discomfort or symptoms. You are likely to be given:
    • Acetaminophen (Tylenol) 1000 mg every 8 hours, space doses 4 hours after Ibuprofen so one or the other is taken every 4 hours
    • Ibuprofen (Motrin) 800 mg or Colecoxib (Celebrex) 200 mg every 8 hours, space doses 4 hours after Acetaminophen so one or the other is taken every 4 hours
    • Gabapentin 300 mg every 8 hours for 7 days. If you have dizziness, double vision, or significant sleep disturbances, consider stopping the Gabapentin.
    • You may also be given:
    • Vitamin C 500 mg daily for 50 days
    • Oxycodone 5 mg – 1-2 tablets every 6 hours as needed for pain, though many patients may not need it
    • Colace 100 mg twice daily to prevent constipation, it is important to have a bowel movement each day. Prune juice may also be helpful.
    •  Zofran 8 mg every 8 hours if needed for nausea
    •  Scopolamine patch will be placed behind the ear on the day of surgery and can stay for 3 days to prevent nausea
  • Eat a light diet for 2-3 days and avoid spicy food. Some suggestions to ease abdominal discomfort or indigestion after surgery:
    • Drink water or warm liquids
    • Prune juice to prevent constipation

WOUND CARE

  • The drainage bulbs connected to the end of the drains should be compressed at all times to keep suction. It is normal for red fluid and blood clots to form in the drains. Please record time and amounts of drainage over a 24-hour period – we will provide a form. Usually the drains will be removed when the drainage is 30cc or less in a 24-hour period. All patients heal differently and according to many factors. On average, drains remain for about one week.
  • You may shower or sponge bath the day after the operation with assistance and wash your skin as you normally would with soap and water. Avoid soaking the incision, although It will not hurt to get a splash of water on the wounds. Avoid submerging the drains. Gently pat dry after washing.
  • Wear the abdominal binder continuously for 3 weeks after tummy tuck surgery, then for 12 hours of each day for an additional 3 weeks, and thereafter as needed for comfort. You can take it off to shower. The binder helps control swelling and fluid build-up. If the binder rubs your skin, it can be worn over a soft t- shirt. We can provide suggestions for other types of binders to order as well.
  • Most wounds will be closed with absorbable sutures that are buried and covered with skin glue. The skin glue forms a barrier to water. Please do not remove the glue, it will fall off on its own after a few weeks. Do not apply any lotions, potions, ointments, creams or solutions (e.g. no hydrogen peroxide or alcohol) as they can be harmful to the fragile healing tissue.
  • Do not smoke or expose yourself to smokers or nicotine as skin and wounds can be compromised.
  • Infection is very uncommon, but please call Dr. Taylor or Dr. Sullivan at any sign of infection which would be signaled by fever, increased pain, spreading redness or significant swelling.

ACTIVITY

  • For the first few days following Tummy Tuck surgery, raising your blood pressure and heart rate can cause bleeding. Stress on your abdominal muscles or vigorous activity could stretch or break the stitches. We recommend walking 15 minutes several times per day and gradually increasing activity tailored to your recovery.
  • Please do not drive until turning the steering wheel can be done safely and without pain (usually 7 to 10 days). Do not drive while taking pain medications such as oxycodone.
  • Do not lift anything heavier than 10-20 lbs, run, lift weights, or perform strenuous exercise for 6 weeks. You may begin having sexual intercourse approximately 4 weeks postoperatively.
  • Massage to the areas of scar and liposuction can help increase circulation and soften firm areas under the skin. Please wait at least 3 to 4 weeks after surgery to start massage to avoid increased swelling.

GENERAL OUTCOMES

  • Moderate swelling and bruising is to be expected. This is most notable in the pubic region, above and below the incision, and in areas of liposuction. Bruising may last for a few weeks and will move down your body due to gravity.
  • The incisions often appear lumpy and bumpy. This is normal and the incisions will flatten over a few weeks.
  • You may find that your clothes may not fit as easily as before. Please be patient. And because of the removal of tissue from your abdomen, a feeling of tightness is to be expected. The swelling and feeling of tightness will gradually subside over the following months.
  • You may notice that you actually gain weight following Tummy Tuck and Liposuction. This is because the body retains fluid with swelling. The swelling may persist for 6 weeks or more before it slowly decreases.
  • Tingling, itching, and numbness of the skin are all normal after Tummy Tuck. Tingling and itching are signs of healing and will resolve. Sensation usually returns gradually and slowly over weeks to months though some areas may always have decreased sensation. Please be patient and avoid resting against hot surfaces, which can injure or burn the skin.
  • Scars take one full year to mature. You may notice that they become red, raised and firm for several weeks to months before becoming soft, flat and pale. Avoid Vitamin E as it can irritate the scar. Mederma has no proven benefit and is not worth the expense. Silicone cream or skin moisturizer with sunscreen and gentle massage may be helpful.
  • Infrequently after surgery you may have fluid in the abdomen after the drains are removed. If this happens, you will notice a fullness or sloshy feeling and may even have some drainage. Please contact our office so we can aspirate it easily.
  • Please call our office (617-492-0620) if you have:
    • Continuous bleeding (a small amount bleeding from the incision is expected)
    • Significantly more swelling on one side when compared to the other
    • Worsening pain
    • Fever, spreading redness or irritation of the skin
    • Shortness of breath

It is important to be seen by Dr. Taylor or Dr. Sullivan after your operation. They will see you in follow-up appointments at 1 week, 3-4 weeks, 3-6 months, and 1 year or as often as needed post-op. Call Taylor and Sullivan Plastic Surgery to schedule your appointments at (617) 492-0620 between the hours of 8:30 – 5:00 or visit our webpage at www.massplasticsurgeons.com. We are always available for postoperative concerns or emergencies and can be reached through our paging service 24 hours per day at (617) 492- 0620.

Download our Abdominoplasty (Tummy Tuck) postoperative instructions.

Call Today 617.492.0620

To schedule a private consultation with Dr. Taylor or Dr. Sullivan, please call the office or request an appointment using our form. We welcome your visit and your questions.

300 Mount Auburn St. Ste 304, Cambridge, MA 02138

Taylor & Sullivan Plastic Surgery Boston
American Society of Plastic Surgeons American Board of Plastic Surgery Fellow American College of Surgeons America Association of Plastic Surgeons Sigill Massachusetts

617.492.0620

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300 Mount Auburn St. Ste 304, Cambridge