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

Abdominal Wall Reconstruction and Hernia 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
  • 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 or deep venous thrombosis, which can lead to pulmonary embolus
  • 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)
  • Practice 15-20 deep breaths every hour to keep your lungs open
  • Take your medications as directed to manage your discomfort and symptoms
    • Tylenol 1000 mg every 8 hours to prevent pain
    • Ibuprofen 800 mg every 8 hours to prevent pain and reduce swelling. The Ibuprofen and Tylenol should alternate such that one or the other medication is taken every four hours
    • Gabapentin 300 mg every 8 hours for 7 days to prevent pain
    • Vitamin C 500 mg daily for 50 days to prevent pain and help with healing
    • Oxycodone 5 mg – 1-2 tablets every 6 hours as needed
    • Colace 100 mg twice daily to prevent constipation
    • Zofran 8 mg every 8 hours if needed for nausea
  • Eat a light diet for 2-3 days and avoid spicy food. To ease abdominal discomfort or indigestion after surgery, drink water or warm liquids. Prune juice may help prevent constipation.
  • Keep your drainage bulbs collapsed and record time and amounts of drainage over a 24-hour period. All of our Boston abdominal reconstruction patients heal differently according to many factors. Usually the drains will be removed when the drainage is 30cc or less in a 24-hour period. Please use the Drainage Output Form to record your output.
  • You may shower or sponge bath the day after the operation with assistance. Avoid submerging the drains in water.
  • Wear the abdominal binder continuously for 3 weeks after 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.
  • Most wounds will be closed with absorbable sutures and 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. It can be trimmed as it falls off.
  • Please call Dr. Taylor and Dr. Sullivan immediately at any sign of infection which would be signaled by fever, increased pain, new redness or swelling in the abdominal area.

ACTIVITY

  • For the first few days following 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 at first and a gradual increase in activity tailored to your recovery. It is good to walk for 15-20 minutes 2 to 3 times per day.
  • Please do not drive for 7-10 days or while taking pain medications such as oxycodone.
  • Do not lift anything heavier than 10 lbs., run, lift weights, or perform strenuous exercise for 6 weeks. You may begin having sexual intercourse 4 weeks postoperatively.

GENERAL OUTCOMES

  • Moderate swelling of your abdomen is to be expected. This is most notable in the pubic region, above the incision, and in areas of liposuction should you elect to have this performed at the same time. You may find that your clothes do 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.
  • 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. Skin moisturizer with sunscreen or sunblock can be helpful. Consumer Reports has found that Trader Joe's and Walmart offer exceptional moisturizer with sunscreen for low cost. Silicone may have benefit with flattening the scar. Some silicone cream also includes sunscreen. Gentle massage of scars may also be helpful.
  • Infrequently after surgery you may have fluid build up after the drains are removed, known as a seroma. If this happens, you may notice a feeling of fullness or sloshing fluid and may even have some drainage. Please contact our office so we can aspirate it easily.

After your hernia repair or abdominal reconstruction Boston plastic surgeon Dr. Taylor or Dr. Sullivan will see you in follow-up appointments at 1 week, 2-4 weeks, 3-6 months, and 1 year or as often as needed post-op. Call to schedule your appointments at Taylor & Sullivan Plastic Surgery at (617) 492-0620 or visit our webpage at www.massplasticsurgeons.com and submit a request for us to contact you.

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 American Society of Maxillofacial Surgeons America Association of Plastic Surgeons Sigill Massachusetts

617.492.0620

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300 Mount Auburn St. Ste 304, Cambridge