AboutPeter A. Aldea, MD, FACS Expertise The entire specialty of Cosmetic Surgery and Aesthetic Plastic Surgery
Experience I have had over 15 years of experience in Cosmetic Surgery.
You may also refer to my web site for further information
Organizations American Society of Plastic Surgeons (ASPS)
Southeastern Society of Plastic and Reconstructive Surgeons
The Tennessee Society of Plastic Surgeons
Fellow, American College of Surgeons (ACS)
Publications Will gladly supply my full CV and publications list if requested
Education/Credentials - COLUMBIA COLLEGE B.A. Biology
- COLUMBIA UNIVERSITY GRADUATE SCHOOLOF ARTS AND SCIENCES M.A.-Anatomy
- COLUMBIA UNIVERSITY COLLEGE OF PHYSICIANS AND SURGEONS M.D. - 1983
- SURGERY and PLASTIC SURGERY TRAINING -
* STANFORD UNIVERSITY MEDICAL CENTER - Stanford, California - Surgery
* THE INSTITUTE FOR RECONSTRUCTIVE PLASTIC SURGERY of NEW YORK UNIVERSITY MEDICAL CENTER - Microsurgery training
* BETH ISRAEL MEDICAL CENTER, New York, New York - Surgery Training
* DUKE UNIVERSITY MEDICAL CENTER - Durham, North Carolina - Plastic Surgery
* KLEINERT INSTITUTE FOR HAND AND MICROSURGERY, Louisville, KY - Hand Surgery training
BOARD CERTIFICATIONS
* Diplomate of the American Board of Surgery 6/1/1992
* Diplomate of the American Board of Plastic Surgery 11/8/1997
* RE-Certification by the American Board of Plastic Surgery 2007
Awards and Honors Chairman, Division of Plastic Surgery, Baptist Memorial Hospital, Memphis, Tennessee – 11/17/2005 – Present
Chairman, Subsection of Plastic Surgery, St. Francis Hospital, Memphis, Tennessee – 5/7/2007 – Present
Member, Regional Advisory Board, Region 6, Blue Cross and Blue Shield of Tennessee - 2004 – Present
Medical Staff Leadership Council Committee, Baptist Memorial Hospital-Memphis - 2005- Present
Leadership Council, Methodist Germantown Hospital – 2004 – Present
Member, St. Francis Hospital – Performance Improvement / Utilization / Peer Review Committee – 2009- Present
Past/Present Clients For comments of previous patients I refer you to the testimonial page on my web site at http://www.cosmeticsurgeryspecialists.org/testimonials.html
When I wake in the morning, my stomach is flat, I have minimal pain. After being up and about for several hours (or right after I lift something), the following symptoms happen:
• a large, football-shaped hard lump appears just under the ribcage to just above the belly button. It looks like I am 6 months pregnant. The pain is right where that top 'slope' is (image attached)
• The area becomes extremely sore. I am unable to hold myself up for long. Every 15 minutes or so (going down to 5 minute intervals as the evening goes on) I have to lie flat on my back to relieve the pain
• Intense pain throughout the middle of my back. Lower back pain too but it pales in comparison to the mid-back pain
I had surgery to repair an umbilical hernia (with mesh), but unfortunately that did not solve my problems.
The only other thing I had been diagnosed with (besides the umbilical hernia) was diastasis. I read all I could about diastasis and did everything I could do but there is still a gap. If I lie flat on my back, there is a big open basin in my stomach and if I lift my head a bit, you can see the split muscles with the loose skin sinking through the middle. You could fill it with water and make a bird bath. If I roll onto my side I just feel this huge lump of something go thump on the bed and it hurts (guts?). You can see the lump too. This did not happen with my first baby. I have a small frame (my waist is 23") and lifted moderate weights up until my third trimester, so not sure if that is a factor in why this happened.
I am (was) an athlete (power lifter, figure/ fitness competitor, gymnast). After lifting, the belly looks pregnant, the pain starts and I am unable to hold myself up. I do not dare try and arch my back or twist for anything gymnastics-related. And the wrinkly skin on my stomach cancels out figure competitions. It has been disheartening to change my lifestyle for this. I'm at the point where I literally can not keep up with my kids, or go anywhere after 3pm where I would have to stand.
Could diastasis be causing all of these symptoms? My general surgeon is baffled since all other tests have come back ok (galbladder, etc.)). Could this be another type of hernia now, or one that was missed before? Would a tummy tuck solve this since they stitch the muscles back together so nothing can pop through (and would I be able to do gymnastics again eventually)? Can I even get a tummy tuck since I was sliced at the midline for my hernia repair?
Answer From Peter A. Aldea, MD, FACS
Memphis, Tennessee
www.TheBeautyDoctors.Com
Hi Laura,
I am truly sorry to hear of your predicament. It must be veruy hard for an athlete to become so limited in her activities.
Before discussing your situation, you must understand and accept that since I did not have the chance to examine you my comments can only be viewed as generic in nature and not necessarily applicable to or truthful in your situation.
First let's define HERNIA. Simply put it is the movement / translocation of an anatomical structure into a location where it does not normally belong. Example, hiatal hernia - stomach sliding into the chest cavity, inguinal hernia - lining of the abdomen by itself or with several other possible intaabdominal contents going through a weakness tunnel in the groin etc. location. In an umbilical hernia, a congenital weakness is made larger and larger by straining eventually allowing abdominal contents to go into it and later through it pooching the overlying skin.
The classical operation for umbilical hernia repair was described by the Mayo brothers at the turn of the century. The problem with ALL hernia repairs using adjacent tissues is that the tissue has sometimes been weakened and will not withstand the repair. While mesh works well in many cases, it involves introduction of a foreign body which may become infected and is not always integrated by the body.
I have a problem with the picture you submitted. The incision appears rather fresh (still has steri-strips on) and INexplicably it is transverse. The vast majority of incisions for either ventral hernias or umbilical hernias are vertical.
If I had to guess, I would say you have a REcurrence of your original hernia. The reasons could be multiple, including but not limited too mesh failure, poor nutrition, persistent coughing (are you a smoker???), poor surgical technique, etc, etc. The appearance of this round mass suggest it as does your typical pain history. A diastasis is usually painless - a hernia is not. The pain of a ventral / umbilical hernia is classically relieved by lying down and REDUCING it(putting the intraabdominal contents back into the tummy).
The ?pulsatile mass you may be feeling MAY BE the aorta, the biggest blood vessels in the body. Even in thin women without a hernia or diastasis you can feel it by lying on your back, gently pushing your left hand with the right just left of center and waiting a few seconds. (Note that feeling a pulsatile aorta in older or more obese people MAY BE worrisome as it MAY BE the sign of an enlarged aorta or an aneurysm).
Unless you failed to tell me something important, HAD your surgery been done through a vertical technique, an abdominoplasty with a good reefing (ie plication) of the six pack muscles could have fixed this problem. At this point, the tranverse incision above the belly button precludes an abdominoplasty UNLESS you are willing to accept a very high and probably visible (ie not covered by your underwear) side to side scar.
Depending on where you live (small town vs. large city), I would see another, unrelated surgeon in consultation and see what he/she says. I would advise you just say hernia when you schedule. Surgeons may not want to address other surgeons complications. I would get a copy of the chart and especially the operative note. It may be easier to get it from the hospital rather than upset your relation with the surgeon by asking for it.
Hope this helps.
Sincerely,
Peter A. Aldea, MD, FACS
Memphis, Tennessee
www.TheBeautyDoctors.Com
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