Dr. Ron Israeli of New York Breast Reconstruction and Aesthetic Plastic Surgery (NYBRA.com) and Dr. George DeNoto, Director of General Surgery and Hernia Institute, St. Francis, Hospital, East Hills New York, discuss the technique they have developed together in Episode 5, abdominal wall reconstruction, for the DiepCJourney Podcast.
I hear from patients in the DiepCJourney Facebook group who requests information on various topics. This is one of those honored requests and I knew exactly who to turn to. I invited Dr. Israeli to do the podcast. To my pleasant surprise he asked if he could be joined by his colleague, Dr. George DeNoto. These two gentlemen have known each other for a while when they trained together in General Surgery. They refer to each other as “surgical brothers” leaning on each other as resource and eventually collaborating on a technique to repair hernia after TRAM flap surgery.
Abdominal Wall Reconstruction Technique
They have modified and perfected their technique over the past 20 years. Post-operative bulges in TRAM breast reconstruction patients were treated in a different way in earlier days before they developed their technique. They took an anatomic approach to repairing the abdominal wall rather than just patching the defect. This approach allows them to reconstruct the abdominal wall providing a more normal anatomy to achieve stable outcomes.
What they realized is that patients were not having recurrences of the bulge or hernia. This was also a less invasive surgery and quicker recovery. The initial cases were presented in 2009 in their study when TRAM flaps were the primary method of performing breast reconstruction.
When Abdominal Bulges Were Not Seen on Scans?
CAT scans often did not show the bulge. Dr. DeNoto states they began analyzing the scans more. They noticed the muscular components of the abdominal wall were separating. Just putting a piece of mesh underneath and suturing it in was not good enough. The mesh would just bulge with the bulge. They carefully examined the underlying muscles that a radiologist was not noticing on the CT scan.
When patients notice this bulging, especially if it stretches out and grows over time, it can really begin to affect a patient’s quality of life. This is when patients need to begin to explore abdominal wall reconstruction. Day to day living activities can be affected and the surgery can improve these conditions. Dr. Israeli and Dr. DeNoto understand the pathophysiology of this problem and are able to address it.
If a radiologist reads a CAT scan and there is no visible bulge or hernia when the patient is lying down, or they do not recognize it on the scan, and yet when the patient is standing up clearly has a bulge, it is time to see a surgeon who specializes in abdominal wall reconstruction.
Episode 5 Abdominal Wall Reconstruction and Recovery
Dr. Israeli and Dr. DeNoto present at medical conferences with the hope more and more surgeons will adopt the technique they have worked years to develop and improve. Additionally, they recommend a patient who has undergone this procedure follow up with a physical therapist. Dr. Israeli encourages patients to explore Pilates to help strengthen core muscles when they are released to do so by the surgeon.
I am grateful to both of these surgeons for their time and sharing the technique they developed for abdominal wall reconstruction. You can listen to Episode 5 here.