By Tiffany Ran
Northwest Asian Weekly
She had her baby five months ago. But a medical condition that can be life-altering makes Jennifer* appear as if she is still six months pregnant. Now, a new procedure is giving new hope to Jennifer and others like her.
In surgery, Dr. Helen Kim can see, with the naked eye, that the fascia — a band or sheet of connective tissue underneath the skin akin to the tough silver skin that encapsulates beef or pork — over her patient’s abdominal region was nothing but a barely there white film, damaged and torn.
Normal, healthy fascia, which sits both above and below the abdominal muscles, is usually three-eighths of an inch thick, sometimes more.
In the patients that Kim has operated on in recent years, she has seen such barely there films of weakened fascia lead to hernias and diastasis recti, injuries prevalent in both men and women. This is more common in postpartum women who have had large babies or many children.
Kim hopes to reach a target audience of petite women, including Asians and Asian Americans who are particularly affected by large weight gain during pregnancies. While many women can have children and recover fully, others, especially those with petite frames, may be at risk for developing tension in their abdominal wall that does not repair itself after childbirth.
Jennifer, a young Indian mother and one of Kim’s patients, was once a skinny 5-foot-5. After giving birth to a daughter and son, both born around eight to 10 pounds, she went to her gynecologist with a painful umbilical disfigurement that limited her activity, one that was growing more painful each day.
“I was having difficulties lifting the baby. I also worked full time and was coming and going from work. I’m the kind of person who has a high tolerance for pain, so even if I had to lift my baby, I would just lift her with the pain. It was becoming more and more severe. It was affecting my lifestyle and at the end of the day, I just couldn’t do anything. I couldn’t move,” said Jennifer.
She experienced pain and sensitivity in her stomach with certain movements, and the pain also spread from her back to her legs. Though a hernia was not visible through ultrasound, her gynecologist found that she suffered from diastasis recti and may likely have a hernia as a result of childbirth.
THE CORE OF THE PROBLEM
In every initial appointment, Kim explains the difference between the two conditions through a series of drawings. She draws a series of lines to detail the layers of our abdomen, including the skin to subcutaneous fat to the anterior and posterior fascia that enrobes a layer of abdominal muscle sitting on the peritoneum that rests above the abdominal cavity and organs.
Kim describes the fascia as the scaffolding that holds the muscles midline and in place, the structure behind what fitness gurus call “the core” of our bodies.
When that scaffolding is weakened or damaged, the floppy muscle, and often the organs behind it, protrudes forward creating a visible lump or mass that juts out of the stomach (a hernia).
Or, when the fascia between the two vertical abdominal muscles is nothing but a mere film, the two muscles separate from one another creating a gap that cannot be healed naturally or through exercise (diastasis recti). Often times, the women who come to Kim suffer from both.
Kim recalled one of her most challenging patients, a petite woman whose hernia was so prominent that she was able to see intestinal movement from the taut outer skin of the patient’s stomach.
A patient she saw recently came to her with a six- by 10-centimeter bulge that can be pushed inward, but would naturally flop out if it’s let go. Many women with these problems resort to wearing a belt to keep their muscles and organs from spilling forward.
With damaged fascia, there is a lack of tension to withstand the pressure and weight of the abdominal wall, which can lead to worsening spine curvature, back pain, or bowel displacement.
“The other thing I’m told, often tearfully, is that many people ask if [these patients] are pregnant or not. The patient I saw yesterday was saying, ‘It’s like having nothing in your abdomen, so when I pick something up, there’s no strength there.’ She can’t pick it up without [the hernia] pushing out, so she has to hold it in. It’s a challenging circumstance for anyone to live that way,” said Kim.
“My own mother, now that I think back on it, she had six children, and I always noticed that her arms and legs weren’t really heavy, but she had this big round abdomen for as long as I’ve known her,” she recalled.
Even five months postpartum, Jennifer’s disfigurement made her appear like she was still six months pregnant.
Unlike many basic hernia repairs across the country, Kim is among the few practicing a component separation surgery, coupled with an abdominoplasty (“tummy tuck”) for those with excess skin. The procedure tackles both the functional and aesthetic challenges of the condition. In the past, a patient would have to go under the knife under two different doctors for both procedures. Now, both can be done in one go, under one anesthesia.
“A general surgeon does hernia surgery, but we’re saying, let’s do it in an aesthetic way. Let’s do it in a way that’s lasting using materials that are biologic and giving you a lifetime repair. Really, it’s a true abdominal wall reconstruction, that’s the best way to describe it,” said Kim.
Traditional hernia repairs were focused on suturing or closing the gap, which often failed to reinforce tension in the abdominal structure. These surgeries evolved and incorporated synthetic mesh, which had their own limitations. The mesh often shift or shrink.
However, the development of a porcine mesh, a natural mesh biologically derived from pig skin, has helped to revolutionize the procedure.
Kim’s procedure reconstructs the abdominal section layer by layer: closing the peritoneum to contain the bowel, closing the anterior fascia, and carefully sizing and placing the porcine mesh, which she fastens in a retro rectus position with anchoring sutures. The mesh will integrate fully with the body (the pig cells dissolve within months) and act as a regrown fascia that corsets the abdominal muscles into its original place.
“Most general surgeons take out the bad organs or fix the problem, but rarely get to see the difference. But when you can see that you’re aesthetically and functionally repairing the abdominal wall, it feels really good,” said Kim.
Though the cosmetic aspect was less of a concern for Jennifer, she reports that the entire procedure, including the abdominoplasty, has helped her feel like her old self again.
“Aside from the cosmetic aspect, I can now exercise with no restrictions. For me, the most important aspect is that I can be active with my family and my kids,” said Jennifer.
So used to such restrictions, Jennifer asked Kim what other concerns she should have now that she’s done the surgery.
“You’re all set,” Jennifer recalls Kim saying to her, “Go live your life.”
*Name assigned to ensure anonymity at the patient’s request.
For more information about Dr. Helen Kim or to schedule an appointment, visit overlakehospital.com.
Tiffany Ran can be reached at firstname.lastname@example.org.