The abdominal wall may be involved in numerous surgeries over a patient’s lifetime for a variety of clinical reasons. One of the most common procedures we perform is the correction of a previous Caesarean section, which may require surgery at various levels: cutaneous, subcutaneous, muscle-aponeurosis and intra-abdominal.
At the cutaneous level, one of the main defects is the scar left by the Caesarean birth (dysmorphic or keloid), which may be irregular and/or hypertrophic. As well as the unsightly appearance of keloids, clothes worn over the abdomen may irritate and compress the scar, causing discomfort and inflammation. At subcutaneous level after Caesarean section, patients may experience scar retraction, causing the effect known as a belly pooch, particularly evident when standing up, since the scar remains in a fixed position deeper in the skin, while the overlying skin and fatty tissue hangs downwards. At aponeurotic level there may be a weakness in the muscle wall, causing a hernia at the site of a previous incision (hence the name incisional hernia). A common finding is abdominal adhesions inside the abdominal cavity. These are asymptomatic in some cases, while causing severe symptoms in others.
When choosing surgery to correct a previous Caesarean section, it is important to consider all of these aesthetic and clinical aspects to ensure that all issues are resolved. We normally treat these issues individually, or in association with reconstructive surgery to treat diastasis recti if necessary. We also treat the outcomes of other previous abdominal surgeries.