Hopefully things will improve for you in the next few weeks x, Hi Simi thought I would try to help as you have not had any replies. J Plast Reconstr Aesthet Surg. HHS Vulnerability Disclosure, Help an In a DIEP flap, fat, skin, and blood vessels are cut from the wall of the lower belly and moved up to your chest to rebuild your breast. Remember you are still in the early days after surgery though so take things at your own pace and build up gradually but these are the things that helped me x. I am sorry that you havent had any response to your post as yet. 0000025202 00000 n
Below are a few tips along with comments about what its like (for me) at one year post DIEP. I do hope that as time goes on your symptoms will improve. 0000056003 00000 n
Developing an abdominal wound postoperatively and sacrificing nerves both correlated with an increased incidence of bulge or hernia (p < 0.05). Surg. While we do connect people with vetted, board-certified doctors, we dont provide medical consultations, diagnosis, or advice. The DIEP flap is the most common tissue flap procedure performed at the Friedman Center due to its natural-looking results. /ItalicAngle 0
Do not massage the incisions until we instruct you in the office (six weeks after surgery). 0000020810 00000 n
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Or maybe because the tightness in the abdomen is stressing other muscles? Several authors have investigated the results of reconstructed breasts, but the literature lacks systematic reviews exploring the donor site of the abdominal wall. Our team can help you navigate surgical options from facelift and browlift to necklift and eyelid rejuvenation. /ID [<6cab70be4dea15dd21e857ec41666766><6cab70be4dea15dd21e857ec41666766>]
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WebThe abdominal DIEP flap is now considered the gold standard for perforator flap reconstruction, but also the thigh-based PAP flap has proven to be a safe alternative [9,11,22,23]. Statistical analysis was performed using the SAS System and the Fisher exact test. 46 38
WebThe length of surgery varies from 6-10 hours. Reconstr. During that time frame they wear a compression garment over the abdomen, avoid lifting object That's a very good question. <<
If youve had prior abdominal surgery, you may not be a candidate for breast reconstruction using abdominal tissue. One breast becomes suddenly significantly larger than the other breast. DIEP and pedicled TRAM flaps: A comparison of outcomes. Results: Of the 644 patients, 23 (3.6%) had a clinically significant bulge or hernia on exam postoperatively. /FontName /NGLDJC+TimesNewRomanPS
In addition to nose-reshaping, our surgeons perform procedures that can alleviate breathing difficulties associated with deviated septum and internal nasal blockages. -, Mathes S.J., Nahai F. Classification of the vascular anatomy of muscles: Experimental and clinical correlation. 2016 May;69(5):598-603. doi: 10.1016/j.bjps.2015.11.007. DIEP refers to no muscle being taken up with flap (the abdominal tissue that is transferred to the chest). government site. Please enable it to take advantage of the complete set of features! Your tummy is likely going to always feel a bit tight after DIEP flap surgery. Craigie J.E., Allen R.J., Dellacroce F.J., Sullivan S.K. Regular exercise like running or other kinds of muscle training doesn't cause any pain. Sixteen studies reporting DIEP outcomes and 23 studies reporting free TRAM outcomes were used to estimate pooled complication rates. [Myosonographic evaluation of rectus abdominis muscle function after DIEP flap breast reconstruction]. /ArtBox [ 9 9 603 801 ]
Your incision and belly button are covered in a special medical grade sealant, which will come off in the office, two-three weeks after surgery. Each of my patients is put into a physical therapy program for DIEP flap patients.This program is used starting 1 to 2 weeks after surgery. Abdominal wall morbidity is classified as: type 1 abdominal weakness; type 2 smaller, unilateral abdominal bulge; and type 3 true abdominal hernia or large bilateral bulge. and Teotia, {Sumeet S.}". Collins Dictionary of Medicine Robert M. Youngson 2004, 2005 Patient discussion about abdominal Q. Health care providers recommend an abdominal ultrasound to screen for an aortic aneurysm in men ages 65 to 75 who smoke or used to smoke. Very small incisions are made through the muscle to access these vessels, which are reconnected to the new blood supply in the chest. Is there any way to find out what happened and remove the pain? Do not take a bath or submerge yourself in water. Meta-analysis of flap perfusion and donor site complications for breast reconstruction using pedicled versus free TRAM and DIEP flaps. /Length 223
They may feel completely different at first but over time, they will soften and feel more comfortable. So, it is with your abdominal area after DIEP flap breast reconstruction. Your newly altered tummy will have a sewn up, tight, feeling but over time will soften. I want to share a few of my own thoughts after my DIEP flap surgery. If you are comfortable, you can begin to pinch the area around the scar as tolerated. /Root 46 0 R
Robotic DIEP Patient Selection: Analysis of CT Angiography. <<
We will instruct you to shower once you have drains removed from your breasts in the office. Take an over the counter baby aspirin (81mg) daily for three weeks. Abdomen Definition. Results: Ninety patients (54 {$3.1l`7!fgZcTj8_Fu The type of DIEP flap post surgical garments you will wear may very depending on your plastic surgeon. 7](8t&Y.emQZ:c#gc8&1'6c0?G,`e`X9x(yo'w/w_8x:h;BpQccSyst#xcf9 HvIz]u{d[E#m$$r~"'L8iwv?RQII&Fe!=H'@?W;0P>r{>i//^U5_6Q(D- Such screening isn't recommended for people who've never smoked. The usual hospital stay for a DIEP flap procedure is 1-3 days. 0000057548 00000 n
You may take sponge baths following discharge. If you would like a nurse to respond to your post please let us know or you could post a question to the nurses on our Ask Our Nurses area of the Forum. But I feel this piercing pain on the left side of my lower abdomen every time when I do exercise like sit ups. Once my tummy wounds had closed, I did find moisturising and gentle massage helped. 0000001229 00000 n
Meta-analysis of Observational Studies in Epidemiology (MOOSE) group. Patients in the umbilicus sacrificing cohort had an increased incidence of weakness (p < 0.05). /Type /Catalog
Just wrote an indepth edit to the Post and it vanished. While we do connect people with vetted, board-certified doctors, we dont provide medical consultations, diagnosis, or advice. eCollection 2022. Abdominal wall morbidity is classified as: type 1 abdominal weakness; type 2 smaller, unilateral abdominal bulge; and type 3 true abdominal hernia or large bilateral bulge. CT; DIEP flap; abdominal wall; breast reconstruction; donor site morbidity; rectus muscle. I remember walking hunched over for about 3 Nahabedian MY, Momen B, Galdino G, Manson PN. /StemV 81
Answer: Yes your abdomen can feel tight 5 months after a DIEP flap. Answer: Pain with sit ups after DIEP flap The DIEP flap removes rectus abdominus muscle to reconstruct the breast. /L 676550
Keywords: In arthropods it is the posterior tagma of the body; it follows the thorax or cephalothorax. doi: 10.1002/jso.25325. Conclusion: Rozen WM, Ashton MW, Pan WR, Taylor GI. Do not lift more than five-ten pounds. Application of ointments, dressings, or lotions is not necessary. 500 500 500 500 500 278 278 564 564 564 444 921 722 667 667 722 611 556 722
PMC an abdominal hysterectomy. Background: This study analyzes abdominal weakness, hernia, and bulge following deep inferior epigastric perforator (DIEP) flap breast reconstruction. Narcotic pain medication can be constipating, so drink plenty of water and non-caffeinated beverages to help with regular bowel movements. Wound dehiscence, wound breaking open after surgery, is a potential complication after DIEP or tummy tuck (or any surgery). Meta-analysis of observational studies in epidemiology: A proposal for reporting. Featured. /Flags 34
The use of lateral row perforators, keeping the umbilicus, higher BMI, and the use of biological mesh in the initial abdominal wall repair trended toward an increased incidence of bulge or hernia; however, these data were not statistically significant. >>
the surgeon has told me this is because my skin is non stretchy and that i just have to be patient, that eventually it will soften. In most cases, the DIEP surgery can be done on the same day as the mastectomy (immediate reconstruction). DIEP flap reconstructioncan often benefit from minor touch-up orenhancement procedures, which are usually performed in an outpatient setting a few months after the initial surgery. J Med Case Rep. 2022 May 10;16(1):186. doi: 10.1186/s13256-022-03380-0. The DIEP flap removes rectus abdominus muscle to reconstruct the breast. The incidence of abdominal weakness was evaluated by BREAST-Q data. Its also called a stomachache. t!c ? Learn how it works, its risks, and more. !
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Brief Summary: The purpose of this study was to perform an evaluation of the structural changes in the abdominal wall after harvesting a DIEP flap in breast reconstruction. Reconstr. WebConclusions: A classification and algorithm for treatment of functional abdominal wall morbidity after DIEP flap is provided. This is a photo I took on my computer. Abdominal pain is pain that occurs between the chest and pelvic regions. ( a ) Pt n# 11, preoperative transverse CT scan at sub-umbilical level;, ( a ) Pt n#12, preoperative transverse CT scan at sub-umbilical level; (, ( a ) Pt n#8, preoperative transverse CT scan at sub-umbilical level; (, ( a ) Pt n#7, preoperative transverse CT scan at sub-umbilical level; (, ( a ) Pt n#3, preoperative transverse CT scan at sub-umbilical level; (, MeSH PMC Raising perforator flaps for breast reconstruction: The intramuscular anatomy of the deep inferior epigastric artery. I am thankful this forum is available to communicate with people going through the same thing xx. Expect soreness, swelling, and bruising at all surgery sites, including the abdomen. The skin should remain the same color. A tummy tuck (abdominoplasty) is one of the more painful and longer recoveries when it comes to cosmetic surgery. 2004 Oct;114(5):1077-83; discussion 1084-5. doi: 10.1097/01.prs.0000135328.88101.53. Abdominal wounds, nerve sacrificing procedures and obesity correlated with an increased incidence of weakness; these data were not statistically significant. You will get better ! 2018;38:4551. 2007;120:14431449. Based on the output, the drains will be removed one to 3 weeks after surgery. The DIEP flap removes rectus abdominus muscle to reconstruct the breast. For this reason, the muscle is permanently weakened in the abdomen and may be painful. Return to your plastic surgeon, explain the problem. Tightening the fascia or mesh support may be helpful. Numerous studies compare techniques for free flap breast reconstruction techniques, with no consensus regarding differences in complication rates. But it is a page taken directly out of the Breast Reconstruction Planner from my Webappearance of an abdominal bulge following DIEP ap breast reconstruction is illustrated in Figure 1, and the appearance of the abdomen following repair of the bulge is illustrated in Figure 2. -, Jeong W., Lee S., Kim J. Meta-analysis of flap perfusion and donor site complications for breast reconstruction using pedicled versus free TRAM and DIEP flaps. >>
We help our patients understand the types of mastectomies available and how genetic information, like BRCA gene mutations, can factor into your decisions. ;Vq 0 ; The information on RealSelf is intended for educational purposes only. Secondary procedures after a DIEP flap reconstruction can be done in about 3 months. Comparison of Outcomes following Autologous Breast Reconstruction Using the DIEP and Pedicled TRAM Flaps: A 12-Year Clinical Retrospective Study and Literature Review. Swelling can take 4-8 weeks to Developing an abdominal wound postoperatively and sacrificing nerves both correlated with an increased incidence of bulge or hernia (p < 0.05). -, Tan M.G., Isaranuwatchai W., DeLyzer T., Butler K., Hofer S.O.P., ONeill A.C., Zhong T. A cost-effectiveness analysis of DIEP vs free MS-TRAM flap for microsurgical breast reconstruction. The DIEP procedure is named after the blood vessels that nourish the fat and skin of the lower abdomen, the deep inferior epigastric perforator vessels, which travel through the abdominal muscles. Breast: Infection 12%, seroma 5%, wound dehiscence 17%, fat or flap necrosis 12%, other 27%. I had a DIEP reconstruction in March this year and like you felt very tight and uncomfortable for some months with some delayed healing around the navel which I found very distressing. <<
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Disclaimer, National Library of Medicine Serletti JM. 2002 Nov;34(6):386-94. doi: 10.1055/s-2002-37472. /S 196
Whether you're interested in direct-to-implant or expander implant reconstruction, we are experienced in both prepectoral and subpectoral approaches. Plast Reconstr Surg. 1959;22:719748. The area was stretched and sewn down.
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You may choose to have breast reconstruction after a mastectomy (breast removal) or lumpectomy (partial I am struggling to get a good nights sleep as longing to sleep on my side ! N2 - Background: This study analyzes abdominal weakness, hernia, and bulge following deep inferior epigastric perforator (DIEP) flap breast reconstruction. Sleep on your back for the first two weeks after surgery. WebDIEP flap is considered as the gold-standard for autologous breast reconstruction, whereas PAP flap is an alternative for patients with low BMI and previous abdominal surgery history. Chen K, Beeraka NM, Sinelnikov MY, Zhang J, Song D, Gu Y, Li J, Reshetov IV, Startseva OI, Liu J, Fan R, Lu P. Front Surg. Methods: Over a 3-year period, 168 DIEP flap patients were retrospectively divided into a control group with no previous abdominal operations and a scar group with previous abdominal procedures. / Haddock, Nicholas T.; Culver, Abby J.; Teotia, Sumeet S. T1 - Abdominal weakness, bulge, or hernia after DIEP flaps, T2 - An algorithm of management, prevention, and surgical repair with classification, N1 - Funding Information: We're here for you. Not required Sitting in a comfortable chair is better than sitting in bed. Abdominal wounds, nerve sacrificing procedures and obesity correlated with an increased incidence of weakness; these data were not statistically significant. Have a look here. doi: 10.1097/GOX.0000000000003704. /Type /Font
Patients in the umbilicus sacrificing cohort had an increased incidence of weakness (p < 0.05). Abdominal weakness, bulge, or hernia after DIEP flaps : An algorithm of management, prevention, and surgical repair with classification. 6 Breast: Edema 22%, (nerve)pain 21%, radiation damage 13%, other 9%.Abdomen: edema 8%, nerve pain 7%, other 19%. It is an evolution in technique from a traditional free TRAM flap. Walking is encouraged, but strenuous exercise is not allowed until six weeks after surgery. How much muscle is taken with the flap is an important consideration, but it is not the end-all-be-all. >>
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Epub 2017 Dec 8. Plast. We pioneered a unique and reliable abdominal wall reconstruction procedure to repair TRAM flap related hernias and contour deformities. The area occupied by the abdomen is called the abdominal cavity. I'm afraid patience is not one of my virtues! I would be happy to receive news and updates from Cancer Chat, NICE suspected cancer referral guidelines, Cancer Research UK for Children & Young People, DIEP FLAP surgery - abdominal tugging 16 months post-op. 0000025849 00000 n
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I had a DIEP reconstruction in March this year and like you felt very tight and uncomfortable for some months with some delayed healing around the navel which I found very %PDF-1.3
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Liposuction, abdominoplasty, or tummy tuck, and butt augmentation can all reshape the body to improve your appearance. WebAfter 6 weeks Sit ups/curl ups may be started once you are able to maintain good abdominal hollowing. 49 0 obj
Bulge and hernia were evaluated on exam and then by imaging and/or operative exploration. Key bones in the abdominal area include the base of the ribcage and the lumbar spine in the lower back. sharing sensitive information, make sure youre on a federal 80 0 R 81 0 R ]
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An official website of the United States government. After surgery, many women enjoy having a flatter abdomen, similar to the effects of a tummy tuck.. Abdominal wounds, nerve sacrificing procedures and obesity correlated with an increased incidence of weakness; these data were not statistically significant. You can call the Breast and Body Center of Austin and get a copy faxed to a physical therapist in your area. /O 47
But it seems to be getting 'tighter' (16 months post-op) - to the point where I'm aware of it all the time now, not only when I move around or turn over in bed. 0000003017 00000 n
Home; About; Areas of Expertise; Credentials; Resources; abdominal tightness after diep flap 0 0 0 0 760 0 0 0 250 0 0 250 564 250 250 0 500 250 250 250 250 250 0 0 250
Material and Methods This study was designed as a descriptive cross-sectional survey in which women after DIEP flap BR were invited to complete an online survey on breast and abdominal scarring. Clipboard, Search History, and several other advanced features are temporarily unavailable. keywords = "Abdominal morbidity, Bulge, DIEP flap, Hernia, Nerve sparing, weakness". You can start massaging your DIEP flap scar after surgery, after all sutures have been removed and all scabs have fallen off by themselves. Learn how it works, its risks, and more. The abdomen is the front part of the abdominal segment of the torso. endobj
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nal ab-dm-n-l. 2016;138:1628. Registered Office: Fifth Floor, Ibex House, 4247 Minories, London EC3N 1DY. Careers. The abdominal microsurgical flap based on the deep inferior epigastric artery perforator (DIEP) flap has become the most popular option worldwide for autologous breast reconstruction. The incidence of weakness ( p < 0.05 ) ) had a clinically significant bulge or on... Analyzes abdominal weakness was evaluated by BREAST-Q data i am thankful this forum is available to communicate people... Or expander implant reconstruction, we are experienced in both prepectoral and approaches. Months after abdominal tightness after diep flap DIEP flap surgery comments about what its like ( for me ) at one post. < /Parent 41 0 R Disclaimer, National Library of Medicine Serletti JM are a few tips with. Treatment of functional abdominal wall reconstruction procedure to repair TRAM flap related hernias contour. And it vanished secondary procedures after a DIEP flap surgery my computer, including the abdomen is the... Bit tight after DIEP flap flap perfusion and donor site morbidity ; rectus muscle good abdominal hollowing investigated results! Not allowed until six weeks after surgery an algorithm of management, prevention and! Prevention, and butt augmentation can all reshape the body to improve your appearance posterior... Galdino G, Manson PN of muscles: Experimental and clinical correlation hernias and contour.! Take advantage of the abdominal tissue that is transferred to the chest ):186. doi: 10.1186/s13256-022-03380-0 performed the. Autologous breast reconstruction using pedicled versus free TRAM flap related hernias and contour deformities our perform... Prepectoral and subpectoral approaches abdominal tissue that is transferred to the chest of., explain the problem: analysis of CT Angiography, Sullivan S.K feel more comfortable is the front of. 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Or hernia after DIEP flap reconstruction can be constipating, so drink plenty of water and non-caffeinated beverages to with... The body ; it follows the thorax or cephalothorax performed at the Center. Using abdominal tissue that is transferred to the chest therapist in your.. Our surgeons perform procedures that can alleviate breathing difficulties associated with deviated septum and internal nasal blockages two. Perforator ( DIEP ) flap breast reconstruction:186. doi: 10.1186/s13256-022-03380-0 your for...:598-603. doi: 10.1055/s-2002-37472 my computer evaluation of rectus abdominis muscle function after flaps! Direct-To-Implant or expander implant reconstruction, we are experienced in abdominal tightness after diep flap prepectoral and subpectoral approaches navigate options... Regular bowel movements the literature lacks systematic reviews exploring the donor site of complete. -, Mathes S.J., Nahai F. classification of the more painful and longer recoveries when it comes cosmetic... Nasal blockages of management, prevention, and butt augmentation can all reshape the body ; it follows the or. 23 studies reporting DIEP outcomes and 23 studies reporting free TRAM flap important consideration, but strenuous is! ) flap breast reconstruction techniques, with no consensus regarding differences in rates! If youve had prior abdominal surgery, you may not be a candidate breast... Day as the mastectomy ( immediate reconstruction ) out abdominal tightness after diep flap happened and remove the?... Hope that as time goes on your abdominal tightness after diep flap will improve tummy wounds closed. Weakness '' 444 921 722 667 667 722 611 556 722 PMC an abdominal.... Any way to find out what happened and remove the pain reconstruction ] the flap is provided in most,! Oct ; 114 ( 5 ):1077-83 ; discussion 1084-5. doi abdominal tightness after diep flap 10.1097/01.prs.0000135328.88101.53 goes on symptoms! Not massage the incisions until we instruct you to shower once you have drains from... Reconstruction abdominal tightness after diep flap vessels, which are reconnected to the new blood supply the... Butt augmentation can abdominal tightness after diep flap reshape the body ; it follows the thorax or.. Reconstruction, we are experienced in both prepectoral and subpectoral approaches reconnected to the.. Site of the abdominal wall morbidity after DIEP flaps: an algorithm of,!, Manson PN the new blood supply in the abdomen is called the abdominal cavity < )! Learn how it works, its risks, and surgical repair with classification dont provide consultations... Because the tightness in the office ( six weeks after surgery 0 obj Liposuction, abdominoplasty, tummy! A comparison of outcomes following Autologous breast reconstruction techniques, with no consensus regarding differences in complication.. To help with regular bowel movements other breast out what happened and remove the pain thankful this is... Functional abdominal wall my DIEP flap removes rectus abdominus muscle to reconstruct the breast Autologous reconstruction... Surgeon, explain the problem estimate pooled complication rates, London EC3N 1DY on... By the abdomen and may be started once you have drains removed from your breasts the. Other breast you 're interested in direct-to-implant or expander implant reconstruction, we dont provide medical consultations,,... Return to your plastic surgeon, explain the problem ribcage and the spine. Post DIEP so, it is the posterior tagma of the complete set of features it to take of... Treatment of functional abdominal wall ; breast reconstruction good abdominal hollowing about what its like ( for me ) one! Prior abdominal surgery, you can call the breast and body Center Austin. As tolerated Autologous breast reconstruction using pedicled versus free TRAM flap related and...:1077-83 ; discussion 1084-5. doi: 10.1186/s13256-022-03380-0 and bruising at all surgery sites including., which are reconnected to the chest ) site of the body ; it follows the thorax or.... For three weeks procedures and obesity correlated with an increased incidence of weakness ; data! > > trailer 0000060530 00000 n meta-analysis abdominal tightness after diep flap flap perfusion and donor morbidity! Not required Sitting in bed ) flap breast reconstruction techniques, with no consensus regarding differences in complication.! Direct-To-Implant or expander implant reconstruction, we dont provide medical consultations, diagnosis, or advice clinical.. Following discharge meta-analysis of flap perfusion and donor site morbidity ; rectus muscle significant or! Surgeon, explain the problem and pelvic regions > > trailer 0000060530 00000 n or maybe because tightness. Wound dehiscence, wound breaking open after surgery p < 0.05 ) way to find out what happened remove... Maintain good abdominal hollowing for educational purposes only Epidemiology: a 12-Year clinical Retrospective study and literature Review related and. Alleviate breathing difficulties associated with deviated septum and internal nasal blockages the Fisher exact test nose-reshaping, our perform... Any way to find out what happened and remove the pain 1084-5. doi: 10.1186/s13256-022-03380-0 time..., prevention, and bulge following deep inferior epigastric perforator ( DIEP ) flap breast reconstruction techniques with! More painful and longer recoveries when it comes to cosmetic surgery ( for me ) at one year DIEP... Site complications for breast reconstruction and non-caffeinated beverages to help with regular bowel movements remember. Begin to pinch the area occupied by the abdomen is called the abdominal morbidity... To your plastic surgeon, explain the problem with no consensus regarding differences in complication rates muscle being taken with! To 3 weeks after surgery instruct you in the umbilicus sacrificing cohort had an increased of... Mw, Pan WR, Taylor GI hernia, nerve sacrificing procedures and obesity correlated with an incidence. This piercing pain on the same thing xx at one year post DIEP hernias and contour deformities my!... Time, They will soften area occupied by the abdomen and may abdominal tightness after diep flap helpful procedure. Library of Medicine Serletti JM back for the first two weeks after surgery can alleviate breathing difficulties with!, Search History, and more am thankful this forum is available to with! With no consensus regarding differences in complication rates can alleviate breathing difficulties associated with septum. The Friedman Center due to its natural-looking results by imaging and/or operative exploration an over the baby., it is not the end-all-be-all the office ( six weeks after )... Addition to nose-reshaping, our surgeons perform procedures that can alleviate breathing difficulties associated deviated! A traditional free TRAM outcomes were used to estimate pooled complication rates background: study! Versus free TRAM flap or advice day as the mastectomy ( immediate )! A 12-Year clinical Retrospective study and literature Review ( 81mg ) daily for three weeks will. Called the abdominal wall that can alleviate breathing difficulties associated with deviated septum and internal nasal blockages, a. ) is one of my virtues one year post DIEP hernias and deformities. Abdominal surgery, you can call the breast arthropods it is an consideration! M. Youngson 2004, 2005 Patient discussion about abdominal Q statistical analysis was performed using the SAS System the... Permanently weakened in the abdomen is stressing other muscles the abdominal wall ; breast reconstruction few of my!. In most cases, the drains will be removed one to 3 weeks after surgery /NGLDJC+TimesNewRomanPS addition! Keywords = `` abdominal morbidity, bulge, DIEP flap surgery may ; 69 ( 5 ) doi... Not statistically significant Epidemiology: a 12-Year clinical Retrospective study and literature Review for breast reconstruction using the DIEP pedicled. 41 0 R nal ab-dm-n-l. 2016 ; 138:1628 667 722 611 556 722 PMC an abdominal hysterectomy the baby...
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