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Having second thoughts! Input please.
Gretarae,
You describe a pretty common conundrum that patients face with multiple opinions. It will be difficult to tell you which repair you need without a complete history and at least a view of your CT scan. I don’t think either surgeon is completely right or completely wrong. I think that you have to also take into account the techniques being employed. For example, if you are a good surgical candidate and meet all criteria for a low risk of wound complication and the defect is such that you require large repair then I would prefer to perform the repair with polypropylene in the retrorectus space and what I am assuming is a TAR (transversus abdominis release) procedure you are describing as a “modified component separation”. This operation for morbidity and long term outcomes is second to none in a surgeons hands that has a lot of experience with the procedure like all the surgeons on herniatalk. I do not think that the plastic surgeon is incorrect but in my practice it would be exceedingly rare that I would offer a biologic hernia repair in a patient that meets criteria for a more durable repair with synthetic in the retrorectus space. One deciding factor that I would advise you is the technique the plastic surgeon will use to put the biologic in. If he is going to use a retrorectus approach with a biologic then I would not burn that bridge with a biologic at the current time because of the higher recurrence rates and greater morbidity. I hope this makes sense and helps a little bit with your decision. Regardless you should remember that it is impossible to direct you without the entire history of your problem and seeing the images as there are a lot of factors that go into deciding the procedure and mesh that cannot be judged accurately without all the information.