Question about plastics

So for those who may have seen my post a couple weeks ago about my mom and melanoma she had her sentinel lymph node removed and biopsied and it came back negative. Yay! Anyway the surgeon *****moved it is a cosmetic and reconstructive surgeon. I went with her to her appointment today and spoke with one of the nurses about their policies and procedures and what my next steps will eventually be for plastic surgery. I'll post this on the PS forums and do some research but I figured I'd ask here too. The nurse mentioned doing the abdomen and breasts together and then thighs and arms together. Are the parts of the body they choose to work on at once just a preference or is this generally how it goes? I did call around a couple weeks ago and one place I spoke with made it sound like they do thighs/abdomen and breasts/arms. My other question is the nurse today told me that this surgery takes about 12 hours (abdomen/breasts) is that normal? This surgeon apparently is the best in the area. My PCP recommend him, my surgeons office recommended him and both my mother and myself have spoken to other medical and nonmedical people and they all say the same things that he's meticulous and takes his time but 12 hours seems like a lot. If you had plastics how long was your surgery and what did you have done?

Also I just want to mention I'm not looking to have surgery until next spring/summer. I'm just exploring my options now because I know to possibly get insurance approval on my panni I need to have any irritation or rash documented and what treatments we've tried to fix it over the course of several months. So please refrain from reminding me I'm only 10 months out. Thanks.

I am 10 months as well and I am already getting documentation of rashes under my panni and using niacin powder my pcp prescribed. My surgeon already said I have to wait till I am 18 months post op and then he will refer me out for plastics. That is the requirements my insurance has. So in April he will refer me and hopefully I can get this taken care of in June. It is not too early to look into your future care and the costs so you can save.

Twelve hours seems like a LONG time to be under!  That would mean that one of the procedures would be 6 or more hours, which is crazy!   Usually surgeon try to have you under anesthesia for as little time as possible because the longer you are under, the greater the chances of complications.  Also, keep in mind that you have to pay for all that OR time and the anesthesiologist's time, and the OR nurses' time, etc!  I would ask a LOT more questions about why it takes so long.

Often they group the surgeries based on how long each one will take specifically to AVOID something like a 12 hour surgery as you indicated.  Often they also have to consider how much the combination will incapacitate you.  Personally, when I had my tummy tuck, there is no way I could have not had full sue of my arms AND legs to be able to get up and down from a chair and get around the house when I couldn't stand up straight and was in so much pain (My TT was the worst pain I have ever had from any surgery, and I have had a number of open surgeries!)  Abdomen and breasts are frequently done together.

As far as your thighs, please make sure that see LOTS of the surgeon's photos of previous patients because many people aren;t particularly happy with their results and most of them say they saw only a couple of pictures of thigh lifts (one woman I know personally only saw ONE photo before she let the surgeon do her thighs!) and theirs looked NOTHING like the "best case" photos the surgeon's book had.  Be sure that you talk to the surgeon about exactly how he will do the thighs (incisions at the top where they just try to pull the skin up usually look very unnatural) and how he handles incision necrosis, because the thighs are notorious for the incision breaking down and turning necrotic (because the skin is usually in very poor condition) and having to have the tissue cut out and then heal up from the inside out.  (I had it happen when I had my tummy tuck (it took 5 months for the crater in my belly to heal up (while being cleaned and gauze packed twice a day) and to re-grow the skin!) and even the possibility of having it happen between my legs is enough to keep me from even considering a thigh lift!)

Also, just because a plastic surgeon is "the best" doesn't mean he has much experience with WLS patients whose skin poses special challenges.  Be sure to consult with at least one other surgeon, ask both of them how long their surgeries take, how much experience they have with WLS patients, costs, whether their costs include dealing with complications (some include all office visits for any complications in the initial price, others include only a single follow-up visit), look at their photo book, etc.

Lora