Plastic Surgery surprise

Yesterday I had a consultation with Dr. Elmaraghy here in Kitchener. I went in to talk about facial fillers and just get a general idea about a plan of attack for  loose skin and I left with a tentative surgery date for an arm and breast lift in October!  I really like him. He was super thorough and answered all my questions. He just seems really keen and excited for me to get started.  Now it's a little too real. Am I ready for this?  It's a lot of money, a lot of time off work, a lot of surgery!  A way bigger deal than the RNY...gaaa!  I'm a little freaked out...

So far, I've had a tummy tuck (with hernia repair), and an arm and thigh lift.  These last two (arms and thighs) were done together.  My experience was that the tummy tuck was much more taxing because of the muscle involvement...coughing, sneezing, etc., were near to impossible without massive pain. 

The arm lift was pretty easy.  I had no issues.  And really, it wasn't very painful at all.  I thought there would be more pain, but easy peasy!

The thigh lift...again, surgery itself was pretty easy.  Not as much pain as I would have thought.  But I did have some complications with the lymphatic system...fluids not moving through the legs as easily as they should, hence swelling and subsequent infection.  I should have known re:  thigh lift.  My family (mother in particular) has a history of problems with legs -- varicose veins, ulcers, swelling, etc.  But a few months after, all is well again.

The two sets of surgery were done within a 6 month period.  I'm all "surgeried" out for now.  (Though, unfortunately, I have one more hernia repair to go through...) 

I may consider a breast lift at some point, but the doctor did mention if I do that, and if he removed the excess skin, I would probably be an "a" cup, and might not be quite as proportional as I should be and/or might be a bit abnormally shaped!  Eek.  On a 5 foot 10 inch frame, that's pretty small, and "abnormally shaped" does not sound promising...sigh!  He said that could be rectified with some small implants...to fill in the gaps and bump me up to at least a "b" cup (larger if I want...but I don't want!)  All that to say, is that I am considering my options, but with all the surgery I've had lately, plus the infections, I will put this on ice for another year or two (if at all).

I don't think it will be nearly as bad as you might think.  I would say that overall, it's easier than the RNY 'cause you don't have to re-learn how to eat after.  No worries about liquid diets, pureed diets, nauseousness or getting in your liquids, etc.  Post-surgery, you resume life as normal, except for the healing of the wounds!

Good luck!

DD

It is a lot of surgery but I'm so excited for you!  I can't wait to be at that point.  Can I ask you what you were quoted for the procedures?  Can they be done at the same time?  

He really stressed the importance of grouping procedures so you can minimize the amount of anastetic etc. but he also wanted to balance the healing time and the "vectors" of my skin that were being affected.  My priorities were Arms, tummy and breasts (lift but not implants).

When he examined me, he determined that I need skin removed from my side (beside the breasts) as well and he recommended that I get a breast lift done and then decide after it's healed if I want implants because he thought I wouldn't really have too much going on in that area without implants.  

So in the end we decided that grouping the arm, breast lift and side tighting would make sense. He will extend the breast incision from under my breast over to the side and remove skin from there.   The quote for this is about 18K (6 for arms, 6 for breasts, 1.5K for side skin removal, hospital fees and taxes on top)

Then he would group the tummy (extended tummy tuck, around my side a bit) and breast implants if I decide to go ahead with that about 3 months later. I haven't seen a quote for that yet....

He was very honest and actually said it will cost a small fortune to do everything.  If all goes well, my annual bonus will just about cover the first sugery...ouch. 

Out of curiosity, did he mention anything about being at a goal weight for a certain period of time before having PS? You're just over a year out I think? Or did he say what to expect if/when you continued to lose weight?

I was really surprised about the fact that he didn't seem too stressed about it.  I would love to lose another 15 pounds, but the guelph clinic gently conveyed that they were pleased with where I am now and that it would be a struggle to get to where I'm thinking because my smaller body is burning few calories.  It would mean very strict calorie counting and much more exercise than I'm currently doing.  

That doesn't mean I can't do it or I shouldn't try.  I told that to the surgeon.  He said if I think I will lose that weight I should wait but he thought that I'm already fairly small and that the weight I think I still need to lose might just be the loose skin.  He thought that I would be happy with the result even if I did lose a bit more weight. That is definitely one of my concerns and a reason to wait.  He really was willing to work on my time table and wasn't trying to rush me.   

Does he realize that you are a bariatric patient and the date of your RNY?

Anyway, I truly was curious and thanks for answering - I really appreciate that. It's interesting how surgeons can differ in their approach to dealing with post-bariatric patients. Most require a stable weighted period of time at a normal weight before considering performing the surgery. I will say, from experience, that your body and it's parts shift and change and redistribute a lot over the first three years post-op.

As for the Guelph clinic telling you that it would be a struggle to get much further - well, I'm absolutely appalled. Sonja, you are only one year post-op! Jeezus, that line of thinking makes me crazy. I continued to lose into my 3rd (THIRD) year post-op! What if I had been told that and simply thought, "Oh. Guess I'm done then."?

Anyway, I know you're very sensible and you'll do what you feel is right for you, when the time is right.

K.

Also a bit surprised!  My surgeon definitely wanted me to be at a stable weight for six months before he would proceed with surgery.  There are some guidelines around that.  When I went for the consult (got the referral at the two year mark), I had been at a stable weight for three months (and he took that into consideration).  I went back to book the surgery after I hit 6 months at the stable weight.  So from referral to surgery, it was probably 8 months.

Personally, I found that my body changed a lot after the one year mark.  Though I was almost at goal weight (had about 20lbs to go), my face was gaunt, and some of my body too thin.  But over the second year, though I didn't lose an enormous amount of weight, things shifted (for the better), and my face no longer looked gaunt.  You might want to consider that as you plan for your surgery.

My surgeon did recommend grouping surgeries, but would do no more than two at a time -- which i was perfectly okay with.  Cost for me, on average, was about $6K for arms, $6K for legs (included hospital fees and taxes, etc.).  The panni was covered by OHIP but not the tummy tuck upgrade, and hospital fees and anesthesiologist were covered as I had the hernia repair done at the same time (and that was medically necessary).  I paid about $4K for the upgrade to a tummy tuck (combined, it would have costed about $8K without coverage).  Don't have a quote yet for the breast lift/augmentation...will see if I even go forward.  It's not the most important for me, as a good bra does the trick, at least with clothes on!  And no more plastics for me! 

Thrilled with the arms and tummy tuck.  Legs were okay...it was probably the toughest part as I had a lot of extra weight on the legs.  Got rid of the overhang over my knees -- so can now wear knee length dresses/skirts, but my thighs are never going to look great.  Well, actually, my legs will never be fantastic...too much damage from my weight...varicose veins and such.  But I'll live with it!  Consider it part of my battle scars from waging war with morbid obesity.

Enjoy the next part of your journey...and yes, don't let them tell you you're done losing...not necessarily the case!  See what happens.  And I would suggest losing all the weight before going for surgery.  My doctor was pretty adamant about that...otherwise, you might simply add a bit of sag to the surgery areas depending on where you lose the weight.  My two cents worth!  [It does cause me some concern that your surgeon doesn't seem to be following what I thought were pretty standard guidelines re:  stable weight, and is not concerned by the possibility of additional weight loss...but what do I know?! Food for thought!]

Good luck!

DD

I think the guidelines may be around OHIP/Insurance approval. since I'm paying out of pocket, it's me that is taking the risk.  I think you're right though. Even now when I'm not losing, my body does change.  I recently read that your skin can contract/heal for 18 months after you've lost the weight.  One thing I mentioned to him was my neck being loose and he said that it would definitely tighten up over time.  I think he was just trying to get me to be realistic about the amount of weight I could still expect to lose and how much I could expect my body to tighten up on it's own.  

I agree with you about the bra!  I like bras! My boobs look great in a bra! I can just wear one at all times! 

I agree with DD my body changed between year one and two even though I didn't lose a significant amount of weight after about 15 months. My weight has been stable for over a year and this past week I have lost 5lbs. Personally I would wait a little longer. You aren't done losing yet!  Things will shift too. Good luck.