Tummy Tuck with Flank Liposuction and MR - Ontario, Canada

Hello! I am a 32 y/o mother of 2 (by c-section),...

Hello! I am a 32 y/o mother of 2 (by c-section), 5'8" and down to 160lb (my pre-pregnancy weight). My tummy bounced back very well after first baby (within 2 months) but I put on extra pregnancy weight with the second, which was a bigger baby. My tummy's muscle function and skin elasticity didn't recover! (And, I firmly believe there isn't any exercise or gimmick that will tighten stretched skin or tighten fascia between separated abdominal muscle.)

I started seriously considering a tummy tuck only very recently (think a few months ago!). I lost 20lbs to reach my pre-pregnancy weight and was feeling better about my body except for that leftover pouch of skin. It was a bit depressing to feel that my clothing choices were going to be forever limited by my darn tummy! I also had mild-moderate abdominal muscle separation. So besides addressing the loose skin, a TT with muscle repair would benefit my posture as well as protect my back from potential work-related injury. A final thought was that if I was ever going to pay close to $10K for a TT, I should do it now while I'm fairly young to give myself the most benefit!

The other factor that encouraged me to seriously consider a TT was that I had consistently heard great things about a particular PS where I work. A work colleague (who sees some of his patients for hand or wound therapy post-op) has always raved about him; a friend of the family who is an OR nurse (works alongside him during procedures; well, just retired) praises his perfectionism and character; and that OR nurse's dtr recently got a TT herself by that PS and said she couldn't have made a better decision for herself. So these different levels of recommendation made me confident pursuing an initial consult with this one PS! I know it is recommended to "shop around" for a PS but, after meeting this doc in person, I was comfortable looking no further!

He said I would benefit from an extended tummy tuck with liposuction of my flanks and muscle repair. That sounded fine to me ;) There are other procedures I would have liked to add on (in theory) but I'm trying to stay grounded about this PS business! Anyway, several weeks after meeting with PS, I went ahead and booked a surgery date of 30 September 2013. (Here's hoping I can pull off looking normal at Thanksgiving so the in-laws don't catch on to my little secret!)

Recap of Surgery Day

Showed up 2hrs before scheduled surgery time as I was told. Changed into hospital gown, reviewed medical history with nursing and had vitals checked. Was asked whether the paramedic students could put my IV in ... glad I said No because the nurse had a hard time finding my vein. The nurse fished around with the needle inside by hand and caused me to get lightheaded/nauseous until she laid me flat and was finally successful.

Then, for almost an hour, I chatted with an elderly man waiting for a hip replacement (same surgery time as me). I was happy to talk to someone instead of letting anticipation get the better of me. He had his share of interesting life stories and I had my experience as a physiotherapist (who has treated hip replacements) to share with him. Eventually, he was taken to surgery, and I was left wondering, what about me?! Turns out some of the OR staff had called in sick and they were scrambling to find replacements. I used this time to say a few prayers under my breath that surgery would go well, without any complications.

In the meantime, PS came in with his reassuring smile, took me to a curtained off area and marked me up. It must have been my old c-section scar causing such pain when he was really stretching my skin up to mark the incision line (below the c-section scar). He explained his markings to me and said he'd see me soon. (My mother had joked with me the night before that everything was gonna be alright if his face was the last face I'd see before surgery, lol ... he's young and attractive.)

I was finally taken into the OR an hour after my scheduled start time. Laid down on the operating table. They strapped my arms down, put ECG stickies on my chest and a sat probe on my finger. Finally met the anaesthesiologist, who didn't really describe much to me except to confirm I was to have general anaesthesia. PS walked in and asked what music I'd like to fall asleep to ... my mind just wasn't able to focus on a song selection, lol. The nurse put a mask over my face and said it was just oxygen (not sure if that was a whole truth?) and the anaesthesiologist was fiddling with my IV, causing a strange prickling and "heavy" sensation to travel through my body. I was kind of ticked off that he didn't provide any warning of what he was doing .... off to sleep I went...

Woke up about 3.5hrs later in recovery (although I think the surgery only took 2.5hr). It was so difficult to rouse fully and I had trouble focusing my eyes. When I was aware of a nurse at my side, I immediately told her I had to go pee. Well, because of the lovely compression garment I was in, bed pan was not an option, so they did an in-out catheter. I almost laughed when two nurses were acting so surprised at how much pee I had. It was a running commentary ... 700cc, WOW ... 900cc, OH MY GOODNESS (gasp) ... No wonder she had to go!, lol. (I did go pee immediately prior to surgery! Must have been all the IV fluids.)

I spent over an hour in recovery. The nurse took off my oxygen and my sats would drop into the mid-80's ... I was deep breathing as best I could in the compression garment! BP was slightly low but within normal for me. I noticed the mechanical compression stockings were still active on my legs but barely squeezed my legs. I told several nurses (after none of them seemed to care) that it didn't feel like they were doing anything. Were they compressing my legs that lightly during surgery or had they been loosened? Knowing that thromboembolism is a major potential complication, I freaked out internally a bit, thinking the DVT prophylaxis (the compression stockings) hadn't been applied properly the whole time during surgery and now my oxygen sats were low ... did I have a PE?! But eventually my oxygen sats finally reached the high 90s and stayed there ... it just seemed to take forever.

PS stopped by to tell me everything went great, not to touch my CG or dressings until I see him for follow-up in 3 days. Nurse showed me how to drain my two JP drains and record volume. It was the first time I really had a good look at my belly area. And although I was in a CG, I couldn't believe how flat I was! In fact, the nurse joked and said I looked "concave" (I'll take that!). Nurse gave me instructions on the situations I would need to come back to emerg. PS had left an extra compression garment for me and materials for changing my dressings to take home.

Drive home (30min) was fine. Happy to have an SUV where I could sit my bum down without bending too much and hubby lifted my legs in. Seat was reclined at an angle and it was all good. Got home, said Hi to the kids (age 2 and 4) ... fibbed that mommy hurt her back but was okay, and immediately went upstairs to bed. Happy to have a bed with a boxspring so everything was already at "bum-level", lol. Pillows were already set up to let me sleep semi-inclined ... ahhh. It was good to be home. Plus, I'll admit, the thought crossed my mind that I was glad to come through surgery alive, lol!
The hard part is over! Rest up and I look forward to following your progress :)
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thanks girl!
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Recap of Post-op Days 1-3

I've been sleeping well enough at night on my back with pillows propping me up. This surprised me because I am a full-out tummy sleeper ... I guess the percocets have helped with sleep. For the first night or two, I would get DH to help me sit up (and lay down) if I had to go pee but by POD 3 I was able to get out of bed on my own by pushing through my arms A LOT.

I noticed the longer I've been laying down, the more stiff and uncomfortable it is when I try to stand up. I guess that's no surprise. But my focus for the first few days was to rest as much as I could but ensure that I was getting up to walk a few lengths of my house every 2 hours during the day to make sure I didn't get a blood clot. I did ankle pumps in bed as much as I could too even though I wore compression stockings for POD 1-3.

Pain control has been fine. I take 1 percocet (mg? not sure) every 6 hours. When I'm laying in bed, there is pretty much no pain. When I get up, there is some burning pain along my incisions because I think the CG pulls on it a bit as I'm trying to straighten up. My lipo areas are very sore to touch but otherwise don't bother me.

I don't want to be on percocets too long because it causes constipation, and I tend to be on the constipated side. I don't think this procedure would be a good mix with constipation! I focused on my diet as a means to prevent constipation: lots and lots of water (also to replace fluid loss), green smoothies, homemade veggie soup (no added sodium), watermelon (vitamin packed), spinach salad with tomatoes (vitamin C)/avocado, and gluten-free breakfast muffins. (I had a BM on POD 4, then regularly thereafter ... and I had to share the news with the family who didn't understand my excitement, lol!)

I'm pretty happy with my PS's choice of CG ... I'm sure it cost me $$$ in my fees but I'm happy for the comfort and support (and he gave me an extra one). It's the type that goes from thigh to breast ... and is crotchless for easy bathroom stops ... love it! It does up with eye hooks along both sides then with (padded) zippers overtop. I haven't undone it because I was instructed not to touch anything until my first follow-up appointment on POD 3. (Well, maybe I was a bad girl because I did end up reaching down CG to move my drain tubing off my hip bones ... felt like the compression of the tubing on my hip bones was giving me a pressure ulcer so I just moved them more toward the midline, making sure I didn't kink or pull the tubing.)

I had a few blood clot thingies in my drain tubes early on, so I figured out how to "milk" those out but it gave my hand a blister because I had to squeeze along the tubing so hard. Draining the (Jackson-Pratt) drains is super easy.

Had my first follow-up appointment on POD 3. It sort of sucked because there were about 5 other patients that had the same appointment time as me BUT I got to go in first. (My husband joked, but it's probably true, I got to go first because I paid the most $$$$, lol ... the other patients were most likely OHIP patients, which is government funded health care.) But my appointment felt so rushed and seemed unsatisfying for some reason.

So PS checked my drainage chart and said I was borderline for getting them out. That I'd risk a seroma if we took them out that day, or I'd have to wait until POD 8 to get them out, which would increase chance of infection but my antibiotics cover me for 7 days. So we left them in.

Next the nurse opened my CG and PS immediately commented on the drain tubing being moved. It didn't seem to bother him when I explained; hope he wasn't upset with me!! I told him one of my drainage insertion sites had leaked a bit the day before and he says that happens. But this was my first time seeing my incisions/belly ... I didn't recognize my BB ... I'm feeling neutral about BB but really, anything is an improvement over the BB I originally had. Main incision line looks awesome ... much lower than I expected and quite symmetrical. Tummy and sides were puffy. I couldn't see much bruising from the lipo. PS said I had 3cm MR which doesn't seem like much but he didn't think it was trivial. I was told to change the dressings every few days and to put polysporin on if I wanted. I had brought my extra CG, hoping the nurse would help change me into it (give me some tips for doing it myself!) but it seemed they just wanted me out. Felt so rushed!

Oh, the other thing was PS noticed I took my TED stockings off. They were digging into my thighs too much by POD 3 so I took them off that morning especially because I knew I was mobilizing enough for my risk of blood clot to be lowered.

So once I got home, I asked hubby to help me put new CG on because I took PS "gross" comment too personally, that I had already let CG get "gross" (which he totally didn't say that way). But, goodness me, as soon as I was out of CG, I thought I was either going to puke or pass out. Hubby didn't know whether to get me a gravol first or frantically pull the new CG on me!! So we went with getting CG halfway on, then when we ran into difficulty, had my gravol and finished pulling CG up. Hubby got it on me a bit crooked but all I wanted to do was pass out on the bed at that point! I really wish nurse at PS office would've done it with me at the office.

I really wanted to get a pic of my new belly on POD 3 so I did manage to get one shot and will post it with this update.
You look really good! :)
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Almost 2 weeks post-op ... things continue to get better and better!

My last post left off at POD 3 so I will pick up from there. I weaned myself down to 1/2 percocet every 6hr and added 1 ES Tylenol every 6hr (staggered so I was taking something every 3hr). By POD 5, I was off all pain meds and I felt fine!! Now, I didn't know what to think because many ladies further into recovery than me are still writing about dealing with lots of pain .... but I'm not complaining! (I did have lipo on my flanks and mons but again, the pain is negligible. Also, I did have minor back strain but that only lasted a few days.)

On POD 6, hubby finally had time to help me sponge bathe.... and wash my hair!! I hated not washing my hair for a week! After the sponge bathing part, I donned a garbage bag and hubby showered my hair for me. Man was it knotty! And I just had to tell him to be rough or I'd be standing there forever getting more uncomfortable. He even had to style my hair afterward, LOL, because I have long curly hair that will just be a big frizzy puff mess if I didn't add product. All in all, he did a good job, and I was so thankful for him!! It felt so nice to be cleaned up.

So as I got closer to 1 week post-op, I spent more time sitting up in the rocking chair vs resting in bed (although, don't get me wrong, I'd still get a nap in). I would venture up and down stairs to constantly refill my water (still drinking tons). And I started making dinner (with help for reaching low-stored pots or putting things in the oven). I'd say by POD 8 I was mostly walking upright ... maybe 90% upright!

My mom has been acting as a caregiver for my children from 830AM to 6PM during the week. The kids have been good, understanding that mommy cannot lift them, and even asking each day, "Mommy feeling better?". Hubby manages their bedtime routine. I must admit, I'm enjoying the break from that!

I had another appointment with PS on POD 8. By then I was draining 12ml and 5ml from each drain. So he removed both drains. Boy, I'm glad he pulled the left one first, otherwise I'd have run out of the office not letting him removing the right one. You see, the first one came out fine with just a bit of stinging pain at the end. But the second one felt like PS was ripping my insides as he pulled the drain tube out, almost like my tissues had adhered to the tubing. I couldn't scream nearly as loud as I wanted, so even after the drain was pulled, I asked hubby for his hand so I could squeeze it really hard. PS told me it was already out, which I knew, but he didn't understand how much tension I still had to relieve from that painful experience.

PS went over driving and other restrictions. Basically I could resume driving whenever I felt unrestricted in my trunk movements. He didn't give specific lifting restrictions except to say there is smart lifting and then there is forceful lifting and my body would tell me if I was doing more than I should. He said I could take a normal shower the following day. He said it was possible to shower with CG on if I like ... and to just use a blow dryer to dry CG off afterwards (which seems like a lot of work!). He said to continue putting polysporin on BB. I could start putting a bead or marble (sterile) in BB to help open it up.

I had my first real shower on POD 10. I decided to keep my taped incision dry by wrapping hips with saran wrap! PS didn't say I needed to do this but I didn't feel good about getting the tape wet. I felt fine out of CG to have the shower but a little tired afterwards. I still seem swollen around my belly/hips but not excessively. I now weigh 153-154lb (from 158-160lb pre-op). I can't remember the last time I weighed that ... maybe before I got married?! It makes me even happier to think that some of that weight is even a bit of swelling weight ... and then if I could tone up my thighs, I'll be set! I posted some pics from POD 10.

Another milestone happened on POD 11 ... I started driving. It didn't feel like a risk as I felt I was moving around quite unrestricted. I had my kids with me and my mom (to manage said kids if they started acting up!). Destination was the shopping mall! I needed a little fun after being cooped up at home. I managed a few hours of shopping just fine. Was tired afterward but not exhausted. Ran into hubby's grandma and aunt at the mall ... they didn't make any remarks suspicious of my condition ;) (I haven't told anyone except obviously hubby and my mom.)

Sleeping is good. I was getting tired of just laying on my back. I found I could tolerate 1/4 side lying (one hip propped up slightly but basically mostly on my back still). But to completely lie on my side bothered my incision. I'm not using as many pillows under my back so I am also lying flatter.

Today is POD 13. I had another shower and had a real good peek at my new tummy. It seems like the swelling keeps improving ... I can't help but wonder how good this tummy is going to get! I'm also curious to see under my incision tape. It's never been changed! (I think PS is going to remove or change the tape at my 2-week appointment.)

It's Thanksgiving weekend here in Canada. I'm hoping nobody will pick up on my surgery (well except maybe to say that I'm looking good?). They know I've lost 20lb recently so hopefully they'll notice I look a bit slimmer and attribute it to continued weight loss ;) I think I'm standing 95% straight. Anyway, Happy Thanksgiving to all my Canadian TT'ers :)

I'm having trouble uploading pictures ... I can just get one up ... hopefully more next time.
How long after tt can a seroma happen? I am 3000 miles from my ps. Spening too mych ime thinking the worst.
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You and I had similar recovery . I have had a couple of complication but overall it has been ok. Keep it up!
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you look mahvelous dear. I wish I had done my tt when I was young, good for you, enjoy it. and glad you are healing so nicely.
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Rest of the 10-day post-op pics....

I'm finally able to upload more pics from 10 days post-op...
I think seromas generally happen within the first 2-3 weeks. It is highly dependent on when you get your drains removed. i.e. if you get them out while still draining lots of fluid, you are at high risk of developing a seroma later. At least that's how I understand it. Not sure about the risk for drainless TTs.
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Thank you for the reply. Whew. I am five weeks today. I still am uncomfortable all the time, as i guess everyone is. Do ya all just suck it up and take Advil or tylenol? I am so not happy with this constant uncomfortableness. Guess i need a pep talk
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I am six weeks today and still have a lot of sunburn feelings across my tummy and midriff. As the six weeks is when you're supposed to be able to exercise, I did a gentle dance practice with my dance partner last night. But I couldn't move normally. Things were tight and pulled causing me to be ginger and frankly it didn't help my dancing at all. I"m not sure whether I should be dancing given that it's pulling - as someone else commented - if you go at it too much at 6 weeks you can still open the scar I think that doctors should give this op an 8 week warning minimum. I'm sure a few get away with a quicker recovery, but there seem to be a lot who don't. I still can't reach the top shelf of the cupboard so how you could be back in the gym at this stage I'm not sure!
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3 Weeks Post-Op ... Still Smiling :)

My last post left off talking about (Canadian) Thanksgiving. Well, nobody at any Thanksgiving gatherings commented on my slimmer physique but that's okay ... I'm feeling good about how I look and feel in clothes and that's what matters!

Still feeling good. Definitely get tired earlier in the day so not at my full level of activity. My mother comes over for 3 hours each day to give me a little break from the kids. Another random thing ... Just after 2 weeks post-op, I began to tolerate sleeping on my sides which is a nice option!

Speaking of 2 weeks, this is what went down at my 2-week appointment with PS:
He removed my incision tape and I had the opportunity to look at my scar for the first time ... and I was pleasantly surprised with how nice it had already healed. PS applied new tape to my incision because he said it helps with scar formation/aesthetics. So that will stay on another 2 weeks (after which we would start silicone scar therapy). He encouraged me to start putting a bead or marble in my BB to open it up. I wish I had taken a picture of how it was ... basically just an ugly closed vertical line.

In terms of working on BB, a marble seemed to large (and a bead too small), so I went with a jumbo pearl (fake). I was surprised how it just popped right in the BB slit and stayed in all by itself, lol! I basically keep it in 24-7 but re-sterilize it when I shower. That pearl is already working some magic :) (I'm showering normally, i.e. no saran wrap, lol, but use a cold hair dryer to dry my incision tape before I put CG on.)

Not much else to say except I'm getting annoyed with my size L clothing! it's too big now that I don't have a belly pouch to hide. My lounge pants are literally sliding off me too, lol! My fall jacket I just bought a few months ago is a Large and I'm kicking myself for not getting a Medium! Not sure when I'll have the money to go on a shopping spree for a new wardrobe but I certainly look forward to it!
You are looking fantastic!!!!
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thank you :)
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Wowee! You look great, thank you for letting us see.
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5 Weeks ... An Update and Some Before-and-After Stats

First, I had another appointment with PS at 4 weeks. Basically removed the "tape" on the incision and gave me instructions for starting the silicone scar therapy (after I aired the incision out for a few days). He was happy with the BB remodelling (using the pearl). Next appointment is at 3 months.

Now about the silicone scar therapy ... PS uses 4" x 7" silicone sheets which are $50 a pop (I cut this into strips to fit incision). So for a box of 5 sheets, it was $150 and I was told this might last about a month! Ouch. I guess if the scar is the biggest negative of getting a TT then the cost of the scar therapy is worth it.

I finally got up the nerve to try on my pre-op jeans. For some reason, I was worried that I would be disappointed ... that they wouldn't be too big. However, the reality was that my old jeans were incredibly big. I'm not talking loose; I'm talking about being able to pull the waist out many inches! I meant to take a picture ... will do next time for sure because it really is shocking!

I also went shopping for a leather coat at Danier Leather. I couldn't help but laugh when the employee told me I look like a size 6 so that I would be a Small but she recommends I go down one size to an XS because the leather will stretch!!! My eyes nearly jumped out of my head in shock because I am used to being a size 11-12 or Large. And yes, the XS fit me! Did it ever feel great trying on form-fitted leather jackets ... in size XS!, LOL! I ended up buying a fitted wool coat at The Bay ... in size Small (and it's not even tight!!!). I wasn't expecting to get down to a Small!

So, in addition to updated pictures, I thought I would share some before and after stats. My measurements were taken at the end of the day when I have some (minor) swelling.

PRE-OP CURRENT
Weight: 160 lb 152 lb
% Body Fat: 27.6% 24.9%
Waist (natural/high): 30.5" 30"
Waist (at belly button): 37.5" 34"
Hip: 38.5" 37.5"
Thigh: 23.5" 23"
Pant Size: 11/12 9/10
Top Size: Large Small/Medium

So, I'm really feeling good about my decision to go through with the TT. It is so nice to now be able to confidently wear form-fitting tops instead of loose or baggy tops. And my husband thinks it was worth it now too. He really is amazed with what PS has done. (Originally my husband was shocked that I was going to go through with TT and he was convinced I was going to die, LOL, but now he's right there with me seeing what a great decision it was.)

Other general things ... I notice increased swelling towards the end of the day but consider it minor. When I wake up in the morning I am completely flat ... feels great! I feel pretty exhausted by the afternoon. I tend to forget that I am 5 weeks post-op so am still healing. I haven't gained any weight (after losing some post-op) but feel that I should start a more regular exercise program. Again, I feel exhausted by afternoon so if I don't get on the treadmill in the morning, I am doomed, lol.

I will update in another week or two.

Forgot to Mention ... Ditched my CG!

I forgot to mention that PS said I can ditch my CG at 4 weeks ... so I did! And it feels fine. I just wear a snug camisole or tank during the day ... that little bit of compression feels reassuring to me.
You are looking terrific! I am 9 days PO and not feelin' great yet. My PS took tape off my incision after 1 week and I am just supposed to put ointment on twice a day. I wish I had tape like you because it looks so ugly to me! I would feel better if it were hidden. I look forward to that scar tape I can use in a few weeks.
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Congrats on being a small and the weight loss! You look great!
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Thank you :)
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6-Week Photos

I had typed up an entry and then my browser quit and I lost it all ... so briefly, here's two pics of TT results at 6 weeks. (Look how big my old jeans, size 11/12, are on me now!!! In my previous post, I said my new pant size is 9/10 but I haven't actually tried on any new pants yet; I may be smaller than that!)
Smokin' results! You really do look great:)
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what a compliment :) thank you!
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