I am going to have a tummy tuck but I had to postpone the date!

I just read a really good question on RealSelf and an interesting response from one of the doctors, so I'm re-posting it on here:

Megan in Indiana had asked a question I had been meaning to ask: if being in shape and physically fit helps the recovery from tummy tuck.

Here's what Dr. Posti responded to her.


Thank you for the question and congratulations on your fitness level and your decision to proceed with mommy makeover surgery.

Although there is no science behind my comments, I think that generally speaking patients who are physically and emotionally in “good shape” to better after major surgery.

However, despite being in good shape you are about to undergo major surgery which involves a significant physical and emotional recovery. A few words of advice may be helpful:?

1. Make sure you are doing the procedure for the right reasons (for yourself) and that you have realistic expectations. Be aware that an improvement in the “problem area” may not translate to an overall improvement in your life situation. You are bound to be disappointed with results of the procedure if your motivation for doing the surgery is not internally driven.
?
2. Time your surgery carefully; generally, it is not a good idea to have surgery done during or immediately after a stressful period in life (for example divorce or death of a loved one). The additional stress of surgery will undoubtedly be more challenging to deal with if a patient's emotional reserves our already exhausted. Remember, that an improvement in your physical appearance will not translate to an improvement in your life situation.?

3. If possible speak to patients who have undergone similar procedures and query them about the toughest times of their recovery period. Any practical hints previous patients can provide may be very helpful.?

4. Make sure you are aware of potential complications that may arise how to reach your surgeon if necessary.

5. Make sure you have a strong and patient support system (several people if possible) in place who have time/patience to take care of you. Arrange for professional nursing if any doubt exists regarding the availability and/or stamina of your caretakers.?

6. Be patient with the healing process, understanding that it will take several weeks to months to feel “normal” again. It may also take many months/year to see the end results of your surgery.?

7. Be prepared to distract your mind with things of interest such as books, magazines, and movies.?

8. Expect less of yourself; do not go back to work, school or chores too early and let others take care of you (for a change).?

9. Pick your surgeon carefully (a well experienced board-certified plastic surgeon) and trust in his/her advice. Keep in close communication with your surgeon and do not hesitate to communicate questions/concerns and the emotional swings that you may experience.?

10. Resume all medications that you were using preoperatively when cleared by your plastic surgeon and stop the use of narcotics and sedatives as soon as feasible after surgery.?

11. Keep in mind the end results as you go through the tougher emotional times after your surgery.

I hope this helps.

In reading some posts about the intensity, length of duration, and pain associated with constipation after tummy tuck, I found this information:

General Anesthesia causes constipation
Any narcotic medicine causes constipation
Antacids cause constipation

Also (and not having too much to do with this), I read that studies show that general anesthesia carries higher risks with it for the patient than other forms of anesthesia, but that surgeons prefer general anesthesia anyway. I read that the reason surgeons prefer general anesthesia despite the higher risks, is that it gives them complete control of the person's airway, and also that it paralyzes the stomach muscles, so they can do the muscle repair suturing very easily.

I found a nifty little interview with a PS. It made me realize how complex is the process for setting the belly button in the new flap of skin, and also how important a stress test is for women over 50, before having TT:

Dr. Brent Moelleken: Now, typically, if the surgeon is clever about it, it should be a very, very appealing sort of good looking belly button. There’s a whole science that goes behind how to make a belly button. You wouldn’t think of it but there’s all sorts of anchoring that’s done and then liposuction around the area and removal of fat so it’s nicely contoured and it’s hooded on the top and then it’s sort of depress it three, six and nine o’clock. It should really look appealing, not too big, not too small. It should really look like an appealing belly button.

Dr. Brent Moelleken: Often, people who have tummy tucks are a little bit older who have a full tummy tuck. For someone who’s in their 50’s or their 60’s who has a full tummy tuck, well, they’re not 20 so their heart maybe weaker. They may have underlying medical problems. There are big fluid shifts that can happen. People can have literally a heart attack after any big surgery.

Teri Struck: So, do doctors get echocardiogram or anything beforehand or do you just tell them to please bring all the proof in. How do you know if patients that know if they have a heart problem?

Dr. Brent Moelleken: Well, that’s a good question. Every single patient that enters my practice who’s over 50 years old and then also some people younger, if there are reasons in their medical history, but every person over 50 gets a stress test before having any anesthetic. A stress test is basically a test that a cardiologist does to see if there’s hidden damage to the heart. People say, “Well, why do I have to get a stress test? I had a cardiogram. My cardiogram was normal.” But, the cardiogram only tells you if you already have damage to your heart. It doesn’t tell you if the heart’s very, very weak and ready to have a problem. But it the person goes to a stress test and they stress their heart and there are no problems, then we feel much more comfortable giving them an anesthetic.

Teri Struck: A stress test is basically what? Is that a treadmill?

Dr. Brent Moelleken: Yes, it’s kind of a treadmill test. One gets on the treadmill, they walk and they run until their heart rate and their blood pressure reach a certain level. Then, the cardiologist knows. You know, “I put the person to the paces. I put their heart to the paces and their heart did fine. So, I’m reasonably certain that their heart is in good shape.”

Teri Struck: Who do you go to for that? Your internist?

Dr. Brent Moelleken: Every internist knows a cardiologist. Many internists do their own stress test or they refer them to a cardiologist to do the stress test.

Teri Struck: Do you have to be referred from another doctor to go to a cardiologist?

Dr. Brent Moelleken: It depends on the
patient’s insurance plan. Many people who have HMO type of insurances need to be referred by their primary doctor. But most plastic surgeons have relationships built up with doctors who can do stress test and with doctors who can do physical examinations. You know, basically, every patient who has surgery needs to be cleared by a doctor and get their stress test if they’re over 50 years old.

http://personallifemedia.com/podcasts/226-beauty-now/episodes/3302-tummy-tuck-doctor-stars-tells-us-what-we