I have Fibromyalgia/Scleroderma and I'm getting a Breast Reduction/Tummy Tuck in April. 6 1/2 hour surgery? (photos)

Question

I was diagnosed in 2011 with Fibromyalgia and in 1/2014 with "mild scleroderma" meaning my symptoms are minimal (joint pain/generalized pain). Should I expect problems with healing after my procedures? Should I expect the pain to be severe? I will off my medications 2 weeks before until 2 weeks after surgery. I've been taking Savella 50mg BID for 3 years and Plaquenil 200mg BID since 1/2014. I am weaning myself off now, with my doctor's oversight, in order to have surgery. Any words of wisdom?

David L. Mobley, MD, FACS · Answer

I often safely combine Breast Reduction and Tummy Tuck.  Especially with the use of a Pain Pump which drips Bupivicaine into the Tummy tuck near the area where the muscles are tightened (plication) these two procedures can be performed together and the pain can be well controlled.  Medications which decrease your immune response can effect your recovery and put you at increase risk for infection:1. Plaquanil - No increased risk of infection or delay in healing.  You do not need to stop Plaquanil according to most experts2. Steroids such as Prednisone (if you have been on this for a period of months) - Definite effect on healing because it reduces inflammation.  This effect can be greatly reduced by taking Beta-Carotene 25000 IU for 1-2 weeks before surgery.  Do not continue more than 3 weeks total as Vitamin A can build up in your system3.  Sevella - No effect on risk of infection or delay in healing.  You should not stop this drugIf you are only on Plaquanil and Sevella you do not need to wean off of these as it serves no purpose and being on them will not affect healing or your risk of infectionYour main concern should be making certain they use sequential compression stockings and TED hose during your surgery and being mobile soon after your surgery to reduce the risk of blood clots.Make sure also that you and everyone (nurses and doctors) who touches you after the surgery has washed their hands.  I know it sounds simple but it works.

Darryl J. Blinski, MD · Answer

Obtain full medical clearances and understand you have a slightly increased risks of complications with these medical issues...

Eric A. Weiss, MD, FACS · Answer

Breast and abdominal surgery are often performed together. The medications that treat the scleroderma and fibromyalgia can delay healing and increase the risk of infection. So if is important  to wean from the medications prior to surgery as you are doing. 6 hours of surgery seems s little long but not too bad. Go in with a good mind set. Get up and move afterwards and you should do wellwell. Eric Weiss MD

Manuel M. Peña, MD · Answer

The combination is not uncommon as they are often interrelated, the breast reduction should improve the FM significantly, but the tummy tuck can be a bit slow to bounce back from with these conditions. The scleroderma should have little to do with your healing unless you have been on prednisone. It would be wise to have your surgeon (board certified plastic surgeon) consult with your rheumatologist directly concerning your perioperative care. Good luck.

Tom J. Pousti, MD · Answer

In my practice, I have had patients with your medical “conditions” do very well after the combination surgery you are scheduled for.  On the other hand, I have also had patients who have had more than average discomfort associated with the same procedures. I have found that the “mindset” the patient's have prior to proceeding with surgery,  regardless of whether they have any type of associated medical condition, makes a big difference when it comes to their recovery experience.  In other words, patients who are “glass half full” and physically, psychosocially, and emotionally stable tend to do well,  as opposed to patients who are "glass half empty”.  Since you considering undergoing a major operation which often involves a significant physical and emotional recovery ( often underestimated by surgeons and patients alike), 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, and the attached link, helps.

I have Fibromyalgia/Scleroderma and I'm getting a Breast Reduction/Tummy Tuck in April. 6 1/2 hour surgery? (photos)

Answers (5)

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