Part 1: Mommy Makeover Preparations...

Back! Had a little trouble posting, what with the block losing electricity (for no apparent reason) yesterday.

Fast forward to April 2012, when the twins were finally old enough that I could leave them with my mom for a couple of hours at a time since they could go a couple hours between nursing sessions. I hit the gym again. HARD. And as I mentioned, got my body fat measured. It's now September--so 5 months have passed--and my latest (professional) body fat analysis came back around 16%. The hand-held meters say anything from 16-19%. But since a healthy percentage is just under 22%, I should be good. I am well-muscled and strong. But this belly!

The Consultations Begin

I'm going to go into these in detail, since I doubt many people will read this anyway, but I'm using this as a diary and want a record of it :). And anyway, if anyone is interested in what consultations are like….

So this past week, I conducted my first three PS interviews (the first really was a consultation, actually). I started with Dr. Samuel Pearl, in Mountain View. He has an excellent reputation, from what I can ascertain, 30 years of experience, his own surgery center in his offices and two nurses who work for him who are down-to-earth but seem competent. Dr. Pearl was not a salesman, but a real doctor, who was more interested in doing what I wanted than in the up-sell. He was also quick-witted. It took him about 5 minutes to suss out that I was an extremely well-informed customer and that he didn't have to dumb-down his vocabulary for me, nor explain things obvious to those of us who have spent literally hundreds of hours perusing RealSelf and other sites, researching our procedures. I disrobed per his instructions, then he came back in and palpated my breasts, measured things, took notes, and noted the extreme lack of tissue in my breasts. What were once two gigantic zeppelins, each larger than a newborn's head, were now sad sacks of empty skin, riddled with stretch marks. The skin is also very thin now, because of all the stretch marks. Poor skin quality, is what they call it. The doctor wrote on them with lipstick, then expertly folded one like origami into a lifted shape and showed me how soft my upper pole would be (not even as hard as weak jello). That, and the fact that small augmented lifts last longer, sold us immediately on the augmented lift.

The doctor then looked at my tummy. The first thing he mentioned was the umbilical hernia, which I hadn't been sure I had, but was pretty sure. My innie BB got destroyed during my twin pregnancy, though I managed to get no real stretch marks (slight marring of the upper ridge of my BB where I had a piercing scar that failed to stretch). Then he had me lie down and do a partial sit-up so he could dig his fingers into my diastasis and allow my husband to do the same. I was very glad of this, because it made my husband understand how I can want to do this surgery. We talked about abdominoplasty, and the doctor said that, unfortunately, he didn't think that I had enough skin to avoid the vertical scar from my old BB. My biggest, ugliest problems in the tummy area are the diastasis that makes me look 4 months pregnant after I eat a meal, and my ugly-a** BB. I asked him if I would need any Lipo, and he said no, there wasn't any extra fat there. I guess cause the part with the fat under it will be cut off. Hah! :)

Then we talked about sizing implants, and that was kind of a disaster, because I want to be small, but it felt like he wanted me to be bigger. He said if he took out 100 cc of breast tissue, that I should put in at least 230 cc. He couldn't make us understand why he thought we should have a net gain when I wanted small breasts.

Overall, we had some difficulties communicating. Sometimes we'd ask a question and he heard some other question (or at least answered some other question). And the whole implant size spiel just seemed nonsensical to us. At one point, when he showed us Before/After photos, I commented that one of the ladies' nipples were still pointing down slightly, and my husband agreed. But the doctor got kind of defensive. I was surprised because I'd said (several times) that I thought the result was beautiful regardless.

Anyway, after spending 2.5 hours with us, until well after business hours, he gave us a quote of about $22k for bilateral mastopexy and augmentation with silicone gel implants, and full abdominoplasty with diastasis and umbilical hernia repair. I almost gasped. I mean, I was expecting close to $20, though I'd been hoping for less, but…. I understand why he charges so much--really, I do. But here is my philosophy:

In a free economy, you get what you pay for; BUT WHAT YOU PAY FOR IS NOT ALWAYS NECESSARILY WHAT YOU NEED OR EVEN WANT.

For example, with Dr. Pearl, you are paying for:
-An artistic eye
-30 years worth of surgical skill and experience dealing with complications
-Two professional nurses on staff, both of whom are older and very experienced, plus an office assistant
-An accredited, in-office surgical suite
-Professional Anesthesiologists (MDs)
-and much more!

All of that stuff is expensive. But I don't really need all that stuff, even if I want it. I do want to pay for an artistic eye (or talent). I do want to pay for some years of surgical skill and experience, but I don't need to pay for 30 years. Perhaps the nurses could be less experienced as well--10 years instead of 30. The surgical suite could be shared instead of private and in-office. Etc. It's difficult to find the subset of things one is willing (and able) to pay for, and map those to an actual PS, but Dr. Pearl is out of our league for sure, and that's that. So even if we'd gotten along swimmingly, we couldn't have gone with him.

The Second Consultation
Our second consultation was with Duet Plastic Surgery in Palo Alto, which is in the interesting position of having a team of plastic surgeons, one of whom is Board Certified and the other not (yet--she is Board Eligible and should be certified by the end of the year). We only met with one of them, as the other was on vacation in Hawaii just then. Also, the assistant went home sick, so it was just Dr. Weintraub there. She was also the one who scheduled me, and answered all of my initial emails. She and Dr. Angeline Lim perform the large surgeries together, and have been doing it for at least 4 years (since 2008). They may have known each other during their residencies--I can't remember that part.

As a side note, I wish that these plastic surgeons would just make it easier to see their CVs. I mean, I realize it may be harder to get people in the door that way, and that's why they don't do it until their CVs are solid, but it really just makes me antsy. I think having to go to LinkedIn in order to find out how long someone's been a practicing PS is a bit blah. And if I can't find out even from that, forget it. I will not hire you.

Anyway, back to the consultation. She was great! She heard all of our comments and questions, we understood everything she said. She did not talk down to us. She noticed things and commented. She told us about the process she's been undergoing to get ABPS certified. We looked at books, etc., and saw good results. She didn't seem to think there would be any problem with stretching my skin to get rid of the old BB and avoid the vertical scar. Unlike Dr. Pearl, they do not quilt down the skin, because they have been unable to get good results in the scar that way (it ends up squiggly for them, which could be an experience thing.) The only thing I didn't like (because I found it inconvenient) is that she referred us to another PS at Kaiser because our insurance is Kaiser and because I have an umbilical hernia, she would prefer that a general surgeon fix it, and so it'd be cheaper for us if we had a Kaiser PS handle the cosmetic part in conjunction with a Kaiser GS to handle the hernia under insurance coverage. I'd been putting off the call because I'm biased against Kaiser PSs and because the pics on the website do not represent what I would consider good results (and none of them were this doctor's results anyway). However, I did finally call, but they charge $100 for a consultation AND are already almost completely booked through October (they had only one appointment left for one afternoon in the middle of the month.) Anyway, I need to ask my husband whether he still wants to do it, though I suppose he will, even though it's the most expensive consultation I'll have AND I have seen no examples of the doctor's work. But I digress (again).

The upshot is that the estimate was $17,650, including the silicone gel implants and garments. It's still a good $4000 more than a lot of you lucky ladies have paid for your wonderful transformations, but such is life in the Bay Area. The price would be doable, if we borrowed from the house. Again. The house on which we already owe more than it is worth. *sigh*. BUT, if they get the general surgeon to do the hernia repair, that's an extra $2k. Which brings that estimate up to $20k. For 4 years of experience per PS. I don't know…that's a bit pricey.

The third consultation was with a PS who is not ABPS certified. Now why did I schedule this? you may be wondering. Heh, funny story (not really). I was looking for good reviews on Yelp! and he popped up. That was before I knew anything about RealSelf or the ABPS. He had great reviews. I scheduled an appointment, along with several others, and then the weekend before I was going to start the interviews, I did a last check of all the PSs to make sure they were all board certified. He was not. And to make me even more nervous, I was unable to find anything reliable about him! He didn't even have before/after pics on his website. And when, in a fit of desperation, I called his office the day before my appointment and asked for a copy of his CV, the secretary did not even know what a CV was! And then she said for patient confidentiality, he didn't give out that information. And then I explained, very slowly, that a CV is like a resume and doesn't include patients' names or pictures or anything. Then she said they didn't give out that information over the net, and that I'd have to come to the office. I was LIVID. And very angry at myself. And scared. After hours of web research, the only thing I could find is that he is a real doctor in California and that he used to work with a female PS who got one excellent web review for a gender reassignment surgery. And that he's published a couple of papers in neuroscience a long time ago. OMG, I was shitting bricks. And HATING Yelp! It's too easy to fudge there. I even joined Angie's List to see if they had anything on this guy. Nothing, and $12 wasted.

My husband was getting kind of impatient with me because I was freaking out. The consultation was free, I wasn't committing to anything. "It's like you think this is some kind of test you're going to fail," he said. *sigh*. He was right. "As long as you're not angry about losing half a day of work for this, I'm fine," I said, and then I was.

The consultation was interesting. The doctor came into the room talking a mile a minute. And that set the tone for the rest of the interview. Him talking almost non-stop, not hearing us, not even hearing himself (and sometimes mis-speaking). It took 5 times of asking him the same question at one point before he heard us. He had a spiel which he could not deviate from. He kept repeating things we already knew going in, and could not modify his presentation to fit an audience that was well-informed and well-educated. We got some good information and I learned something new about the anchor lift (it's a small technical detail but I'd been missing it). He also seemed to think my skin would reach to avoid the vertical BB scar, but it was difficult to ask exactly. There was exactly one point at which I had the time to ask about why he's not ABPS certified, but it was just before I was going to take off my clothes, and I thought there'd be time later. I never got to ask it. He talked his way out the door 90 minutes later, late for lunch, and I guess I'll never know, now. There's no nice way to ask something like that over email or over the phone. The doctor sent a nice thank you card, (hand written) and the estimate for the full shebang (bilateral breast lift with gel augmentation and full abdominoplasty) was $14,590. His before/after pics were fine--nothing stellar, nothing worrying--just like the previous two. He uses the exact same surgical suite that 5 of the other PSs I'm interviewing use, and he has more experience than Duet. There were some boxy breasts but I think that comes with doing post-bariatric body lifts and, frankly, he may be willing to take some clients someone more experienced and expensive would refuse because they may not get a perfect result. Anyway, the guy was nice, and I think that for someone who clicked with him, he'd have worked out fine. We had a lot of stuff in common, actually--both personally and educationally--but in the end, my husband and I are desperate for someone who communicates well with us.

The difficult part now is that I have to wait over a week until the next appointment, because my mother is away and I have no childcare.

Talked surgery dates with Duet yesterday, (not because I've chosen them yet or anything,) and they are already booked through January and almost through February. They only do surgeries one day/week. That might take them out of the running, since we're going on vacation in July and I don't want to go still looking like the Bride of Frankenstein.