51 yo, Fleur-De-Lis TT, BL & BA; 5'5" 156 lbs - East Texas

I'm 51 years old and had gastric bypass 17 years...

I'm 51 years old and had gastric bypass 17 years ago, losing about 80 lbs. I gained back about 20 over the years but have been stable. I currently weigh 156 (I'm 5'5"). The weight loss left me with loose skin & apron that I've just lived with over the years. I've also always had significant asymmetry in my breasts. They've never fluctuated much with my weight gain/loss, though.

I've had consultations with 3 surgeons (2 in Tyler, Tx and 1 in Longview, Tx). The first doctor (in Tyler) I never felt comfortable with from the very first interaction. In fact, I went home crying & decided this just wasn't for me. But then I realized that the problem wasn't ME, I just needed to give another doctor a try and see if it was a more positive experience. SO glad I did! Loved the next two surgeons. So, word of advice - DON'T GIVE UP UNTIL YOU FIND A SURGEON YOU FEEL COMFORTABLE WITH!

At this point, I'm 99% sure I'm going to go with Dr. Gary Jacobs in Longview. With all other factors being fairly equal, the primary reason for this choice is location (he's an hour closer to my home).

I've already decided on silicone implants. Wavering on size. My goal was never really to have large breasts, just pretty, symmetrical ones. I've learned this - the clothes you wear when trying on the implants makes ALL the difference. My first visit, I wore a button down shirt and we tried a 350cc (on my smaller breast). I turned sideways to look in mirror & immediately decided it was WAY too large! I looked like a square from my chest down!

Next visit, I wore a fitted tank top (not on purpose, just what I happened to be wearing). We started with a 450cc on the smaller breast & my profile/silhouette was beautiful! That's when I realized that my wardrobe was going to have to change. SO KEEP THAT IN MIND when you're choosing your implant size & final desired look!

Dr. Jacobs discussed a fleur-di-lis incision for my tummy tuck. This is a decision we'll make together, so I'm waiting until my scheduled pre-op visit (one week prior to surgery) to finalize that and the implant size decision.

I'm hoping to schedule the procedure for early April. Will add photos soon.

Doing this because the other posts on RealSelf have been SO helpful, and I hope my experience can help others and answer questions as well!

Photos added

I know how much before-and-after photos help, so I'm posting all my 'before' shots now.

Surgery date tentative for Apr 6, 2016

Dr. Jacobs' office asked another patient if they would reschedule so I could have that date - it's the best one for my kids to be with me when I have surgery. So excited they called to inform me I could have the date & they'd get back with me to confirm time & pre-op consult one week prior.

After reading up on it, I've decided to go with the fleur-de-lis abdominoplasty. Seems I'm a perfect candidate: it will remove the excess skin above my navel, it will help to contour my waist more, and I already have the vertical scar from my gastric bypass.

Will make final decision on implant size at that pre-op consult as well. Last I was there, we were discussing 400-450cc on right and proportionately smaller in left (I can't remember how much smaller).

Told my kids (21-yr son, 25-yr son & wife) this weekend about the surgery. It's not easy for boys to hear their mom is getting brewst implants, but I assured them I wasn't doing this for size as much as for lift & symmetry (without going into details), and they're all very supportive.

Will schedule time off from work this week. Can't wait!

Surgery date/time & final pre-op visit scheduled.

Confirmed my surgery date again for Apr 6. I'll have a pre-op visit on March 31 to discuss TT incision and make final decision on implant size. As of now, I'm thinking of 450cc on R side & whatever surgeon feels would be necessary to create symmetry on L. Still looking at dozens of pictures to try and decide, but it's hard when you don't know the height/build of the person. I know implant size doesn't correlate to bra size, but when bra size is the only measurement you've gone with for years it's hard to think any other way! I'd like to be a full D, maybe DD, but no more.

On the 31st I'll also make my payments and have lab work done. I'm assuming any pre-op instructions for the week prior will be given to me at that time as well. Vitamins? Diet?

I'm wondering what would be the best vehicle for the drive home the day after the surgery. I live about an hour away, and I have a high truck that's easy to get out of, and a low car that's easy to get into. If anyone has suggestions, I'd appreciate it!

Just found out this week I'll be a grandmother for the first time in November, so the timing couldn't be any better as far as my recovery goes!!

16 days pre-op...pricing & such

Thought I'd add this info just so those of you shopping can compare. Everyone knows cost shouldn't necessarily be the determining factor when it comes to your health and safety, but if you have some ballpark figures, you know if what you're paying is in line with those around you.

The total quote for my abdominoplasty, breast lift w/silicone implants, hospital, anesthesia and an overnight stay was $15,625. This broke down like this:

Surgeon's fee - $11,100
Hospital fee - $3,000
Anesthesia - $1,075
Overnight stay - $450

This is for silicone breast implants, and although my doctor said there's a 50/50 chance I'd stay overnight in the hospital, I'm most likely going to request to stay. I figure if you're spending $15K, $450 is a small price to pay for the extra medical oversight and pain management I can get. But that's something that could change after surgery.

Dr. Jacobs offered a 10% discount off his fee only if paying with a credit card, bringing his portion down to $9,990 and total surgery to $14,515. If paying cash, he's offered a 15% discount on his fee bringing his portion to $9,435 and total surgery to $13,960. I was contemplating using CareCredit to pay for the procedures, but have decided to go the cash route - both to save money and to not have a monthly payment to worry with. I'll pay all of it on the 31st at my pre-op visit.

I should note that the quote states this special is only good through April 30, 2016, so I don't know if it will be the same after that time.

I'm still THOROUGHLY confused on implant size to go with. I thought I was good with 400cc to 450cc, but then read tons of reviews last night that said to increase this by anywhere from 10-30% to make up for some of the volume lost by placing the implant under the muscle.

Going to by rice today to try the rice/pantyhose test to see if that helps me any. Also, don't know about the whole low/moderate/high profile option. I have to ask my doctor what that means. I've read it simply means how the breast will project from the side, but I don't know if that means when I turn sideways how far the breast will stick out from my chest or when I face forward how far the breast will stand out from the width of my chest.

SO confusing!! i also read on another website that you should know your BWD (?) as a starting point because it determines the suggested starting point of the implant size. Gonna have to add that to my list of questions to ask Dr. Jacobs next week!

Wouldn't it just be SO SIMPLE to give them a picture and say "give me THOSE"!! Hahaha. I wish!!

Worrying about recovery!

I took more "before" pics today - this time in clothes so I can compare in the same clothes "after". I'm currently wearing a size 8 in pants, small to medium in tops. Bra size 36C. Hope to be a D-DD. I'll post the additional pics after surgery.

The more I read about the recoveries here on RS, the more I worry. I'm not married, not in a relationship & live alone. My grown boys will be able to be around, stay the night (some)...but when I hear about all the PERSONAL assistance required post-op - no way they're handling those issues! My daughter-in-law will be available most of day 3 & 4, but that's about it. I'm taking a full 19 days off work, with the option to work from home another week or two after that, so I can take my time but I live 20 minutes from the closest person I can call if I need help!

Just wondering if anyone else went this road mostly alone? What are the absolute necessities if I'm alone and what can I do in advance? Fortunately, I don't have to worry about cooking meals or doing anything else to prepare household members for my convalescence, but this does come with its own set of problems!

Wish pics

To be honest, I didn't see the point of putting "wish pics" on your profile....until I began seeing people compare those wish pics with their "after" pics. Soooooo....I'm putting some out there. Honestly, I've looked at SO MANY pictures of breasts and tummies, they've all begun to look the same!

Lots of these may be different sizes, but I think the overall look (at least to my unprofessional eye) is the same. I still am not clear on the difference LP, MP and HP will make...I just know how I want to look!

A week from tomorrow!

Went to bank today to draw full surgery fee out of savings. That was heavy stuff! I'm paying cash to get the 15% discount & also just so I don't create debt. Didn't wipe me out, but still, it took a LONG TIME to build up that nest egg!

I see Dr. Jacobs, get lab work done, make final implant decision & pay everything day after tomorrow. I'll wait until this weekend to buy whatever it is I'm going to need. Mon & Tues of next week will be super busy getting everything caught up & in place at work, then Wed is the big day!

Praying I can clearly convey to dr what I'm wanting the outcome of the BL/BA to be, since it will be his discretion, ultimately, that determines the look. Taking extra tops with me to the appt for when I try the sizers for the last time.

Can't stop looking at boobies!!

I'm like a kid in a candy store...but you can understand when you see what I've been working with all these years!!

Pre-registered, paid & final decisions made!

Saw Dr. Jacobs for my final pre-op visit yesterday. Surgery is in 5 days!

I had lots of questions in this visit, mostly because my other visit was to determine if Dr. Jacobs was the surgeon I wanted to use. Today was all about the surgery itself. We discussed TT incision placement and expected results, and confirmed that we're also going with the Fleur-de-Lis as well as the abdominoplasty so I can anticipate tightening of the skin between my navel and breasts as well as the apron below the navel. This should also help tighten my waistline, since it pulls in from the sides.

Since most of my questions were regarding the implants...here's just a quick rundown of what we covered. Should I increase implant cc's to accommodate for loss of volume due to under-the-muscle placement? (Yes, slightly). What measures could be taken to keep implant from sliding under my arm...especially when laying on my back? (Implant size and existing breast tissue can contribute to that, but he felt a good bra while implants are "settling" would be my best guard against it.) Should I consider textured implants? (In his experience, textured implants didn't 'move' as naturally as untextured, but he had no reason not to recommend them if that's what I preferred...I didn't.)

Other general questions...When would my first post-op visit be? (One week after dismissal from hospital.) How long will the drains stay in? (Hopefully one will come out after one week and the 2nd after 2 weeks.) When would I be able to drive? (Preferably not for two weeks, although physically I could drive before then.) Was there anything I needed to do now to avoid post-op constipation? (Begin daily stool softener now, Milk of Magnesia after surgery, and if nothing happening with 3-4 days, then add a laxative).

I then spent probably a good 45 minutes doing nothing but trying different implant sizes with the nurse. Susan was the nurse today, and she was UNBELIEVABLY helpful in my problem with this decision! She was finally able to help me understand the whole relation between my breast width (14.5, which indicated to Dr. Jacobs that I wouldn't need to start with an implant any smaller than 450cc), implant size and implant profile. She also kept reminding me that what I was seeing in the mirror wouldn't be quite accurate, since the implant would be going under the muscle and therefore wouldn't be as prominent. (After all these years of looking at small breasts, looking down and seeing that kind of profile is pretty overwhelming...hope I don't freak out after surgery when they're high and swollen!)

Susan listened to everything I said, and I felt like she really understood what I was going for. After MUCH trial and error, multiple sizers, multiple profiles, shirt changes and chart consulting, we decided on.....Nutrelle Moderate Plus 575cc (right) and either 457cc or 492cc (left).

They also told me, that due to my asymmetry, Dr. Jacobs would be using sizers during my surgery. I wasn't sure what that meant...so in case any of you aren't clear either, it's pretty simple: with saline implants, they can insert the implant and increase or decrease the volume at will to see the desired results; silicone are pre-sized, so they can't do that. What he's going to do is actually put in a saline implant, fill it to see which volume (the 457 or 497) is best, then go with that size in the silicone. I felt much better after hearing that! I realize they're not going to be perfectly symmetrical, but Dr. Jacobs explained that during surgery, they would sit me up, he'd take a sort of "consensus" of opinions from those in the OR as to how similar they looked...but then HE would make the final determination. I trust him. I have to!!

So I paid my fee in full, went to the anesthesiologist's office and paid them, then went to the pre-admissions for the hospital to pay them and get my lab work done. Since I don't smoke or have any heart or diabetes trouble, they only had to do basic blood work and no EKG. My original estimate from Dr. Jacob's office didn't include a pain pump for my hospital stay, so I had them add that on for an additional $150, bringing my total surgery cost to $14,930.

I only have one day between now and my surgery to gather supplies and really get ready, which will be tomorrow. The other 3 days are full of travel and work...so I'm making my final list tonight. Planning on getting a mani/pedi tomorrow too since it may be a while before I feel like it again (yes, I'm vain!).

I have to be at the hospital at 5:30 am for my scheduled 7:00 am surgery...so let the countdown begin!!

Pre-op pics with sizers

Just 9 hrs away!

Since I live alone, my prep today was easy! Put my iPad & warm socks in a bag. Wearing loose fitting hoodie & swears to hospital in the morning & wearing same ones home. Showered with alibi lens tonight & washed my hair. My kids came home & we played games all evening. Youngest is spending the night & riding to hospital with me, since it's about 45 minutes away. Others will meet me there at 5:30 for 7:30 surgery!

This time tomorrow I'll have it behind me & begin my road to recovery. No nerves...just excited!

Day 1

Surgery went well - at least it think it did! I haven't seen Dr. Jacobs yet this morning. My kids told me it was a 7-hr surgery & something about putting an implant in upside down? They were probably kidding but I was in a fog so I'll have to ask.

I've been sleeping pretty hard since about 3 yesterday. Got out of bed once & sat in chair with help from nurse. But I was light-headed & it made me nauseous. She gave me a cream to rub on my wrists for that & it helped.

There was a good-sized clot in my drain last night. Gotta ask dr about that too.

All-in-all I'm doing ok but that's because I haven't had to move! I can't imagine you women go home straight after this procedure!

I haven't even looked at all the wrapping under my hosp gown. But I can say this, used to see flat (boobs), then round (tummy) when looking straight down. Now it's swapped! I'll update again after I talk with dr & get home today.

Can't tell you what it meant to see all the warm wishes & positive thoughts from you ladies! Thank you all so much!

Day 3 Post-Op

I've been home a day and a half and can honestly say I see improvements every day. My daughter-in-law has been staying with me and I couldn't have done it without her. The hospital nurse told us the drains had to be emptied every 3 hours, so she set her alarm and we were up every 3 hrs on the dot to measure. Fortunately, I called Dr. Jacobd's office the next day and was told we only have to empty the twice a day!

I've taken my pain med every 4-6 hrs even if I didn't need it too badly, because I don't want to get behind the pain. But I can honestly say that I think today I'm going to see how it goes & possibly try Tylenol. I'm not against pain medications at all, just want to gauge how good or bad it really is.

I'm staying in my recliner with a pillow under my knees. After 24 hrs home, I was able to stand up, walk to bathroom, use toilet, and get back in my chair without assistance. I've only unwrapped everything once, last night when my daughter-in-law helped me shower. They actually told me I could shower on day 1 before I left the hospital, but I just didn't have the energy to tackle that. So I used a shower chair and it went without a hitch.

My boobs look great. I'll try to get some pics, but can tell you they're high, tight and kind of square right now. Fortunately, I've seen enough reviews on here to know not to worry, so I'm happy. I only had the BL on my left breast, and implants in both so the incisions aren't the same. When I stand, more than anything, it's gravity pulling on my breasts that hurts. My left boob looks like the implant is upside down, but Dr. Jacobs said that is on purpose because I had so much extra skin below that breast, and that once the implant settles in, it'll have better shape. I really expected my boobs to be up to my chin when I first looked down, but it wasn't so bad.

My TT looks good. The horizontal decision looks really low and straight, and the vertical one looks good as well. My navel is taped, so I can't see it. He said they were able to take out a lot - from the top of my pubic area to above the belly button. He said they removed right at 4 lbs.

There's swelling at my tummy, which I expected, and since I can't stand up straight I can't really get a great look at things, but I gotta say what little I saw I'm completely pleased with!

Wondering about switching from the ace bandage to a sports bra now. The bandage gives me great support, but the instructions also say that wrapping too tightly can affect the healing. How quickly did y'all make that move?

This morning is my first time in the house alone. I made some oatmeal, walked around a bit. I'm in no hurry, so this is easy. My drainage is minimal...its been at over 12 hrs and there's very very little in each bulb. I can see that as a good thing, that it's almost done...or a bad thing in that I'm not draining as I should.

Anxious to post some pics so if nothing else I can get a good look at what I'm working with!

First post-op pics

One week out

I've been doing great and am very happy with results and constant improvement. Still monitoring two drains, hoping to have one removed tomorrow. Sleeping in recliner, walking more every day but still taking it very easy. Not going to do anything to hamper my recovery!

The only place I had tape was around my belly button and that came off at 3rd shower. Right now, I shower, dry, and reapply compression garment and sports bra I owned prior to surgery (since I'm so much bigger now, it's more snug and gives light support). Taking antibiotic, no problems with constipation. No feeling in my left nipple (the only breast that received a lift), but all is well in the other.

Uploaded pics. I'm really happy with TT incision and how low, straight and clean it is. Looks like my left implant is lowering a little more than the right, but Dr. Jacobs explained that the bigger the implant/smaller existing breast tissue, the slower the drop. Since my right breast had little tissue and received the larger implant, I expected this. He said this give the muscles and breast tissue time to adapt and therefore creates a more natural finished look. And of course, that's what I'm hoping for!

First week follow-up visit tomorrow...hoping he's as please with the progress as I am!

8-day Post-Op visit

Saw Dr. Jacobs yesterday and got a good report. Had right drain removed, and he advised me to keep antibiotic ointment on the wound when showering. I told him the sensation of an internal stitch popping keeps happening...several times a day, typically when I'm sitting up straight and not moving, and always right in the same place (at the top of my vertical tummy incision). He said it could be a stitch that is poking and will likely stop as the tissue around it surrounds it...or it could be the drain. I think now it was the drain, because it hasn't happened again since I left his office.

I'll continue to wear the compression garment around the clock. However, he told me I could cut about 2 inches off the width of it and that has made all the difference! It was just too wide for my short waist. He gave me a strap to wear across the top of my breasts around the clock as well, to help them drop. The nurse instructed me on breast massage but advised I put off massaging the left breast another 4-5 days, since it has more incisions due to the lift. Still no L nipple sensation.

Dr. said no lifting over 10 lbs due to my tummy, and as for my arms, just listen to my body and if it hurts, don't do it. No driving for another week, but I can increase my walking so long as I don't do anything involving resistance.

He said the intersection of my two tummy incisions looks good - this was the highest risk area in doing the fleur-de-lis TT - and my belly button is good as well. He explained the likely order of the swelling areas of my tummy that would go down, with the lower portion around the incision to be last...up to a year.

I feel great and am super happy with the results so far! Back to Dr. Jacobs in a week, most likely will have other drain removed!!

More pics

Got behind in uploading, but here are more pics from day 5

Updated pics - almost 5 weeks post-op

Everything is progressing nicely. Breast scars look great, but there is still some slight tenderness on left side (where the lift was done). Vertical tummy scar is SO thin, loving it. Horizontal tummy scar is kind of thick and rope-like. Belly button looks great. All scars are still numb, as is my left nipple (again, the only one that got a lift).

I'm in a 36-DD bra, but mostly still wearing sports bras. My jeans size has gone down from 8 to 6. I'm supposed to be massaging 3 times a day, but honestly I forget. Right implant is still dropping slower than left, but progress is being made and I'm patient. My left aureola is larger than the right - but I'm not complaining when you see what I started with!!

I don't have any trouble sleeping on back or sides (haven't tried tummy) and really don't have any issues at all. I do, however, feel as though the skin above my belly button is not as tight as it was a few weeks ago. Not sure if it's because of something I'm doing, but will discuss with Dr. Jacobs at my next visit. Still lots of swelling all above the horizontal tummy incision - Dr. says that will be the last to go and could take up to a year. Frankly, I'm just so glad the skin hanging over is gone that I wouldn't dare complain about a little swelling!
Longview Plastic Surgeon

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