Tummy Tuck with Flank Liposuction and MR - Ontario, Canada

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!)

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!

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.