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

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I'm interviewing physicians in or near...

I'm interviewing physicians in or near Tallahassee that will do lipo with a tummy tuck, and not do a muscle repair, since I want to forego that, and I've never had children, nor been 100 lbs overweight, or anything like that.

I'm 61, and although not exactly skinny, but I'm not in bad shape. I'll include a photo as soon as I can.

I have a situation in which the skin (and fat) below my waist hangs over my bikini panties. (See photos). I plan to lose more weight before and after the surgery, but it's very hard to get weight off. I work out almost every day, and I'm doing my best to eat healthfully.

My target date for surgery is before mid-December.

So far I've found one physician who will do what I'm seeking, but he's in NY City, and that's so far away. I'm interviewing others. I found one that is closer (Tampa), but he's prohibitively expensive! ($15,000+).

I will post every step of my process, if you are all interested.

Okay, I had the meeting with the P.S. He is...

Okay, I had the meeting with the P.S. He is WONDERFUL. Oh my God what a 'bedside manner.' He encouraged me to ask every question I wanted, which was good, as I arrived with a list I had typed out.

He advised me that what I need is an extended tummy tuck. That means that the lower abdomen skin along with the fat gets removed completely. Goodbye to that hanging skin and fat. The cut goes all the way to the back, so of course, the entire abdomen and part of the hip is involved.

An extended tummy tuck automatically comes with liposuction of the flanks. I told him I was concerned about getting a waist, and he said he'll be sure to 'create' one. :)

He said the fat below the belly button gets removed completely when he cuts that huge slice of skin off (it takes the fat with it), so there's no need for lipo there at all.

Regarding the upper abdomen (where I also have fat), he will not be suctioning the fat off that area because the tummy tuck involves pulling the skin from the upper abdomen area off the muscles and extending it all the way down to the pelvis, where it is sewn up. He said it would be too risky to compromise that area any further by doing lipo in the (upper abdomen) area as well as detaching, then re-attaching that skin further down. Besides, he said, since the skin below the belly button will all be removed, and the skin from the upper abdomen stretched to reach my pelvic area, the upper abdomen will be compressed, pulled, and more than likely appear flattened, and will probably lie somewhat flat. He said that after the FULL recovery, once I'm completely healed, if I still wish to lipo that area, I can have it done.

He said 'dog ears' are not a problem with extended tummmy tuck. I was concerned about that when they sew the corners together, getting a 'bulge.'

The cost will be $8,214.00 which is definitely within my budget, although I will be getting a loan to have it done. Definitely worth it, since that hanging skin I have in the lower abdomen has been causing me a lot of skin rash under it, and I spend my summers applying skin rash ointments to the area under the hanging skin.

He will be using general anesthesia with epinephrine. I don't do well with epinephrine in the sense that my heart beats too fast and I have Mitral Valve Prolapse, but he said that I will be completely asleep and will not notice, I'll be completely 'controlled' (my heart and respiration will be completely monitored), and he reassured me about that. (I'm a basketcase about general anesthesia, among other things). He also said that by the time I am removed from the general anesthesia, the epinephrine effect will be gone.

I am going to select the date by the end of the day, and I will be putting a down payment of $800 to reserve that date. That's my problem. I'm looking at my calendar at work, and oh boy, I'm a busy gal.

Oh, and while I'm at it. He said I need 10 days. He will probably not require doing a muscle repair, however, if he goes in and sees there's separation, he might need to do a little bit. OUCH! You all might recall that I wasn't too interested in muscle repair since I have never had kids and I'm afraid of the pain associated with the muscle repair.

Wish me luck, y'all! I'll write again later and let you all know the date of my surgery.

I've selected a date: November 30. Oh my gosh,...

I've selected a date: November 30. Oh my gosh, I'm so nervous! I'm going to start exercising and eating very healthy foods so I will be in as good a shape as I can be by surgery date.

Okay, it's 10/28/11 and I've put the down...

Okay, it's 10/28/11 and I've put the down payment on my tummy tuck. I also asked for an explanation of the flanks. Turned out the flanks are around the hips, so I asked what would happen with the bulges above my waist around the back. The surgeon was called and saw me one more time to tell me that he intends on doing some lipo of my lower back as part of the procedure. Thank goodness! I have a lot of fat back there.

Right now I'm getting a little nervous about the pain, particularly if he goes in and does some muscle repair. :( I'm also nervous after reading about infections, problems with general anesthesia, being too long out of work, not getting back my energy for months, etc.

One thing that really concerns me is that I won't have anyone to take care of me.

One good thing is that today I asked if after the TT, I will have to bend over for days to protect the wound. I was told I wouldn't have to, that the wound does not tear if one stands up straight. However, I was told that most people who undergo tummy tuck have a tendency to NOT want to stand up straight because of the pain and tightness, but that it's not necessary to remain bent over at all. I had read in a few sites people saying that they were told to remain hunched over for days, and now I hear that it isn't necessary. I'm finding out more each day.

I still don't have a date for the surgery, but...

I still don't have a date for the surgery, but I do have a new perspective on it. It seems to me that a tt surgery can be unpredictable. One can go two weeks, or three weeks, and suddenly have a setback. I'm even thinking that perhaps it's not even the first week that is unpredictable. It's what happens later on, as the healing begins. From swelling, to abscesses, to belly buttons oozing, to infections, to returns to the OR, no doubt it's an unpredictable surgery. Granted, it's not open heart surgery, but it's not like having a pimple removed, either. Each of us goes through a completely different experience based on a million factors. TT is certainly not for wimps!

Okay, here I am awaiting my second root canal, and...

Okay, here I am awaiting my second root canal, and I still haven't figured out a date for my tt. I have moved from thinking I could take off 1 week, to 2 weeks, and now finally to 3+ weeks. I search my Outlook calendar at work every day for a time that is best, but I haven't made a decision yet. I'm shooting for next week as the week to decide when I can get this done. My work calendar is so full! Where will I eek out 3 weeks? That sure sounds like a heck of a lot of time to take off. It's obvious I won't be having it done before Christmas.

I just found out some interesting things in my...

I just found out some interesting things in my preparation for my tummy tuck. I plan to write these down on a poster board and post it on the wall, so I can read them while I'm healing and don't start imagining my case is any different from anyone else's:

1) The pain medicines the doctors prescribe for pain after the tt, cause horrible constipation AND cramps. However, the medications are necessary to avoid the pain felt after the tt. Experiencing too much pain (by not taking the meds) is not healthy and can cause a delay in healing. (Damned if you do, damned if you don't).

2) The incision scar usually looks its worst at about 3 or 4 months.

3) Depression (and regret) about having had the tummy tuck) often experienced, and is quite common. This is because the general anesthesia can cause depression, the let-down of long recovery can cause depression, and the 'coming down' from the elated feeling before the surgery - "I'm going to look so good" - compared with the after surgery's "oh my goodness, my whole body is a mess, I feel horrible, and my belly looks terrible right now" can cause depression.

4) Numbness in the belly (as well as itch and weird sensations) is normal, because nerves have to be cut in the process of doing the tummy tuck. This usually gets back to normal after the healing period is over.

5) Using nicotine patches, gum, or smoking while the incision is still open, is a no-no, because nicotine delays healing. No nicotine should be inhaled or taken orally or in patches for 6 weeks before the surgery, all the way to 6 weeks after the surgery.

6) General recovery generally takes 3 to 6 months. However, the swelling can a LONG time to resolve: 8 to 12 months, maybe more, depending on the individual.

7) Walking after the tt is incredibly important to avoid embolism, but too much exertion soon after the tt, is not good at all. Maybe I'll space out walking in between rest periods?

8) Drainage can stink and look horrible, and the tt can still be normal - doesn't necessarily mean something is going wrong, but the doctor should be advised in case it is an infection. Temperature over 101, increasing pain and redness over the area, discharge coming from the incision (other areas than the drain), or horrible smell and a funky looking discharge coming from the drain.

9) The risk of infection can exist even up to a month and a half after the surgery, so it's important to keep an eye on the incision and take the temperature regularly. Also, following the belly and incision cleaning instructions given by the surgeon is important to help avoid infection. Not following the surgeon's instructions for cleaning the area as he instructs, is one of the most common reasons for infection. (Although one can get infections during surgery itself).

10) Compression over the area (by using compression garments) is important because these improve circulation, get rid of the fluids that accumulate in the area (which minimizes swelling and decreases chances of infection).

Okay, more things I have to remember. I read that...

Okay, more things I have to remember. I read that the reason the belly swells is because a tummy tuck surgery damages the lymphatic drainage system, which then has to rebuild itself. The rebuilding of the lymphatic system takes MONTHS. The lymphatic system is the body's system of regulation of fluids, drainage of fluids, disposal of bacteria, filtering fluids in the body, and getting rid of toxins.

If the lymphatic system is damaged (as is the case in tummy tucks), there is an accumulation of fluids, and draining doesn't occur as it should. This causes the fluids in the lymph channels (lymph fluid) to 'leak' out of the lymph channels and engorge the surrounding tissues, causing them to swell, sometimes dramatically, and even to the point of the tissues feeling hard. The accumulation of lymph fluid throughout the tissues is called lymphedema.

Certain things are recommended for lymphedema:

-Drinking lots of water
-Staying away from rigorous exercise
-Doing a gentle exercise program
-Keep the area clean as instructed
-The area may feel better when lying down
-Lymph drainage massage, if allowed, might help

Okay, it's scheduled. 2/29 is the day. I have my...

Okay, it's scheduled. 2/29 is the day. I have my pre-op on 2/15. To say that I'm nervous would be the understatement of the year! I'm nervous about everything. I'm nervous about my elderly parents (who are so afraid), I'm nervous about the GA, I'm nervous that my belly button will end up on my hip, I'm nervous I'll have a scar 3 inches thick, etc.

I need some courage!!! Help!

I found a nifty little interview with a PS. It...

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.


In reading some posts about the intensity, length...

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 just read a really good question on RealSelf and...

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.
Tallahassee Plastic Surgeon

I still haven't had the surgery, but so far he is great and so communicative, approachable, available, helpful, can ask him any question, oh, and he's very knowledgeable!

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