How my Hysterectomy Will End with a Tummy Tuck - Thibodaux, LA

I'm 45 with three children, two born C-section....

I'm 45 with three children, two born C-section. The skin of my belly and pons pubis (the area of fatty tissue above my vagina) were stretched badly during the C-section. For the last 15+ years I've hated my belly, it hangs over and makes me self conscious, but even worse was the pons pubis. It is a badge of honor my ex-husband said, it doesn't bother me. I learned to live with it. The last few years I started getting rashes under the Mommy Apron, as I call it. Everytime I work out, cut the grass, walk a fair or festival, it gets red, inflamed and irritated. Just another thing I have to live with I decided. I also started to have stress incontinence, another lovely thing to live with. If my friends made me laugh, I pee my pants a little, or a lot, sometimes...super embarrassing. Coughing or sneezing made it happen too. I was told by my Mom it was just something that happens after having babies, nothing to worry about. I started bleeding heavier and between periods. Yuck...Then pain during intercourse...this was the last straw...I just remarried and can't enjoy sex? Time to see a doctor. My Gynecologist was amazing and listened to all my concerns. He ordered blood tests, ultrasound, referred me to a uro-gynecologist. I didn't have one of my dreaded rashes when I went to see him so I didn't mention it, seemed to me there was enough to deal with already.
The ultrasound showed that I had a cystoocele (prolapsed bladder) and prolapsed uterus which was causing the stress incontinence. Then I had a DNC to check for uterine cancer since the bleeding had gotten so heavy. Not a fun procedure, had to go under general and the anesthesiologist nicked my esophogus, causing my throat to hurt for two weeks afterward. The doctor didn't find cancer so said we would go ahead with a hysterectomy to deal with the bleeding and hopefully resolve the painful intercourse, as the position of my uterus could mean he's hitting it resulting in pain.
At the same time, I'm visiting the uro-gynecologist who has given me meds to try to control the incontinence. Helpful, but makes me super-constipated and I already have IBS. When I let him know about the hysterectomy, he gave me questions to ask my GYN about the procedure and when I did, he suggested the uro-gynecologist do the hysterectomy since he will be able to surgically correct the bladder and urethra issues, which my regular GYN isn't comfortable doing. At one of my visits, I had the dreaded rash, from trying to work out again, to lose some weight. I'm 5'8" and weigh 250 pounds. I carry the weight well, but it would be nice to be a bit smaller. As usual, my belly gets inflamed. My uro-gynecologist sees the rash and prescribes me nystatin powder. The next time, I went to see my primary care for the rash, and they say the same, use the powder and put gauze over the sores. When I discussed having my uro-gynecologist do my Hysterectomy, I jokingly said can you cut off my mommy apron at the same time? He said no, but if you have a plastic surgeon in mind, I'll work with him to do that. Wow, just the idea that I could have a future without that apron of skin and rashes when I walk too much or sit outside in the heat, its just wow...
That's how I found RealSelf...researching Mommy Apron Excision, aka Panniculectomy. Under my circumstances, it might be covered by insurance. I looked up surgeons that had the same hospital affiliations as my uro-gynecologist and came up with Dr. David Jansen. After asking my PCP for a consult request, the insurance company called and asked if I had someone in mind, I gave them his name and they got him credentialed and made the appointment. Not that it was hard to get the Plastic Surgeon approved, since he's the chief of plastic surgery at Tulane. I had my consult with him yesterday.
Dr. Jansen was very kind, listened to my story and took a look at my Apron and said he could fix it. He's submitting a letter to my insurance to try to get the panniculectomy approved. He also quoted what it would cost for him to tighten the muscles and raise the pons pubis, that nasty stretched skin above my vagina. Coming up with the money in a short time frame is hard, but I'm so excited by the prospect of having a smaller flatter belly that I'm going to try my damnedest to get it. If the panni gets approved, I'll at least not have to worry about rashes or incontinence anymore. The Tummy tuck would just be a bonus. I told my Mom and she is happy for me. My Mom told my sister however and she asked why I want to do this to myself...to which I promptly said mind your business, then explained that I'm going to be in pain from surgery anyway, may as well get it all done and out the way. She told me about horror stories her friends experienced about not healing. I guessed that her friend didn't stop smoking. Right on the money, she didn't. Smoking is the number one way to ensure complications in any surgery. It restricts oxygen flow to tissues and slows healing. If you smoke and have to have any surgery, quit...I quit three weeks ago when I was told I needed the hysterectomy, and I'm so glad since I may now be having an even more heal intensive procedure. It is totally worth giving up to gain so much. Plus I'll save money. Now I wait to see if the insurance will cover the procedure...and for my rash to heal, which means no walking long distances for a bit.

Getting Ready

Both Doctors are looking at dates that work for them and the hospital. Will post exact dates as I get them. In the mean time, working on making meals, getting supplies, researching what to expect. And...taking before photos...

30 Days til Go time

Pre op appointments are set for both docs and surgery is scheduled for November 1st. Doing preparatory shopping, gotta get granny panties and Milk of Magnesia. Two things I forgot last shopping trip. Really want to buy a compression garment that covers the mons pubis area since the PS is going to do a lift there. I feel the compression belt I used after my c-sections could have contributed to the collection of fat at that area in the first place, after all my research that says the compression garment closes the gap between skin and muscle. The mons tissue was separated from muscle during my c-section but got no compression after since the compression belt went from the top of my bikini line to under the breast. Only problem is what size to order, since I'm not sure what my waist size will be after the procedure. I'll probably wait and order it shortly after surgery, when I can get more accurate measurements. I'll bring it up with the plastic surgeon as well, perhaps they can give me an idea what to buy or they will order it for me. These last few weeks are a challenge because I have to be completely rash free before the surgery. That means no walking more than across my house and no sweaty activities. Hard to do when you want to do so much for Halloween...I love haunted houses. But I guess one holiday is a good sacrifice to gain a life with no more rashes. Uploading more before pics so I can see the difference after the surgery.

Before Measurements

Under Bust - 41"
Waist - 44"
Hips 52"
Thighs - 29.5

I include the thighs because I read in another review that their thighs swelled as much as their abdomen, just want to keep track. Definitely will order a compression garment that goes down to the thighs just in case...attaching a couple pics in my bathing suit, haven't worn a bikini since I was 24, so doubt that is gonna change, but maybe I'll look better in my bathing suits after this is over.

Supplies

Things I purchased
Arnica Gel
Protein shakes
Fajate Post Surgical Abdominal Compression Lipo Board
Bowink Female Urination device (don't laugh, if you don't have a raised toilet seat, this is the way to go, I've read.)
MyM Hair Removal System for Home Use (Home laser hair removal to get rid of pubic hair which might cause infections with the mons pubis lift)
Bromelain tablets (reduce bruising and inflammation)
Surgical Pads (can also use maxi pads)
Paper tape
Butterfly stitches (just in case of incision separation)
Dial Anti bacterial soap (will start using daily after pre-op, normally like shea butter dove)
Milk of Magnesia (for narcotic induced constipation)
Azo Urinary Pain Relief (don't know about you, but I get pain after having a catheter)
One A Day Womens multivitamin 50+ has all the recommended vitamins for healing. Only problem is it does contain some that might have to be stopped just prior to surgery due to the increase in bleeding risk. Will let you know what they say about them in pre-op

Things I already have that I plan to use:
Wedge pillow
lots of regular pillows
recliner
tv tray table
books
tablet (electronic)
Hi waisted girdle
Shower Chair
Walker

Ok so Food prep I consider very important, since its the thing that will help you heal faster

I got enough Protein shakes for two weeks, just in case I don't feel like eating, they say appetite sucks just after. And protein is essential for healing. You body needs about 60 g of protein a day normally and healing bodies need it even more. So I'm trying to get about 75 a day
I got 15g protein shakes, but wish I'd gone for the higher ones now, might make a trip back to SamsClub for the 25 g shakes I saw there. Bonus is the shakes have lots of vitamins, so no reason to take extra as long as i'm drinking those.
For when my appetite returns, I wanted super healthy meals, but not something my husband would need to work hard to make for me as he only likes unhealthy food and I don't want to inconvenience him with making his junk food and my healthy food.
Family pack of Chicken Breasts from SamsClub
Brown Rice
Mixed Frozen Vegetables (broccoli, sweet bell pepper, zuchinni, squash, edamame, wax beans)
My husband grilled the chicken breasts, in a few different flavors, bbq, lemon pepper, and italian dressing, and I cut them into halves and packaged them with 1/2 cup brown rice and 1 cup veggies per quart sized ziploc bags. I pre-cooked the rice and veggies too so all he has to do is pop a bag in the microwave for 2 minutes and pour it on a plate for me to eat. I'm not picky about my food touching so its a great way to have healthy dinners at the ready. Each packet has about 25-30 g protein. YAY
I also think before my surgery I will start to drink protein shakes for a few days prior to clear my digestive system of solids, to hopefully make constipation less of an issue. I'll let you know how that works out for me.

There are a few more things I'd love to have prior to surgery, but I'm stretching my budget as is, so I'll just have to make due with what I have. As you can see, I'm a planner and a researcher, I've been doing my best to be prepared so that I'll have optimal results. Its 23 days away and I've gotten most of my prep work done. Will do some cleaning and organizing just prior to the big day, but I'm just about ready. Its kind of a bad thing though, because I'll be reading reviews and thinking of whether I forgot anything non-stop until then. Gonna drive my husband bonkers, I'm sure...

Pre-op Urogynecologist

1st pre-op appointment done. My Urogynecologist is pretty freaking amazing. He explained the entire surgery and ended it with a procedure I wasn't familiar with. When I asked what it was he said it would tighten things up. My best friend went with me and when we left we couldn't help but joke that I was getting a designer vagina. Vagina by Hallner, Barry Hallner. Yes, I am easily amused. Anyhow, it will be excruciatingly painful, but I was assured that most of the pain would be from what my plastic surgeon will do to me...

Pre-OP PS

Jenny at Dr. Jansen's office went over all the pre-op and post-op instructions line by line, wow did it take forever it seemed. The worst one was she said avoid caffeine for 2 weeks prior and 2 weeks post...even chocolate. I have given up smoking (8 weeks now, I think), I had my last drink last weekend, but now even my coffee and chocolate have to go? I suppose I won't have any vices for the next month. Waking up without coffee is so hard...but I digress. Dr. Jansen came in and I signed all the consents, and he said he may do a little lipo as well on the upper abdomen. I figured he would have to to get the belly button right. He can do as much as he likes as long as I have a good outcome :D. My husband asked if he could drop me off at the hospital early after I told him I couldn't have any coffee or chocolate...poor guy

1 week to go

I'm getting excited. I'm not looking to be a perfect doll, just fit better in my clothes and make moving around easier and way less painful. It will be amazing to have no more rashes. I joked about taking up jogging and my gynecologist said no, don'the ruin my work. So, walking it is. I even have a couple wish pics. I just want to look good in my lingerie. Can't wait...

Wish pics

16 hours til TT

Doing my last minute prep, fleet is not fun...and the Doctor's office called to say my primary care doctor hasn't faxed the medical clearance letter...really will be angry if I prep and they postpone my surgery because of a technicality...

Made it to the Pain Side, hehe

Seems my bladder wall was thin, so Dr. Hallner had to reinforce it. As a result I get to keep the catheter for a week. No trips to the bathroom unless it's Bowel movement. I thought I would have a pain pump, but nope, didn't get that. I did get some lipo though. I wasn't supposed to get any, so perhaps he traded the cost of the pain pump for the lipo. The nurses don'the know how to milk the tunes for the drain, I had to teach them. Can't eat until tomorrow cuz of the bladder thing. I asked for ice packs for three swelling and they said not unless the doc writes orders for them....like really it's just ice packs...falling asleep they are really nice and the room is great...

Made it to the pain side

Touro Infirmary is a nice hospital, but they don'the deal with plastic surgery patients often. Thanks to my research, I was able to guide them a bit, but my three days there were definitely not easy being in pain and having to tell nurses constantly not to lower the foot of my bed or the head because I needed to be in a lawn chair position...home now but can't seem to get comfy. My chin is in my chest, it's ughhh. Might have tone try the recliner.

Go for the Recliner

Some made the bed work, but for me, the recliner is golden. I can sit up enough to keep my lungs clear (coughing every few hours is essential to not getting pneumonia) and lay back enough to rest pretty well. Gotten more sleep already than I did for 3 days in the hospital. I'very read that cats should be kept away because of the bacteria on Thier feet from using a litter box, but I can'take keep my little buddy away so I set up my quilt to cover all incisions and vulnerable areas. I'll have my husband switch the top blanket often to stay clean. Staying on top of my pain meds has made things better. Every 4-5 hours. Taking the arnica and bromelain tablets 3 days before and since ( took them after the first day even though the hospital wanted me to only take what they gave me. Didn'the get my blood pressure meds til late that day because of Thier policy. Blood pressure kept increasing, so I finally said screw it and got my blood pressure meds out of my bag and took them. Seriously let a patient feel sick and have heart palpitations because of bureaucratic policy. I felt better within an hour.) Have VERY little bruising from the lipo. I'miss gonna say it's because of the bromelain and arnica. Make your own decision if you will be medically rebellious but I'must sure glad I did. Catching up on Grey's Anatomy, and other series I missed preparing for surgery.

Ileus (Gross, read at your own risk)

Third day, second day home, I lost my appetite and started burping a lot, not so much bowel gas. Took my meds, ate, and then started vomiting, like alot. 1/2 gallon per episode ( gallon ice cream bucket vomit receptacle made it easy to Guage how much happened) Vomited three times from 8 pm to 5 am, called the doctor and they had me come back to the hospital. Started having bowel movements literally when I arrived. Had to get the Porter to wheel me into the ER bathroom. They did a CT with contrast to rule out a blockage and said it was an ileus ( sleepy bowel) because i was under anesthesia so long and taking opiods, hydrocodone for pain after surgery. 24 hours with no food later, i have horrible gas pains, but no pain from the surgery unless I accidentally stand too straight. Getting tired now. Post pics and take a nap. Hoping this food digests properly...

Post op visit and Useful List

Got my staples and the waterproof bandages removed, as well as one underachieving drain. It was only putting out 15ml a day. Doctor gave me the ok to switch to spanx from the torture device abdominal binders they gave me in the hospital. It feels so much better in my girdle. I ordered an underbreast boy short girdle with an open crotch, but it hasn't come in yet, so I'm wearing my high waist short girdle with a compression shirt, so they overlap and give good compression. Doesn't have an open crotch though so I have to pull the girdle down every time I go to the bathroom. The even compression from chest to thigh makes such a difference over the abdominal binders. With the abdominal binder on my butt swelled a lot and made the elastic of the binder cut into my waist. After a week of that, my waist is bruised. If I'd known it would cut so much I would have ordered a compression garment and changed into it immediately.
List of things I've used
Bromelain (so worth it)
Vitamin C
Pre-made dinners
Sleep mask
Abdominal lipo board (helps to press on this when having a bm)
Safety pins
Rubber yoga band ( pinned drains to it and hung around neck to shower)
Phone (didn't read or use my tablet, just TV and my phone.)
Bra (breasts hurt from swelling)
Bacitracin
4x4 gauze
Paper tape
Long panty liners unscented ( good to cover incision)
I'll add pics of my incision later, looks really good.

Incision pics

Thought I'd add pics I took after my second shower, still some swelling but I think it looks great!!

2 week post ops

Little infection from my drainage site and one of the lipo sites that had been stapled. Doctor gave me cipro and told me to clean and change the dressings twice a day. I admit I was lazy and didn't clean and change the dressings daily the last few days before my post op. I had a migraine for 4 days on the left side of my head and stayed in bed with ice packs most of that time, so the infection is most likely my fault. So I cleaned and changed the dressings twice today and its already noticibly better. Posting a before and after, but there is still swelling so its not exact. I love it though. Moral of todays post...follow the doctors instructions...just cuz bandages look clean, doesn't mean infection isn't brewing.

Infection before treatment

Drains gone!!!

Ladies, if your BMI is higher than 30, expect to have your drains at least 2 weeks. When I had my surgery my BMI was 37. I had my drain 3 weeks and if it hadn't gotten infected and painful, I'm sure I would have had it another week. It was still draining 70 ml a day. But Dr. Jansen took pity on me and removed it. That hurt so much, but its so nice now that its gone. Just praying i don't end up with a seroma because the fluid has no where to go. Wish I'd known more and lost more weight before surgery. Might have avoided having the drains so long. He had to work on my belly button as well, cleaning with saline and packing twice a day. Gonna be 3 more weeks for that to heal he says. Good luck to everyone whos on thier journey now too. May your road not be as rocky as mine, even though it hasn't been horrible...I'd still have done it, just might have tried to lose more weight beforehand.

1 Month

Swelling everytime I do anything for longer than an hour is a little annoying, but I'm getting better. Not sure how to tell if the flap is healing right and connecting to the muscle wall, but I'm sure thats a common concern. The doc removed 2 stiches from my belly button and I'm still packing it twice a day. Hopefully it will be healed by new years. It is kinda shaped like a smily face...maybe I should have one tattooed around it, xD. 1 month before & after pics today

Belly Button Evolution

How long before I have a decent looking belly button? It seems huge right now. Been cleaning and packing it twice a day. I thought it would be smaller by now...its been a month, plus the edges have clearly healed, so is that going to be the official border of my belly button? If so...refer to my previous happy face tattoo idea...cept now one side doesn't seem to be smily anymore...kinda rounded. Hate to complain but really...don't want to go through a revision. Heal process all over? Really...
Metairie Plastic Surgeon

David A. Jansen, MD was my first choice and thankfully my insurance approved him. He's one of the top plastic surgeons in Louisiana and he's earned my trust. My issues are a little different than those who just want to look better. I got horrible rashes when I exercise or just sweat for too long in the Louisiana heat. I had to have a hysterectomy with urology repairs, and my surgeon advised me to contact a PS when he saw the rash under my Pannus (mommy apron of fat). Dr. Jansen evaluated me and submitted a letter to my insurance to get the panniculectomy approved. He also quoted how much it would be to have the muscles tightened and skin manipulated to create a flatter waistline. Thankfully the other surgeries covered most of the expense, so I was happy to come up with the difference. He did a great job, I look so much slimmer! I'm super happy with his work! Thanks Dr. Jansen, and a special thanks to Jenny and Debbie who went above and beyond to get my clearance letter from my primary care and was there to relay messages between me and Dr. Jansen. You are a credit to your profession, all of you.

5 out of 5 stars Overall rating
5 out of 5 stars Doctor's bedside manner
5 out of 5 stars Answered my questions
4 out of 5 stars Time spent with me
5 out of 5 stars Phone or email responsiveness
5 out of 5 stars Staff professionalism & courtesy
5 out of 5 stars Payment process
5 out of 5 stars Wait times
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