Tummy Tuck for Obese Patient

57 year old female. 272 lbs. 5"8"
I had never considered surgery until I retired from my job. My weight was never an issue, I lead an active life, participated in sports and did pretty much everything that non obese people did. I have always been overweight, but over the years my belly had started to hang over my thighs creating problems with hygiene and skin breakdown.
I was diagnosed with type 2 diabetes and needed large amounts of insulin as well as oral medication, which still didn't control my blood sugar as well as I wanted. I did some research and asked my doctor to add glickazide. It worked beautifully, bringing my blood sugar to normal levels and allowing me to reduce my insulin. The addition of insulin to my regime made me gain weight that i couldn't shift. I have never been an over eater, but was tired of doctors rolling their eyes at me. It seems that the consensus out there is that there is only one reason for being obese and that's over eating. I started using an online app to monitor my nutrition just to make sure I wasn't deceiving myself. I eat between 1200-1500 calories on a normal day and even after adding a light aerobics class to my day, my weight still didn't budge. I got an exercise bike, but with all that belly, I got out of breath very quickly.
After taking early retirement a couple of years ago, I started renovating my house, but found it very difficult to do anything that required bending. I would get winded very easily, I had sat at a desk for so long that I wasn't as fit as I used to be and I didn't want to spend my senior years as an unhealthy person who couldn't enjoy a full life. I considered my options and decided that getting the belly out of the way would kick start a healthier more active life for me.
I researched surgeons in my area, but couldn't find any who would consider an obese diabetic as a candidate for surgery. Many of them do the surgery from their own clinics and aren't equipped for any patients outside of their criteria. I felt very disappointed. Most of the Toronto and GTA surgeons perform abdominoplasty only on patients who are at or close to their 'normal' body weight and many patients are seeking this type of surgery for cosmetic reasons.
I had lived my life quite confident in my appearance and wasn't suffering any psychological negativity from having a large tummy, I purely wanted to improve my health. I was very surprised to find a lack of surgeons who supported abdominoplasty to improve the quality of life for overweight patients. I still find it very puzzling that the support for vanity driven surgeries are supported far more than for improving health of people who are in need of these drastic measures, though many of them were willing to take my consultation fee knowing that they were going to refuse me as a patient.
I had more or less given up my search for a surgeon. Yes, I could have gone out of the country for my surgery, and I could certainly have saved money in doing so, but I would rather put my trust in a professional who practices within the professional guidelines established here .
However, one last attempt to find a surgeon lead me to Dr. Leila Kasrai. Her philosophy didn't reflect the other surgeons who i had contacted and there were many things that I liked about her. She actually conducted the initial consultation herself; many surgeons have 'intake' staff who assess you and you don't get to meet your surgeon till the day of surgery. Dr. Kasrai also didn't support using BMI to make her decisions for her. Many surgeons will not do this procedure if you are over 30 BMI. So after assessing me, she and my family physician supported this surgery as a positive measure. Dr. Kasrai also said that it may be possible to reduce my insulin after the surgery - another bonus.
So I went ahead, I had the surgery almost two weeks ago. Dr. Kasrai has hospital privileges with St. Joseph's Health Centre, and I stayed there for one night post op just as a precaution, I am no home enjoying my recovery. I have had very little pain and am able to move around the house well enough. I still have the drains and am wearing an abdominal binder, but there are no complications and everything is normal. I saw doctor Kasrai last week for my first follow up and she asked if I felt different without the tummy. To be honest it's too early to say. I see in the mirror that the tummy is gone, but i feel a bit encumbered by the binder and the drains, so I can't really test-drive my new body yet.
I have however, been able to take less insulin since the op and from a hygiene perspective, I already feel much fresher down there without being eclipsed by all that hanging flesh.
I do wish that other surgeons would take greater risks and offer their expertise to people like me, but in the meantime I hope that surgeons like Dr. Kasrai are flooded with business, i just hope she doesn't make so much money that she can take early retirement, it would be too much of a loss to patients like me.
I don't have any photos yet, but I will post some before and afters when the drains come out.

Today I am 2 weeks post op.

The experience hasn't been too bad, except for the boredom of having to stay in a resting position. I'm not an athletic person, but I do have to be doing something, usually i'm at a keyboard, writing or planning something, but the psychological aspect of feeling restricted from movement makes me want to be more active than I normally would be. However, I persevere to be compliant with my doctor's instructions. The problem however, with starting to feel better as the recovery process progresses, is that one feels that one can do more, but it's important to follow your surgeon's directions. For me however, direction alone isn't enough. I need to understand why I need to do or not do certain things and so I have to gather more information to reinforce the directions. My directions were to keep my legs up, don't sit except to go the loo and to get up every few hours to stand for a while, but not walk too much. It doesn't all make sense and seems a bit contradictory. with the move/don't move direction. As humans do, we seek and share information and we hear things that stick with us, such as it's important to get up and walk soon after surgery, but not every surgeon does their surgery in the same way, and not every surgery requires the same approach to healing and recovery. This is why it's very important to follow the directions of your own surgeon and not go by information that you've heard or read elsewhere.  I was actually one of those people. Naturally i'm going to find out as much information as I can before I decide to have a procedure. I read articles, reviews, commentary, watched videos and thought I was well equipped. Every thing that I saw or read said that after a tummy tuck you can't stand upright for a couple of weeks. So I emulated that, and when I did need to get up and move around, I was slightly bent over. It was killing my back and I commented to my surgeon that I should have done some back exercises before the surgery. She was puzzled and I explained why. "Did I tell you to bend over when you're walking?" She asked. Enough said! The surgery that she performed on me didn't require me to hunch over - but that doesn't mean that your surgery won't be different to mine in some way or another. My surgery required me to stay in hospital for one night post op, while many can go home the same day. Even the directions from the hospital weren't exactly what my surgeon had told me, so I can't echo enough how important it is to follow your surgeons instructions and only your surgeon's instructions and if you're unsure, contact them for clarification instead of getting on the internet; while there is a wealth of good information out there, it's not specific to you and your contributing factors. But here are some things that are the same for everyone and so I hope that these explanations may help you to understand the recovery process a little better: During a Tummy Tuck, a full abdominoplasty, your abdominal skin and fat is surgically separated from your muscle. When tissue in the body is separated or damaged, fluid is produced by the damaged cells. With a small incident such as a blister, the body can handle the small amount of fluid that builds up, but with a larger trauma such as a Tummy Tuck, there is a larger volume of fluid. If the fluid isn't drained, it can lead to complications like seromas or infection (a seroma is a build up of fluid that isn't able to drain) so this is why most of us leave the procedure with drains in place. There are other methods of doing this surgery that are called 'drainless', where the surgeon stitches the layers of tissue back together, but it is still sometimes possible for seromas to form with this method. Until the layer of skin/fat has reconnected to the layer of muscle, you still have a 'cavity' of sorts between the layers and as the cavity heals/diminishes, less fluid will be produced, to a point where the drains can be removed. I find that this is important to know because too much movement will delay the layers reconnecting and extend the amount of time that your body produces fluid, hence still needing to keep the drains in. This isn't the only reason why some people take longer to heal, but it is an important thing to know, so that you understand why moving around too much may delay the healing process. As you move your body, the layers can also move so be careful not to twist to reach for things, even during walking you may twist slightly with the body's natural movements. This is one of the reasons you may be required to wear an abdominal binder. It helps push the layers together and though it may feel very tight, it's doing a necessary job. You may also become bored of having your feet up and staying in one position, but sitting for extended periods isn't good for any of us at any time, blood circulation can be restricted by sitting for too long and you may end up with blood clots in your legs. This is called Deep Vein Thrombosis (DVT). The clots cause problems in your legs, but can also travel to the lungs and restrict blood flow to the lungs. This can be fatal.  So while we shouldn't move around too much to help the surgery heal better, we have to be very mindful of preventing blood clots. So if we are lying still for long periods, we still need to flex our feet, so that the calf muscles can help circulate blood in the legs. Most of us are advised to flex our feet 10 times each hour and to get up and stand for 15 minutes every few hours. Walking too much isn't advised because walking can move those layers that are trying to heal.  The risk of DVT is present for everyone but it is even greater for people with a higher risk, for instance, if you smoke, if you are on HRT or birth control pills, if you are over 60, if you are in poor health and if you are obese; these are some of the factors that can increase your risk of blood clots in your legs, so be proactive and make sure you do as instructed. Drinking too much liquid can increase the amount of fluid that is being drained, so it's best to limit your fluid intake and drink only when thirsty while your drains are still in. You might feel great after your surgery, I didn't really have much pain but I did feel encumbered by the drains, abdominal binder and support stockings. As soon as I was able to remove the stockings I felt much better and when the first drain came out I felt like I could return to normal activity, but don't be fooled. You aren't any different to any other patient so even if you have miraculous healing powers, do what your surgeon tells you, your healing process will be a lot easier. You've gone through a lot to get to this point and you've put your trust hopefully in an experienced and licensed professional, so be patient and let your body heal how it needs to without doing anything to compromise it.

Since my surgery my recovery has been fairly standard. My scars are healed and I'm seeing the results that I had hoped for. Once the wounds had stopped scabbing I started to use silicone tape to help the process. I do have a few bumps under the skin so I have started to massage them to get rid of them. My surgery goal was to improve my health, my tummy was just in the way of being able to bend and I got out of breath very quickly, it just sapped my energy.. My surgeon removed 11lbs of fat/skin with the tummy tuck and a further 2lbs from liposuction. Post op I had lost 4" from my waist and 4" from my hips. I was 278 prior to starting this process, I lost a few lbs before my consultation where I weighed in at 275. Since the surgery I have been able to reduce my insulin by half. For quite a few years now my diet consists of 1200-1800 calories a day - finally with the reduced insulin i'm starting to see some weight loss. I'm now down to 255 having lost 7lbs in the 3 months since surgery. I don't want to lose weight too quickly, I've been heavy since childhood and I want to be sure I can maintain it.
After surgery I was getting dizzy and realized that my blood pressure was low, so I may not need my BP meds anymore, i'll find out at my doctors visit this week. These are the results that I was hoping for, being able to reduce my meds, become more active and generally become healthier. It feels very good. This surgery really did kick start me into becoming healthier and preparing for an improved lifestyle as I enter my senior years, proving it's never too late to improve yourself.