SkinnyKathy

I am starting to think about the next step in plastic surgery for me. I have lost 184 pounds, want to lose another ~50 to get me around 200 pounds before I go under the knife again. I say "again" because I had a panniculectomy about 100 pounds ago. My pannus was such a problem that I had it removed when I was only partially down, knowing that I would still need a full lower body lift when I get to goal weight. Now looking at my body, I know I will need a lower body lift, inner thigh lift, breast lift with probable implants, and possible brachioplasty. And lipo in various spots for sure. I know this is two operations, possibly three. So since I know it will be complicated and expensive I want to start researching options now. Obviously I can go back to the doctor who did my panni (which was covered by insurance), but I am hesitating for two reasons. First, I was not 100% pleased with the results. In the end it turned out OK but not great. Second, he is expensive. As is virtually any plastic surgeon in the San Francisco Bay Area. So I'm hoping any of you regulars on this forum can give me any links or advice on having plastic surgery done outside the US, or other options for less expensive surgery when you have to pay out of pocket. Thank you!

Cool, do you know the answer to the question about whether the scar has to go all the way to the elbow? Is there a chat feature on here?

Dr. S: I have a quick question about brachioplasty (armlift). Does the incision have to go all the way to the elbow? If most of your hanging skin is in the upper half of the upper arm, can you get an incision that only goes that far? Or is there any other way to avoid a scar all the way to the elbow if you don't have full-on bat wings, only partial bat wings?

Oh, and here are my "before" and "current" pictures. I'm proud of me! Kathy

I started this journey at 433 lbs in September 2009 and as of this morning I have lost 132 lbs for a current weight of 301 lbs. I'm so happy to be almost at Twoderville! I'm really starting to feel like a normal person again. I can do almost anything, sit in any chair, fly (sometimes) without a seatbelt extender, buy clothes retail, and I feel sexy and desirable for the first time in a long time. (Ok, not as much when the clothes come off... after losing 132 lbs, Spanx is my friend!) But I do look cute in my clothes, and even though I want to lose another 100 lbs, I already feel like I have my life back. I've lost my weight slower than a lot of you, but I've kept my sanity and I've continued to lose steadily, so I'm not fretting about that. I do need to exercise more to keep up my rate of weight loss and tone up my muscles more. So that is my goal moving forward. Kathy:thumbup:

Pegge, It sounds like you haven't reached your sweet spot yet. It takes time after surgery to get there, but my experience is that once I got there, the weight came off much easier. When I'm at my sweet spot I rarely get hungry and I do lose weight unless I make bad choices (chips, ice cream). I take a Protein powder shake for Breakfast every morning and that really helps me also. Have you ever had a feeling of "tightness" since your surgery? Like you were full without eating very much? If so, it sounds like you haven't reached your sweet spot yet. It took me 4 fills to get there, and the 5th to really stay there for a while. It was longer than I expected and I got discouraged, too. But now I have lost 172 pounds, and stil losing about 2-3 pounds a week. But getting to, and then maintaining myself at, that sweet spot is critical. if I get too loose or even too tight my weight loss slows way down. You do have to manage a lap band, it doesn't do everything for you. But if you manage it well, it will make things much easier for you. Right now I'm only 12 pounds away from my first (initial) non-stretch goal, which was 250 pounds. That sounds really high, but keep in mind I started at 433 pounds and I am 5' 9.5". So I honestly wasn't sure I would even be able to get to 250. But my current goal is to get to 199. When I get there, or when I get close, I will evaluate whether I want to try to go lower. The lowest weight I have been as an adult is 169.5. I would love to get back down to that point, but I would honestly be thrilled with 199, too. Good luck! Kathy

Thanks, everyone, for the kudos and encouragement. And, I have now officially entered Twoderville! In fact, my weight did what it is often apt to do... I plateau for a couple of weeks and then quickly drop 4-6 lbs in a couple of days, then settle out there again. Well, as of this morning I am at 297, for a loss of 4 lbs since I wrote this post only a few days ago. (Unfortunately I can't sustain that rate of weight loss, wouldn't that be wonderful!) But I am definitely now in Twoderville! Kathy

I was pretty well prepared for my panniculectomy and everything has gone smoothly. But one thing that I am still surprised at, a little over 3 weeks post surgery, is the amount of swelling I still have. I feel bloated all over and lately the scale shows me gaining weight even though I have had a re-fill on my lap band weeks ago and I have continued to eat pretty well (with a few exceptions here and there). I am certainly not pigging out which the scale would suggest. So I think it is swelling. Ladies (and gents, too) who have had plastic surgery, what has been your experiece with swelling after plastic surgery? When did it peak? When did it subside? Do you have any idea how many pounds of swelling you had?

Dr. JLo, can you tell me more about lymphatic massage? I am the original poster on this thread. I had a panniculectomy on October 8, and here it is almost 3 months later, and I am still dealing with quite a lot of swelling, especially on the side where my original drain fell out soon after surgery. I have been trying to keep my sodium intake down, although I have been getting lazy about wearing a compression garment (Spanx one size too small) every day, so maybe I should get more serious about that. I had to have a drain put back in me one month after surgery and they took about a liter of fluid out of me and then I drained some more over the next few days but this drain, too, fell out sooner than we had hoped. My doctor doesn't think I have any more seromas but rather just very swollen tissues. I have also taken a lot of antibiotics, but the healing is quite slow. I have not heard about lymphatic massage before and I wondered if that is something that one can do at home or do you need to see some kind of professional to do that? Thanks in advance for any advice. Kathy

Hi all, I'm so excited, I just found out that my appeal of the denial of my panniculectomy was successful, and now my procedure is approved as medically necessary! This is important for me because even though I am only 1/3 of the way to my final goal, my pannus was already quite extended before my surgery, and my weight loss has only exacerbated it - with rashes, back problems, etc. I know I will still need cosmetic surgery when I get to my goal weight, probably a lower body lift, but this will make it a lot easier to exercise and improve my health while I am getting there. Has anyone on this list had a panniculectory while they were still quite far from their goal weight? Does anyone have any advice for me? Now that it's real I'm starting to get slightly scared, but also excited. I will be so glad to see that ugly pannus gone forever (but probably more skin to be loosened as I continue to lose weight). I will also need that LBL or tummy tuck to tighten the muscles and reposition the belly button as the panniculectomy will not do that.

I really can't give you any advice except to say ask your plastic surgeon what he thinks your chances are of getting insurance to cover it. One thing I would recommend you do is every time you see your primary care doctor make sure you mention problems with rashes and get him/her to make notations about this in their notes. Because that is a key part of the documentation. If you are quietly taking care of it yourself, then you won't have the documentation you need. On ther other hand, it could be argued that a rash which you can quiety take care of yourself does not need surgery to correct it. I know I had to submit photos of my rash and the pannus from various angles so insurance could judge for themselves how serious it was. Part of the criteria is how low the pannus hangs also. Your plastic surgeon is your best resource on this. Kathy

Yes, I have tried Protein bullets a few times, but the ones I tried tasted nasty and were really hard for me to get down. I prefer the milkshake-y type Protein drinks, although I am picky about the brand. I just choked down a Protein shake with a non-preferred Protein powder, and I would almost prefer a really nasty protein bullet, at least I could get that down more quickly, LOL! But I love my Champion Nutrition Pro-Score 100 chocolate flavor, yummy! Do you have any brands of protein bullet that you would recommend? Kathy

There was more swelling on the side where the drain fell out, but it is clear that there is/was swelling on both sides.... ... Well the saga continues... I went back to the doctor today and he took 8 more syringes of Fluid out of me, until he couldn't get any more, but it was clear that there was still fluid in there. He thinks there may be multiple pockets, and he is not able to fully drain me without any visual indicator of where the fluid is. So long story short, I am going back to the hospital on Friday, and will go under fluorosocopy (like x-ray) so they will be able to visualize the fluid, suck me dry, and then put in a new drain that is able to drain any future accumulation from any and all fluid pockets. The other thing my doctor asked me is about my Protein intake. Now normally I am very good about that because I eat a Protein shake for Breakfast every day. But lately I ran out of my favorite Protein powder (which I order online from vitalady) and so I had been getting sloppy about protein intake. He says that even if you are feeling fine on an overall level, the cells may be struggling to rebuild without sufficient protein. So I wonder if that has contributed to my problem. Anyway, I have bought some protein powder from a local retail store and will order my favorite today so it should arrive soon. Anyway, that's the latest.

Well, I didn't want to get to pointing fingers really, but I do think that there was somewhat of a failure on the doctor's part. I am now convinced that I had the beginnings of this seroma three weeks ago at my last appointment, but he didn't catch it because it was underneath all my fatty peaks and valleys. It was only plainly noticeable to him (and me) once it got so severe. Even today when he looked at my belly before he started he said something like, oh yes, this is looking much better, not much Fluid in there now, probably just 2 or 3 syringes, this will be your last seroma visit... Then even he was surprised as the fluid kept coming and coming and coming... We haven't hit bottom yet because 16 syringes (2 oz each, 1 quart total) is the most he will take out at a time. So the saga continues. But it is causing me no lasting ill health effects, no lasting skin damage, no pain, very little discomfort (now), and only a moderate level of inconvenience, so it isn't too hard to laugh in the face of this one of life's little trials... Kathy

Mimilou, to more directly answer your question, I don't think it is necessary to replace the fluids lost, per se. This is Fluid that the body no longer needed, it just had no way to get rid of it. It would be the same as if I had been able to keep my drains in longer. Instead of draining out of me, the fluid built up inside me. My doctor didn't give me any special instructions about drinking liquids, but he did tell me to stay on a very low-sodium diet for the next few weeks. However, any and all prayers are always gratefully appreciated. Kathy

No, no IV fluids to replace the Fluid taken out. He took another 16 syringes out today. That's another full quart. So far he has taken out almost three quarts of fluid from my belly, not to mention the extra fluid that I have peed out from the dieuretic. But my lower belly is starting to look again like I remember it looking right after the surgery, almost sort of flat-ish (not to be confused with the flatlands, these are still wildly rolling hills by comparison, just not rugged Alpine peaks any longer, LOL) I go back next Wednesday for another withdrawal. Thank goodness my plastic surgeon's office is only a 10 minute drive away. And as a bonus, I have had lots of free consult time. It takes quite a while to suck a quart of liquid through a 12 guage needle! So I have been able to pepper him with lots of plastic surgery questions, LOL!

Sorry to those who asked for pictures that I haven't sent them yet. I ended up with really bad swelling, which turned out to be a rather severe seroma, a pocket of fluid under my skin. My doctor took out a full QUART of fluid on Monday, and another 3/4 of a quart on Wednesday, and I am going back today and probably a few times next week. Plus I am on a dieuretic and antibiotics. So I thought it would make more sense to wait until after the swelling settles down to take my official "after" picture. So I will probably take a picture this weekend or next week and then send them to you. Kathy

Yep, that's what it was. A seroma, a pocket of fluid. Except in my case it was more like a lake. I went back to my doctor on Monday and he pulled out 16 syringes of fluid (2 ounces each). That's a QUART! (He says the biggest seroma he had before me was not quite 3 syringes of fluid). And he stopped at 16 kind of arbitrarily because he didn't want to upset my electrolyte balance by taking out too much fluid at once. So I came back on Wednesday and he took out another 12 syringes. And I am going back today and probably at least once next week. I am also on a diauretic and antibiotics. But it makes a huge difference and I look and feel so much better. Also, my weight had been on the way up due to the swelling, I had gained 8 pounds from my lowest! Now almost all of those 8 pounds are off. Fortunately I didn't freak out too much because I knew it wasn't fat gain, it couldn't be because I have been on the tight-ish side with my band and couldn't possibly eat enough to gain weight right now (unless I ate bad foods, which fortunately I am good at staying away from)

One other factor that I think might be making my swelling worse than normal. My drain on the right side fell out after only a week, and the doctor removed my drain on the left side after a little more than 2 weeks because of a business trip I had to go on. I was still draining a moderate amount of Fluid every day (100 cc or more) in the remaining drain when it was removed. And it has been since my drain was removed that my weight has started going back up, not down. I am doing a pretty good job about remaining cool about it. I know the thing that matters is that I am continuing to eat right, and hopefully I am losing fat even if I am gaining weight. And it will come back down eventually. In the mean time I am trying to watch my sodium intake. I need to be more vigilant about getting enough fluids to drink, though. Since the weather started cooling down I haven't been as conscious of my fluid intake as I was over the summer.

Oh that is cool. I'll bet you will look like a totally new woman with an extended tummy tuck after losing 160 pounds. $9k to do that plus arms is a great price, I think. Where is that? In the US? When it comes time to do my lower body lift I may choose to travel somewhere where the surgery can be done more cheaply since I will have to pay for it all out of pocket. My plastic surgeon quoted me a little over $9k just to do the panni, no tummy tuck and no arms. But I live in the San Francisco bay are and prices are quite high here. I will send you pictures tomorrow. Right now I have to finish getting ready for a Halloween party. I am so excited, I am going as a sexy witch and even at my current weight I can pretty much pull it off. I have a black leather corset and fishnet stockings, a poofy net skirt and black leather boots, plus a witch's hat. Woo woo! Kathy

Oh, I realized that I didn't answer all of your questions so here is a few more points. Yes, I am still glad that I did the surgury but keep in mind that my situation is not the same as yours. Perhaps if I was in your situation I would want to push for insurance coverage, or consider waiting and then getting a full tummy tuck, or even getting a full tummy tuck now. And yes, I have pictures. As they are pretty graphic I would rather not post them on the internet. However, if you PM me your email address I would be happy to email them to you. Kathy

I am a little more than 3 weeks post-op and I am still glad that I did it. However, in my case I was probably only 1/3 to 1/2 of the way to goal when I did it, and I was able to get insurance to cover it. I fully intend to get a lower body lift when I get to goal or near it, which I know I will have to pay for out of pocket. So the difference is that (1) I got insurance to cover this surgery, and (2) I still have a long way to go before I reach my final goal. Also, my doctor told me that my pannus was so severe that if I lost all my weight and then came to him for the final surgery, he would have to stage it into two operations anyway. So I might as well have the first operation sooner rather than later. As for how I feel about it now, I am having quite a bit of swelling still so it is hard to say. My upper belly does protrude now more than it did before the surgery, and the lower belly is protruding more also. It's kind of discouraging, especially since I am actually gaining weight in the last week or so even though I have been pretty good on my diet. I have heard that swelling peaks at three weeks after surgery (not sure where I read that though) so I am hoping that it will start to go down now. So with those caveats, I will say that I am slightly less thrilled now than I was right after the surgery with the way my tummy looks overall. My upper belly does protrude more than my lower belly. However, a good pair (or 4 or 5 pair) of Spanx does wonders. I started wearing them a few weeks ago in lieu of the binding garment (with my doctor's approval) but I think I will keep wearing them indefinitely as they really improve my figure and are quite comfortable. I bought the "higher power" power panties that go from mid-thigh to a few inches above the waist. That way they cover the upper and lower belly, hips, and upper thighs. All my problem areas. Did you try to get insurance to cover your surgery? It seems that if you have lost that much weight and are having back problems you could make an argument. Do you ever get rashes under your pannus? That is the usual argument for insurance to cover it.

I just had my panniculectomy on Thursday, two days ago. Everything went very smoothly. I spent one night in the hospital, but honestly I would have been just fine if I went home the same day. The pain really hasn't been too bad at all. I'm keeping up with the vicodin, and I'm only in a little bit of mild pain when I need to stand up or sit down. The rest of the time it is more discomfort than pain. I'm still wearing a binder, but I got a good look at my naked belly yesterday finally when I got home from the hospital, and I have to say I think the doctor did a good job on me, considering that this was technically a medical, not cosmetic procedure. And I am still far from my goal weight. But the pannus is gone and my overall shape is much improved. And it will be a lot easier to exercise without that huge pannus. And no more rashes. I do have a freakishly low belly button now, but when I reach my goal weight I intend to have a lower body lift in which he will reposition my belly button at that time. Of course that surgery I will have to pay for myself. The one thing I was afraid of, from looking at panniculectomy pictures on the internet, was that I would look like I had a carved out lower belly on top of my previously existing bulging upper belly. But the surgeon managed to more or less flatten and stretch things out a bit, so that my upper belly bulge is flatter and looks mostly consistent with my lower belly. In other words, I look like my fat could have been distributed this way naturally, as opposed to some freakish after-effects of lopping off part of your belly willy nilly. Does that make sense? I saw some pictures on the internet that looked scary, and I didn't want to end up with scary freaky belly. The doctor cut off 14 pounds of skin and fat, but I don't see all of those results on the scale yet due to swelling which is still pretty severe. In fact, I still cannot get my wedding ring on! So I am trying to drink a lot of Water and get walking as much as possible. Can't wait to get rid of these drains, too!

I'm so excited! My panniculectomy is scheduled for this Thursday, October 8. Wish me luck, girls! Of course I still have a long ways to go, but I will be so glad to get rid of this hanging flap of skin. It will make it much easier to exercise and will help so much with rashes. I wonder how much weight the doctor will end up cutting off? Ironic but this surgery will most likely catipult me over the 100-pound weight loss milestone...

Hello fellow bandsters, Well even though I am only about 1/3 of the way to my final weight loss goal I am thinking ahead to the future plastic surgery that I will certainly need. My question is about breast surgery. My breasts were very stretched out even before my lap band surgery, and since the lap band I seem to be losing weight on my breasts more aggressively than anywhere else, LOL! This, of course, makes the breast sagging even worse and now my nipples point straight down. In spite of all this I love my breasts because my nipples are wonderfully sensitive, much to the delight of my husband and myself! So I'm really reluctant to undergo any kind of breast lift surgery that might reduce my nipple sensitivity. I don't feel like I have to have the breasts of an 18-year-old when I'm done, but I would like to have nipples that don't point straight down without losing sensitivity. Does anyone know if there are breast lift procedures that work on severely sagging breasts that don't reduce nipple sensitivity? Thanks for any advice from personal experience or reading, research, etc.