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January 2014 Sleevers Come In!
VPAPNYC replied to HipsAndLipstick's topic in Gastric Sleeve Surgery Forums
I have the same date as you both (Jan 6) at Lenox Hill Hospital in NYC and was told only to do clear liquids starting 24 hours before surgery. But I've been having a lot of "last meals" which I'm worried will cause more weight gain (I'm on vacation and have no scale) so I think I'll put myself on a low carb diet until the 5th and then do the day of liquids. I'm also weaning myself off of coffee and caffeine now because I really don't feel like going through caffeine withdrawal while trying to heal from surgery...lol -
You Should Not Consider Bariatric Surgery if..
Butterflyhigh replied to No game's topic in Gastric Sleeve Surgery Forums
Very very good post. Laura-ven, I always appreciate the insight that you share with the rest of us. It has been very helpful to me personally. I am still pre-op and haven't yet scheduled my appointment because I realize that all of the above statements are true. It will not be easy. It is not a lifetime guarantee against weight gain. It is ultimately up to me making good choices regardless of the size of my stomach. I have been kicking this idea around for more than two years, and very very seriously for the past eight or so months. I am slowly working through each of my mental stumbling blocks wanting to make 100% sure that this is the right decision/time for me. I am currently at about 98% sure....there are just two remaining little nagging worries I am dealing with. One thing that strikes me as....silly, I guess...is the newbie posts around here about how they are disregarding their surgeons recommendations in favor of their own "common sense" version. I mean, if their personal version of healthy living was accurate they wouldn't have had to resort to WLS, right? I am actually thankful to those people's arrogance opinions because it reminds me of the importance of the MENTAL changes that I need to make in order to have lifelong success with my sleeve. -
Female issues with RNY?
LindsJ83 replied to Kremmell785's topic in POST-Operation Weight Loss Surgery Q&A
I don't think I ever experienced weight gain with bc. Maybe it depends which one you were on. I've had the best luck with a pill called Kariva. Fairly regular cycles, only 4 days max and I barely needed to use anything. Loved it. Def talk to your doc. They would know better!! -
seroquel preventing weight loss
follmerpa replied to freezyfree's topic in Gastric Sleeve Surgery Forums
My Psych said it helped me gain weight Seroquel and other meds where lin.ked to my weight gain. I gained 45 lbs in about 4 months. We have switched my meds around a bit and have found a good combination to keep me well and not gain the weight, -
I am testing my plan.... eat some off plan stuff a few of the days of holiday.... 5:2 fast one or two days a week, and so far so good. Up two pounds over my high bounce a couple of days, at my high end of bounce the last couple of days, fasting tomorrow.... then I should be good until New Years day.... I make sure to write it all down in MFP and try and get in some walks. Today I was over plan by about 700 calories.... the most yet, but with the fast tomorrow, that should balance it out. Not burying or hiding my indulgences helps me to stay in the drivers seat... writing them down helps me to face the facts about my choices, and not get caught by surprise with an unexpected weight gain, or a run-on unconscious eating spree. I suspect I will have carb craving for a few days... but thats the price of eating some real sugar and such in higher quantities. I have enjoyed most of them.
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Any Happy Bandsters Out There With 5 or More Years Of Banding?
sunnysidega replied to NeenBand's topic in WLS Veteran's Forum
10 1/2 years post and very thankful for my band. Not to say I haven't had my issues with some weight gain and difficulties but I attribute that to me learning about the reasons for being overweight, emotional eating and learning to life a healthier lifestyle. I am very blessed to say I have had no issues with my band such as reflux, etc. My band keeps me in check but a lot of the weight loss success has to do with me keeping up my end of things with exercise, making good food choices and not reverting to emotional eating. -
Typical or weird? (weight GAINS)
Melting in Az replied to cathibass13's topic in POST-Operation Weight Loss Surgery Q&A
I've had my weight go up as well, it was frustrating at first but when I look at the big picture (say what I lose in a month rather than a week) it's always good regardless of any weight gain. Hang in there because in the long run, you're still going in the right direction. -
Typical or weird? (weight GAINS)
cathibass13 posted a topic in POST-Operation Weight Loss Surgery Q&A
I am 5 weeks post-op, and twice now I have experienced 3-5 lb weight GAINS. The first time was random, and it really upset me. The second time was after I hurt my back and was basically immobile for 3 days as well as taking (liquid) pain meds (hydrocodone). It is very frustrating, especially when I think that I have only lost 20 lbs (+/-) total since surgery, at a time where I thought my numbers would be much higher. Is this typical?? Right now, I just got down to 1 lb BELOW the last 5 lb gain (so I lost 6 lbs, verrry slowly) and now I'm up almost 2 lbs. IT'S SO FRUSTRATING!! Especially when I don't know if anyone has ever experienced such a strange phenomena. I can't call my regular doc since they are closed for the holidays. I have to admit, I am not exercising (because of my back issues, in tandem with the stress of the holidays), and I'm hoping that this, in conjunction with my choosing high carb items (baked potato Soup, cheese soup, noodles, etc) has something to do with it. Please tell me that this is actually what the problem is, so that I can begin that rapid downward scoop that I was looking for pre-surgery!! Or, am I just expecting too much, and should I be happy with my weight loss to date? I began at 245 which is comparatively low for GSS patients, in general (I'm told). Could that be it?? I'm just stumped, and frustrated. -
Typical or weird? (weight GAINS)
cathibass13 posted a topic in POST-Operation Weight Loss Surgery Q&A
I am 5 weeks post-op, and twice now I have experienced 3-5 lb weight GAINS. The first time was random, and it really upset me. The second time was after I hurt my back and was basically immobile for 3 days as well as taking (liquid) pain meds (hydrocodone). It is very frustrating, especially when I think that I have only lost 20 lbs (+/-) total since surgery, at a time where I thought my numbers would be much higher. Is this typical?? Right now, I just got down to 1 lb BELOW the last 5 lb gain (so I lost 6 lbs, verrry slowly) and now I'm up almost 2 lbs. IT'S SO FRUSTRATING!! Especially when I don't know if anyone has ever experienced such a strange phenomena. I can't call my regular doc since they are closed for the holidays. I have to admit, I am not exercising (because of my back issues, in tandem with the stress of the holidays), and I'm hoping that this, in conjunction with my choosing high carb items (baked potato Soup, cheese soup, noodles, etc) has something to do with it. Please tell me that this is actually what the problem is, so that I can begin that rapid downward scoop that I was looking for pre-surgery!! Or, am I just expecting too much, and should I be happy with my weight loss to date? I began at 245 which is comparatively low for GSS patients, in general (I'm told). Could that be it?? I'm just stumped, and frustrated. -
Awaiting final medicare approval
SuperFab replied to SuperFab's topic in Tell Your Weight Loss Surgery Story
Maybe you should think before you make a smart ass remark like that. These types of surgeries aren't for vanity reasons. They are medically necessary. I was in an accident on ice and subsequently acquired severe spinal stenosis when my hip was injured. Couldn't walk for over a year unassisted. At that time I wasn't overweight and was very physically active. Having to be sedentary caused me to gain over 140 pounds. In 2 years. Then I developed HBP and severe sleep apnea Bc of that weight gain. This surgery could actually help me to lose enough weight that it may take the pressure off my spine and allow me the opportunity to get off disability. You can kiss my fat ass -
Fell Off the Wagon...How do I get re-started?
Gpsteph replied to Kathy =^..^='s topic in Tell Your Weight Loss Surgery Story
Fear of failure or critisim and shame are powerful tools that sabotage us. It's likely the reason why many of us comfort ourselves in different ways. Food, alcohol, sex, religion or other substances and activities help distract us or let us escape from those feelings. Sadly, some of the ways we can self medicate have negative affects. Maybe if you start your conversation by telling the drs that you're afraid they'll chastise you, it will help them understand. Remember that they've likely had other patients who've experienced this come to seek help. I hope any dr who helps people who are over weight realizes that weight gain is not a cause, it's an effect. That's seems like a simpe concept and I'm not a dr. You need to be helped, not scolded or told by your Dr or from some Dudley do right on their own journey who loves to feel so enlightend by stating the obvious (ex: "You have to stop eating the white chocolate."). I've had the band for seven years now and I understand now that it's not the biggest resason I lost weight. I lost nearly half my weight going from 289 lbs to 148 lbs, went up to a more comfortable weight of 165lbs after being told I looked sick and now I'm up to 180lbs. I was freaking out over the fear of getting huge again. For me that was a hellish prison. I'm a bit older now and maybe my motivation isn't as fired up as it used to be but I thought maybe by going to the gym and joining this site it will help trigger some reaction. "For every action theres a reaction", right? Your fear or shame may be the real problem here so don't beat yourself up. It sounds like the time I had to climb this really tall ladder. I stood at the bottom of it for quite some time, staring at the top of it thinking "how the heck is my foot going to reach that high up?". After feeling very nervous and thinking it might be easier not to bother trying at all, I looked down and saw the first step. It was only a small step up but it got me closer than staying still. That's obviously a fictional storey and simpler compared to what we are really dealing with but things can only get better if you do something, even a small thing. Actually, you already made your first step by posting the problem and you may have helped someone else who can relate to you..... like me! -
Hi all, Merry Christmas, I hope it is okay and does not offend anyone. I thought I would update this post. I saw a neurologist and after tests etc, bottom line is they found a slight abnormality in my left temporal lobe. We are watching it and I am now taking meds but other than some weight gain and NO desire to exercise it seems to be fine, but I was fine up to the day I had the seizure too. So all in, does not seem to have anything to do with my sleeve! Good news. Take care
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See you said you will taste things. So the band is not completely restraining you. So for those of us that aren't at goal yet and therefore still carefully managing our calories those little tastes do add up. Now will there be enough tastes to cause weight gain? Probably not if the band is properly adjusted but there might not be a loss on the scale. And then remember how many on this site are newbies. Their bands probably are not properly adjusted. So the band is not fully working. And they know that a taste can turn into a full fledge bite that can turn into a high calorie meal. These are some reasons why people are struggling. Just think back to your early struggles and you'll find some understanding.
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I had a similar reaction but a different explanation. For years (unknown to me) I had pancreatic tumors that secreted insulin. The results (aside from massive weight gain) was that every few hours, no matter what I ate, I would experience a pretty steep drop in blood sugar. Diabetics learn to recognize this and everyone reacts in their own way. I have a cousin who gets sweaty panic attacks and knows his BS is low. For me, the sea monster would rise out of the ocean and I felt hungry. Removal of 2/3 of my pancreas (mostly) solved this. But post op (and for a few weeks while my body adjusted to my new intake levels), I would get the sea monster but not feel the hunger so I didn't realize where my bad mood was coming from. Once I did, I would have some broth or a sip of Protein shake or distract myself. Once I just took myself out of the house to spare the other residents. For me, all this (mostly) passed around week 3. But I watch out for it because it still happens, especially on days (like holiday prep days) when I get so busy, I get off my food and Water intake.
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The waiting game begins
LivingForGod replied to Superfluous's topic in PRE-Operation Weight Loss Surgery Q&A
The lady from my dr said because of weight gained. I have arthritis and degenerative disc disorder in my back. I havent worked since August. I cant exercise...I can barely walk. I also have PCOS which causes me to gain weight as well. Ive changed my eating and everything but I cant drop the weight. -
Day 10 & 11 weight gain!?!? Normal?
Sabredy12 posted a topic in POST-Operation Weight Loss Surgery Q&A
So weight is up on these day more today than yesterday!!! Normal?? -
I remember my first Christmas as a post op. It was 5 months out and nothing sweet perturbed me, in any way. It was so easy. I could sit around people, parties and xmas time food, yet utterly lack the desire to eat any food that was off " the plan." So easy I tell you. Fast forward to this Xmas and it is a much different story. We host parties. That is who my wife is. It is so easy to grab a small piece of home made almond Roca, a home made this or a home made that. My desire for sugar and salt comes alive. Granted I only have eaten about 100 calories extra this weekend of Xmas part food (big party last night too), but I am quite surprised at what difference a year makes. I reached goal at 7 months, about 10 months ago. I have been able to eat my paleo friendly diet without too much effort since then, but, man, this Christmas has been so much harder as a vet. I am sure come Monday things will be fine again, once back on the eating plan and back to the cross fit workouts (today is my rest day). I am going to need to be careful when tempted around holidays. It is not about weight gain (working out keeps me fit), but more about being disciplined, about being in control of my motivations and my goals. Things I should have responsibility over. How has your Christmas time been? Do you get these holiday lapses? What are your strategies when you are around parties (either hosting or attending) and your vet mind starts tricking you ?
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I can respect your opinion Cheryl, although I do disagree with you. I do think a forum like this can be used to talk about things like pain, etc and to get perspective from people who have actually had the procedure. Though surgeons are obviously educated they, most likely, never had this surgery. So they may not have tips and tricks that people here have. For example, I saw one thread for dealing with gas pain that discussed a yoga pose that was helping people deal with the gas pain. No ones surgeon knew that would help. That was discovered through talking to people in the same boat as you and someone figured out something that was helping others. To me, that is what this is all about. Yes it was a newly started thread that discussed that topic and it had a lot of activity. I get that this is a hot button issue for some of you. For me I see the value Ina new thread, but I believe forums allow for the ability to agree to disagree. That's part of the beauty. If you ever feel like someone is seeking advice that they should be paying for... Then I hope you exercise your right to move along. In my opinion, people aren't trying to use veterans in place of doctors.. It's more about talking to people with practical experience, who may have something to offer that a doctor doesn't. I can also assure you that I will not be eating an entire pie at Christmas and seeking your input about it. I've actually never had poor eating habits, so it's also not about changing the way I eat. My weight gain was due to a medication that I took for many years. I have always eaten healthily and made wise choices since I was a young child, as that's how I was raised. I was finally able to get off the medication and my doctor recommended this path for me. With that said though, people are human. They are going to make mistakes, and sometimes they are going to come here to talk about them. I'm sure there will be a time that I will put something in my mouth that I shouldn't have and I might go here to seek support from the only people who will really understand the torture that goes along with such a decision. I suppose why I commented I this thread is because I felt like there were comments intimating that newbies just didn't know how to play here correctly. I was hoping to remind everyone that all were newbies at one point in time. Perhaps my attempt failed or wasn't appreciated. Either way, I'm going to continue to post and be a part if this community even if the way I participate is frowned upon.
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If You've Had Duodenal Switch Surgery Share...
Elisabethsew replied to Elisabethsew's topic in Duodenal Switch Surgery Forum
Congratulations on your success, Sheanie. I love that you don't own a scale. Do you ever have difficulty with weight gain? -
How was your 5:2 day today?
Ms skinniness replied to Oregondaisy's topic in Gastric Sleeve Surgery Forums
Sheryl you have done amazingly well with your plastics and losing weight after wl. Weight gain is probably something we will always have to be on top of our gain. Congrats on your daughters 13 th birthday! As far as eating terribly, I've also been in that same boat! I just want to munch. My son's girlfriend brought home donuts and I had no cravings or thoughts of eating doughnuts until then. I ate 2 of them throughout the day. Some of it was emotional eating I know. But what the heck.... My DH shopped at target and we got a telephone call from our Southwest Airlines card and they were inquiring about a recent purchase for a trip to the Cayman Islands......We didn't schedule it so the credit card company canceled it and issued us another card. Checked my bank account and nothing is taken. I had applied for the red card at target but put down some miss information bc I didn't want them to have that info. Best thing I ever did for myself. I do miss the 5% discount though. Georgia sorry you had to deal with the extra stressors and the pork butt smoked sounds delicious. I have been very busy with stuff.....Last 2 days we have been making tamales. We haven't done this for years but I was getting tired of tasting other family members so we jumped right in. We made a batch of meat that was delicious and for some reason, it spoiled and we had to throw it out......So frustrating......So we made more.....Now it's done and they are so delicious. However in the past few days I have put one a couple of lbs to my bounce and it is such a reminder that I can not be eating cr**! I am so dishearten. Cognitively I knew this could happen, but emotionally, I wasn't expecting to gain I guess. Today is back to he drawing board for me. I will be going shopping with a friend bc I have done no shopping what's so ever so it will be impossible to keep my calorie intake at 500. So Instead I will be focusing on proteins. -
Weight gain the first week?
kll724 replied to kimk1999's topic in POST-Operation Weight Loss Surgery Q&A
You probably just have excess Fluid weight gain. Your weight will drop off as Bandista said. Best of luck, tr to clam down. Back away from the scale!!You are in the healing process! Best wishes for your healing! Karen...aka..kll724 -
I will be two years out Feb. 2. I started at 358 now I fluctuate between 200-205. I feel I should have lost more but I guess my body is settling. Yes, there are time I notice weight gain. The most I've gotten up to is 210. When I see that happening it's time to do something. So, believe it or not I go back to the liver shrink diet we had to do before surgery. Protein shake and a piece for fruit for breakfast and lunch. My dinner consists of 4oz meat and unlimited non starchy vegetables. I got those extra pounds off.
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I'm feeling frustrated. Surgery (banding) was the 16th. I'm not hungry and not eating that much but I'm still not below my pre-surgery weight. I've been taking the milk of magnesia (so things are moving). I'm struggling to get to 800 calories but I'm just so frustrated that I'm not even back down to surgery weigh in. Anyone else have this problem?
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Female issues with RNY?
Kremmell785 replied to Kremmell785's topic in POST-Operation Weight Loss Surgery Q&A
I'm afraid of the weight gain with b/c. I was on it since I was 16 because of my periods. So I'm now completely lost as far as bc goes. My husband and I were trying to get pregnant but now we're obviously waiting the 18 months. -
Lap Band a "Tool" not a "Miracle Cure"
jfreeohio posted a topic in Tell Your Weight Loss Surgery Story
Surgeon: Dr. Patricia Choban Columbus, OH I can safely say I am a "Lap band Success Story" now. However, I had a very slow start. My wise surgeon told me the band was a "tool" and not a cure-all and that I would still have to diet. She was right, but I had a lot of other contributing factors which made me fat and kept me fat. Here is my story: I was always slim (size 8/10 135 lbs at 5' 7") until my second of 3 sons was born, 27 years ago, and I lost my father. 4 years later I had my 3rd son and lost my Mother. I went into a deep depression for which my family doctor put me on Zoloft. A year later I was up 150 lbs! Now I really WAS depressed!. I was also diagnosed with Hypothyroidism and was put on Synthroid. Each year my family doctor would test my blood and each year he would tell me my meds were fine. Yet, I had every classic hypothyroidism symptom in the medical books! I read him a list: hair loss, brittle nails, constipation, inability to lose weight, gain weight easily, lethargy, memory loss, inability to concentrate, etc.. He never dug deeper so for 20 years I stayed on Synthroid and felt lousy. I have since found out, General Practitioners get just a few days of training on Thyroid and glandular disorders. That's why they are all quick to write a script for the popular Synthroid. I joined a Medifast diet clinic and was on an 800 calorie ketogenic liquid diet yet could not lose a single lb. I was 5'7 and 318 lbs at my heaviest and wore a size 30 dress. My doctor decided to change my anti-depressant to Wellbutrin as he read Zoloft caused weight gain. I remember a different doctor saying, "When you are on the RIGHT dose of the RIGHT medication, you won't just feel better, you will feel WELL!" I wracked my brain to see if I could remember what "WELL" felt like. Well, after a week on Wellbutrin, I remember looking in the mirror as if I was Rumplestiltskin, waking up for the first time and I said, "What the hell have you let become of yourself?!" As the fog lifted, I effortlessly dropped 45 lbs, just changing meds. I tried many diets, still with very little success. I knew my surgeon through our sons and she suggested I get the Lap Band in 2006. I saved up $11,000 and had it done. I lost exactly 15 lbs the first week due to nausea and then never lost another lb for several years. It wasn't until the rest of the health puzzle fell into place that my Lap Band started to do its job. I went to a D.O. (Doctor of Osteopathy) in my town for hormone replacement to help me through menopause. I began to feel less moody and depressed right away. I read him the same list of Thyroid symptoms I read my family doc and my D.O. immediately pegged my Thyroid as the culprit. He did not just perform one blood test, which my family doc did each year, measuring T-4, but he measured 4 or 5 things. He reported at my next visit that my body was not converting T-4 to T-3 so it was not being absorbed into my cells. He started me on a new med, Tyrosint, and within days I began to feel better. I complained to him I was on Atkins and eating nearly zero carbs, yet I could not get my ketose dipstick to turn pink. He told me I must be insulin resistant and put me on Metformin. I am not a diabetic but insulin resistance is a possible precurser to Diabetes, if I continued the way I was headed. Within 2 hours of taking my first tablet, my dipstick was dark purple and the weight began melting off. So Hormone imbalance, Thyroid deficiency and Insulin Resistance were my biggest obstacles to weight loss. I had some other issues which he uncovered. I was borderline wheat gluten intolerant, mildly lactose intolerant, and I had burned out my Adrenals by eating wheat as a carb addict for 50 years. I felt so much better on the Atkins diet, which made sense as no dairy or grains were permitted. I now could remember what "WELL" felt like. My energy was back, I was back selling houses, I had energy, I no longer had to shop in the Women's department, I had my Mo-Jo back. In addition to using the Atkins Diet, I also did the HCG shots and a 500 calorie diet. This was a grueling diet and one which cannot be entered into lightly. You need to look at your calendar and make sure you have 90 full days for the 30 day diet, 30 day transition and 30 day maintenance before even starting on it. Otherwise you will gain it all back again and more. So I lost my weight in sort of a stair-step fashion. 20 lbs or so at a time over a few years. Alternating between Atkins and HCG. Luckily I never gained more than a couple lbs. in between. As I lost weight, people began treating me differently. I was no longer "invisible". Men began holding doors for me and making eye contact when I walked by. I was getting compliments from my female co-workers and it was fun to buy clothes again. So my road was a very long one. It was almost 5 years before I had all of the puzzle pieces in place and the band started doing it's job.. I saved up for a Circumferential Tummy Tuck last summer which carved off another 20 lbs. Now, at 159 lbs, I wear a size 10 at Talbotts. And without the belly fat, my blood profile has normalized. I am no longer insulin resitant and my cholesterol and Tryglycerides are now normal. There is more skin I would like to have removed. The surgeon did liposuction of the thighs but now I need a thigh lift. I would like to have a breast lift, arm lift and maybe an eye lift. But just getting the tummy tuck made a HUGE difference in my wardrobe and how I feel about myself. I can wear Spanx for my thighs and a good support bra and long sleeves to hide the arms, but there was no good way to disguise my gut. Having it off, I no longer have to wear a long jacket over every outfit I own. For the first time in 27 years, I feel pretty again. At least as pretty as you can feel at 57. LOL So my advice, before you drop $11,000 or $12,000 on bariatric surgery, go to a good D.O. or better yet, an Endocrinologist, and have a full Thyroid panel done, Vitamin D, hormones and have them check for insulin resistance and gluten sensitivity. Once you have these items addressed, see if you can lose weight without the band. Try a low carb diet like Atkins. If you feel great on it and lose weight, you may well have been gluten intolerant. You might not even need the band. The band is not without risks. I have had to work very hard to handle vitamin and mineral deficiencies from both dieting and the band. Healthy salads and fruits and veggies are hard to eat with the band. I rarely got in all the Protein I required without a supplement. I also have much more GERD or indigestion at night with the band. This can be very serious and cause esophageal cancer if left untreated. Our bed is propped up 6 inches and I can't eat spicy foods. The band has been a God Send but don't get it if you can lose weight on your own. Just get these items "ticked" off the list before you go under the knife. If nothing else, it will make your lap band more successful and you wont take 6 years like I did. While the band, never really caused me to lose weight. It has been helpful keeping the weight I lost off. I can take a a few bites of a small piece of pizza and be stuffed, I can take a tablespoonful of Thanksgiving goodies and try a taste of each thing, but push away from the table with a plate still half full. In fact, I had my band tightened just before Thanksgiving to make sure I did not put any holiday weight on. My band in 2006 was one of the early ones. The port is very prominent now that I have lost 100 or more lbs. and the band is tight even when empty. The new bands are larger in circumference when empty. I am going back in to have a new, lower profile port put in. When my plastic surgeon did my tummy tuck, he repaired 3 hernias. This caused the port to move to the mid-line since it was attached to the muscle and fascia he was pulling together. I want it moved back to under my ribs and right breast, where it originally was. Dr. Choban explained this replacement is not without some risk. She has to carve out a pocket for the newly moved port and then hope the empty pocket does not get infected. It is definitely not something I want a doctor doing who is inexperienced in lap bands. If you do decide to get a lap band and later a tummy tuck, allow for your bariatric surgeon to be present to adjust your port and possibly put a lower profile port in place. I thought it was something the Plastic Surgeon could have done but it turns out to be much more complicated than I originally thought. So discuss it with your Bariatric Surgeon first. Make sure your Bariatric Surgeon and Plastic Surgeon have privileges at the same hospital. It turns out, mine did not. Feel free to message me if you want more info on the HCG diet or doctors.