I have questions for you PS vets about my "problem areas."

Candle · May 7, 2008

I'm physically ready for PS but not financially. My boyfriend is changing jobs this summer and while he's 110% confident about the career change, I'm a little nervous about incurring a huge debt at the same time. Plus, if I jump thru the insurance company hoops, I should be able to get the pani portion of my TT covered. (I have to be 18 months out from WLS surgery)

I'm going to start some consultations this summer.

Anyway ...

A breast lift and TT are my priorities right now. Possibly a LBL but my butt is only a little saggy and my outer thighs are fine. One of my questions is about my inner thighs. They really aren't too bad on the inside where the thighs touch but I have 2 little fat pads kind of on the front of my thighs near my pubic area. If I pull the skin up a little it looks fine. I don't think it's something that can be fixed with Lipo because the skin in that area is stretched out and creating a little saggy crease now. (almost like a hanging pani) Is that something they can kind of pull up when they do a TT and mons lift? It doesn't really bother me too much now but after a TT it's going to look awful in contrast to a “flat” stomach!

My #2 problem area is my arm pit area. I still have a pretty prominent roll of fat on my back that I hope lipo will take care of and my arms are little saggy but not too bad. The problem is, I have extra skin that spills over the band of my bra. I can't wear tank tops because I have a bunch of stretch mark ridden saggy skin that you can clearly see in front of and under my arm pit when my arms are at my sides. Is this something that will be fixed with a breast lift and/or removal of my back fat or is that only something that would be fixed by having my arms done?

I hope I explained all that clearly - I should have just take some pics. - lol

I appreciate any advice or opinions. Thanks

Frangipani · May 7, 2008

Hey Candle,

Your old buddy here !

I think you're going to find when you start digging into this, that no two surgeons are exactly alike in their approach to fixing multiple areas of the body, (which is usually what we bariatric patients need). I think you might also find that your priorities will change a bit as you start looking at photos, researching, and talking to doctors.

For example, I started out thinking that breasts were not a priority for me, but after looking at photos and being reminded of what "younger, perkier" breasts looks like, I have now placed a very high priority on breasts.

As far as the inner thighs, I have the same issue, but my Dr. wants me to wait a bit on those. He explained why by showing me photos of several of his patients where he got some inner thigh lift with the TT (or LBL) and in many of those cases the amount of lift he got satisfied the patient. That said, he cannot tell me with any real degree of certainty how much lift he will get with me because it varies from patient to patient, which is why he wants to wait until we are finished with the LBL.

This PS journey is very interesting and I think you will be learning a lot through your research and talking to doctors in person. But do keep in mind that if you do everything you are wanting to do, you will likely be having more than one surgery, so the "wait and see" approach will probably be part of this whole planning/staging process.

A final thought regarding this issue is that it really does help to learn as much as you can about the various techniques for addressing the body areas you are concerned about. There are so many different things that can be done and ways to do it that it is a bit mind boggling, but having this information (and developing some idea of your own preferences) will help both you and your surgeon to figure out the best way to approach your concerns.

Candle · May 7, 2008

Thanks Frangipani

I'm not expecting to get everything done in one shot. My TT alone is going to be MAJOR. My pani is ridiculous! I've been over 200lbs since highschool and well over 250 for almost 10 years. Plus I have fair skin and lots of stretch marks.< /span>

If my inner thighs never get fixed I think I'll survive. I probably wouldn't ever be comfortable in a normal cut bathing suit bottom. I'm always going to be a skirt/shorts kinda gal.

I’ve been wanting a breast reduction for years and now they are so deflated that a at least a lift, is HIGH on the priority list!

My side boob fat is the big surprise to me and not something I see a lot of people talk about. I still need to do a lot of research but I'm praying that can be fixed. The skin under my arm pits is busting out of my bra. I just wonder how that's most commonly fixed.

Edited May 7, 2008 by Candle

shortgal · May 7, 2008

Candle: Just wondering if you've had a professional bra fitting since you've lost your weight? A small shop that specializes in bra fittings are in most areas. You might find that you're wearing the wrong type or size of bra and that could make a difference in the area you mentioned.

It's worth a try to go in and be fitted.

Candle · May 7, 2008

Thanks shortgal. I was actually thinking about doing that once my weight stabilizes.

I’ve gone from a 44DDD to a 36D.

I was trying on dresses the other day for a wedding I'm going to in June, so I tried a few different bras as well. The only bras that didn't give me the hang over of skin, were bras that were too big and didn't give me the support I need. I need a nice tight bra or my girls are down to my knees :cursing:

shortgal · May 7, 2008

That's a big difference in size. I need to do a bra fitting as well, but waiting until I get closer to goal. Then I'll get one professionally fitted and wear it a bit before I decide if I want more. Standing in one trying them on, is so different from actually doing things while wearing one.

I think it's harder figuring out a new bra to buy than clothes.

A new bra might not fix all the problem areas you have, but might minimize them. Let's face it, we all have problem areas we're trying to hide. :cursing:

Dr. Schulman · May 8, 2008

I'm physically ready for PS but not financially. My boyfriend is changing jobs this summer and while he's 110% confident about the career change, I'm a little nervous about incurring a huge debt at the same time. Plus, if I jump thru the insurance company hoops, I should be able to get the pani portion of my TT covered. (I have to be 18 months out from WLS surgery)
I'm going to start some consultations this summer.

Anyway ...

A breast lift and TT are my priorities right now. Possibly a LBL but my butt is only a little saggy and my outer thighs are fine. One of my questions is about my inner thighs. They really aren't too bad on the inside where the thighs touch but I have 2 little fat pads kind of on the front of my thighs near my pubic area. If I pull the skin up a little it looks fine. I don't think it's something that can be fixed with Lipo because the skin in that area is stretched out and creating a little saggy crease now. (almost like a hanging pani) Is that something they can kind of pull up when they do a TT and mons lift? It doesn't really bother me too much now but after a TT it's going to look awful in contrast to a “flat” stomach!

My #2 problem area is my arm pit area. I still have a pretty prominent roll of fat on my back that I hope lipo will take care of and my arms are little saggy but not too bad. The problem is, I have extra skin that spills over the band of my bra. I can't wear tank tops because I have a bunch of stretch mark ridden saggy skin that you can clearly see in front of and under my arm pit when my arms are at my sides. Is this something that will be fixed with a breast lift and/or removal of my back fat or is that only something that would be fixed by having my arms done?

I hope I explained all that clearly - I should have just take some pics. - lol

I appreciate any advice or opinions. Thanks

Hopefully I can answer your questions.

1. Regarding the inner thighs - This area is best addressed with an inner thigh lift in which the incision is maintained in the groin crease. Given your amoutn of successful weight loss, your surgeon may recommend an "up and down" incision as well for better contour. Yes, during a TT or LBL, your surgeon can remove some of this skin, without doing a "full" thigh lift, and this can give improvement - but it may not give you the improvement you want.

2. Regarding the skin overhanging the bra - This problem is common after weight loss and will not be improved significantly with an arm lift. This area is better addressed with an upper back lift, or upper body lift. In this operation, the skin of the underarms and upper back is removed, and the scar goes accross the upper back and is hidden under the bra line. This can be perfromed in combination with other procedures such as breast reduction or arm lift.

Hopefully this helped. Obviously this information should not replace an actual consultation with your surgeon.

Jachut · May 8, 2008

Its frustrating isnt it, to do all this work and not not be 150% satisfied with what remains. I mean, you can see from my avatar that I got out of this pretty lightly, but I have the side boob thing going on too and I was never morbidly obese to begin with. The right bra can make a big difference - I cannot wear little fanciful bras with one hook backs, I can buy nice ones, sure, but they're sturdy garments, if I dont I get the roll over the side. Yes, mine is tiny but it ruins the line of anything I"m wearing if I'm not wearing the right bra. That bikini top I have on is brilliant because it covers the sides.

The right bra size is also important, if the back is too big, it will ride up and you get the back roll, a smaller back, that is sturdy enough fixes this problem for me.

The inner thighs - I have that poochy fat bit right up the top too, my view on it is if the choice is that or a thigh lift, I'll live with it. I mean, it only matters when you're half naked in a bathing suit anyway, doesnt it? So why would you swap it for a huge scar? If your thighs are ruining what you're trying to wear, that's different, but really, I think we have to be realistic - after a large weight loss we are probably not going to look fantastic in bathing suits or naked. We just arent, and even PS wont fix that.

Most people walking around dont look that naked either, but then again, nobody else looks at you as critically as you look at yourself. I think boobs are important, those ARE visible, you DO show large areas of your decolletage, they do affect the way your clothes look, and they do give you maximum pleasure and satisfaction for your hard earned money, same with a Tummy Tuck if you're left with a pannus. If you cant even wear shorts happily then perhaps a thigh lift is on the agenda - you really have to way it up according to what you wear and like to do.

Frangipani · May 8, 2008

This area of the board is so awesome because you can often get answers straight from the doctors themselves, as we have right here in this thread!

Jachut you made some good points too. I know that everything can be fixed beautifully and well, but I do worry about my body looking like a road map when it's all done.

Extensive scarring is definitely an issue that concerns me, but I haven't really considered this question in enough detail to know for sure whether it's an acceptable trade-off for having everything fixed to satisfaction. Right now I am just focusing on getting the high priority PS done, so that I don't feel like all of this effort to get the weight off has been for naught.

Jachut, you are one lucky lady -- you did come through this with flying colors. If I looked as good in a bathing suit as you do, I would be saving a lot of money!

Dr. Schulman, I read someplace that it's a good idea to do the inner and outer thighs in separate surgeries because addressing these areas simultaneously can adversely affect the result. Is this true?

Dr. Schulman · May 8, 2008

Dr. Schulman, I read someplace that it's a good idea to do the inner and outer thighs in separate surgeries because addressing these areas simultaneously can adversely affect the result. Is this true?

I think there is some truth to that. The only way to really help lift the outer thighs is through a lower body lift (this helps the abdomen, outer thighs, buttock and lower back simultaneously). The inner thighs would need a medial (inner) thigh lift. Doing these two operations at the same time may compromise the blood supply and may increase the possibiity of complications. A LBL is a large operation and I generally do not perform any other significant procedures at the same time - I will do liposuction of other areas at the same time.

Many of these procedures can be combined.....but a LBL is the largest of all the procedures and should be done alone.

Candle · May 9, 2008

Thank you Dr. Schulman!

I've read a little about the upper body lift, although I wonder how that would work for me. I have extensive scaring on my back from spinal fusions when I was a teenager. (scoliosis)

I'm really looking forward to getting the opinions of a few surgeons. Although the thought of having my body examined in that way, scares me to death :thumbup:

I still have AT LEAST another 20lbs to lose and I’ve started running – we’ll see how the inner thighs do …