Tuesday, January 3, 2012

Skin Removal Surgery, Part 1

After losing well over a hundred pounds, I knew I was going to need some skin removal surgery--particularly from my abdomen. My skin was so deflated and saggy, and it got in the way all the time. I got rashes and infections under the "apron" of skin and in my belly button. Running for exercise was hard, because my stomach would bounce up and down, causing a lot of pain.  My clothes didn't fit right, because I had to tuck my extra skin into my pants. And no matter how big my pants, I always had a hangover of skin on my sides (love handles).

I called my insurance company, just to see if it was even possible to get the expensive surgery covered by insurance. Surprisingly, they told me that it's possible. They told me to go see a plastic surgeon, who would determine if it was medically necessary, and then submit the claim. I had no clue what the surgeon would be looking for, and more importantly, I had no clue how to pick a surgeon.

When I went for a consult (I'll explain how I picked my surgeon later), she told me I was a perfect candidate for not just a tummy tuck, like I was planning on, but a lower body lift (also called a belt lipectomy, or circumferential tummy tuck, among other names). Basically, the surgeon makes an incision ALL THE WAY AROUND your lower abdomen, and all the way around your upper abdomen, and then pulls the top down to meet the bottom, and sews it back together. It includes a muscle repair of your abdominal muscles, which pulls your muscles together and gives your stomach the very flat look--rather than a rounded, beer-belly look.

I was very anti-body lift, because I'd heard it was much riskier, and I really didn't care what my butt looked like. However, I eventually decided to get it (I'll explain that more later, too). I had the surgery and am THRILLED with the results! Here, I will write ALL the details for anyone who is considering the surgery. This is all from my own experience--remember, I'm not a doctor! ;)


Candidates for surgery
This is NOT a weight loss surgery. I can't stress that enough. If you are overweight, you will not get skinny from this surgery. The surgery is meant for people that have lost a large amount of weight and have saggy skin around their middle.

To get an idea of the results you can expect, put your hands on your hips and holding tight, pull up all that skin--you'll notice your hips, butt, and abdomen all lift up tight. If you don't have a lot of flabby skin on your butt or hips, then maybe a tummy tuck would be the way to go. I would talk to a plastic surgeon and see what they recommend.

Insurance
There is a (very small) chance that your insurance company might pay for a part of your surgery. I almost didn't even ask, because I was SO SURE that my insurance company wouldn't cover it--but I'm glad I did, because I was pleasantly surprised to find out that they covered about 3/4 of the cost.

I would call your insurance company ask what the requirements are to get a panniculectomy covered. A panniculectomy is the removal of the "apron" of skin on your lower abdomen. This does NOT include  muscle repair or replacing your belly button to where it should be. I learned that a panniculectomy would be covered, but everything else would be considered cosmetic, and I would have to pay out of pocket for that.

The requirements for MY insurance to cover the panniculectomy were: 1) Must have lost at least 100 pounds; 2) Must have kept the weight off for at least 6 months, and 3) Must have rashes caused from the excess skin. Since I met those three requirements, my insurance covered that part.

The rest of my surgery--muscle repair, replacing my belly button (both of which are included in a full tummy tuck, or abdominoplasty), and the hip and butt lift part were considered cosmetic, and not covered by insurance.

Choosing a plastic surgeon
My selection process was actually quite simple. I only went to one consult and decided she was the surgeon for me. But first, to select a surgeon, I decided that I wanted to pick someone in the Henry Ford Health System. I've seen great doctors in that system, and I used to work for a fantastic OB/GYN in the HFHS. My jaw surgeries were at Henry Ford Main Hospital in Detroit, and I was happy with how everything went. So I started looking online at the plastic surgeons of HFHS, and reading their bio's. All of them sounded impressive. There were a few that specified they worked with post-bariatric surgery patients--while I did not have bariatric surgery, I did lose a lot of weight, so I knew that these surgeons were probably the right choice. One really stood out to me, for some reason--Dr. Donna Tepper. I never thought I'd pick a female surgeon, but I liked her bio.

I decided to e-mail the surgeon who performed my jaw repair surgery and ask him if there was a plastic surgeon he would recommend for me. I really liked him, and trusted his input. When he wrote back, he said Dr. Tepper--without my even mentioning that I liked her bio. So it was almost like a sign that I should choose her.

I set an appointment, which took about 5 weeks to get in for a consult. When I met her, she was VERY confident, and happy that I lost the weight through diet and exercise--she made me feel very comfortable. She had a great personality, sense of humor, and wasn't too pushy. She answered my questions and didn't seem like she was in a rush to get out of there.  I felt like I was talking to a friend. I really liked her, and didn't see any reason NOT to choose her. I listen to my gut feeling when I'm making an important decision, and deep down, I knew she was the right choice.

When choosing a surgeon, it's VERY important to choose a surgeon who is board certified. Don't just take their word for it, either--you can look here to check for yourself. I would also recommend that you choose a surgeon who has hospital rights, or who only works out of a hospital. Some surgeons do the procedures in their own offices, so if something goes wrong, you can't just go to the hospital to fix it. Dr. Tepper works out of several different HFHS hospitals, which eased my fears--and also made it more convenient, because I was able to see her in different locations, depending on what was easiest for me.

Also, and this is just coming from my opinion, of course... the very very popular plastic surgeons are not necessarily the best ones. A lot of times, they are only popular because they have commercials advertised on TV, or billboards with their names on them. They are probably very busy and won't have much time for you--a lot of people don't put much thought into selecting a surgeon, so they just pick the guy who has a television commercial, because he "must" be good to have his own commercial.

I think it's very important to choose a surgeon that you can tell LOVES HIS OR HER JOB. Dr. Tepper was very excited about my weight loss and I could tell she was excited that I was going to have a good result due to my hard work. Seeing that she was excited about it, I knew she was in it because she loved her job--and because of that, I knew that she would want to do her best job during my surgery.

When I read the tummy tuck message boards, I notice that everyone asks, "Who is 'the BEST' surgeon in such-and-such state/area?" and they let that be the deciding factor. But a lot of those people don't have very good results after their surgery, and then they later find out that their surgeon doesn't have time for them to work with them and make them happy, so they are stuck with a bad surgery. 

My advice would be to do your own homework--choose a hospital that you trust, and check their website for plastic surgeons. Read the bio's and see if any stand out to you. See if they specialize in post-weight loss surgery. Then meet them and see if they seem confident, excited about their job, and tell you what to realistically expect from the surgery.

Questions for your surgeon
Once you choose a surgeon, you'll want to come up with a list of questions that you want answered before surgery. Make sure you carry a list everywhere with you so that you can add to it if a question pops into your head. Some questions I asked:
*Is it possible for this to be covered by my insurance? Do you submit a claim for me?
*How long before I can run again?
*How long can I realistically expect to need help at home?
*How long is the surgery time?
*Do you take precautions during surgery to prevent blood clots, since the surgery time is so long?
*Will I stay the night at the hospital? Can my spouse stay with me?
*What can I do after surgery to recover as quickly as possible?
*Do I need to buy a compression garment?
*Can you show me exactly where my incision scar will be? Will it be visible above my panty line?
*What positions can I sleep in after surgery?
*Will I have drain tubes? How many? Where will they be placed?
*If I have a question or problem after surgery, and I need to get a hold of you after office hours, what number should I call?

If you work, you'll want to ask about when you can go back to work, what the restrictions will be, etc. At your pre-op appointment, you'll want to ask everything. If your surgeon seems annoyed at the number of questions, I would definitely reconsider that surgeon! Dr. Tepper was very patient and answered everything I asked.

Pre-Op
I asked all my questions at my pre-op appointment (this was the appointment after my initial consult, and was more detailed), and was given the prescriptions for the medications I would need after surgery: an antibiotic to prevent infection, Vicodin for pain, and a muscle relaxer for muscle spasms.  I was also given two sterile antibacterial soap-filled sponges--one to wash with in the shower the night before surgery, and the other to use the morning of surgery.

I had about two months to wait until surgery, so I spent that time getting prepared. My husband requested some time off work to care for me, we started saving some money for those days he took off work, and I bought a few things that I figured I would need--gauze, medical tape, my compression garments that my surgeon told me to get, a Go-Girl thing so I could pee standing up after surgery (laugh now, but it was my best friend for two weeks after surgery!), and protein powder (the doctor wanted me to have a lot of protein).

About a week before surgery, I quit drinking wine :(  The instructions were not to have alcohol for 48 hours before surgery, but I figured a week would be even better. I filled my prescriptions so they were ready when I got home. I paid for the part of the surgery that my insurance wouldn't cover (see below for costs). I had to get some blood drawn for lab tests. And then I arranged with my parents for my kids to spend a few days there.

The day before surgery, I washed my bed sheets so they would be nice and clean. I cleaned my house and made sure there wasn't any clutter. That night, I washed with the special sponge they gave me, and I was told not to eat after midnight (I quit eating at 7 pm). I went to bed and set the alarm for 3:00 AM--crazy, I know. I was told to be at the hospital at 5:00 in the morning, and it was over an hour away. When I woke up, I took a shower and used the second sponge, then dressed in comfy, baggy clothes. Jerry drove us to the hospital.

Cost of surgery
The cost of the surgery I had varies ENORMOUSLY, but I'll share the costs that I incurred. The costs are broken down by anesthesia, operating room use, hospital stay, surgeon fees, etc. Keep in mind that my insurance covered a huge chunk of it...

Out-of-pocket expenses:  $134 one-time consultation fee; $200 for 4 compression garments; $4,380 for the cosmetic portion of surgery; $808.73 for co-pays to insurance after surgery. TOTAL: $5,522.73.

I'm not sure how much the surgery would cost if you paid straight cash (no insurance whatsoever) but I'll ask my surgeon next time I go in. The average cost of this particular surgery (from what I read online) is $18,800. Yes, that sounds like an insane amount of money--you could buy a car for that! But this is something that I wanted more than anything else, and if I have to make payments for a few years to pay for it, it's worth it to me.

But like I said, the cost varies enormously, so don't write off the surgery if you don't think you can afford it. I would at least go see a surgeon to find out the cost and what your options are. I was SHOCKED when I discovered that a huge chunk of the surgery was covered by insurance.

The surgery
You can read about my experience the day of surgery here.

The hospital
I have to admit, when my doctor said she wanted to do the surgery at a tiny little hospital called Cottage Hospital in Grosse Pointe, Michigan, I was nervous. I was hoping she'd want to do it in the huge Henry Ford Hospital in Detroit--it just seemed "safer" because it was bigger. But the doctor's secretary told me that Dr. Tepper really likes the staff that she works with at Cottage, and that it's in MY best interest to go where the doctor is comfortable. I could have insisted that I have the surgery in Detroit, but of course I wanted my surgeon to be happy while she's working on me! So I agreed to go to Cottage. It was the best decision I could have made, and I'm SO GLAD that I had the surgery at Cottage Hospital. (So keep in mind that it's important for your surgeon to feel comfortable).

We were the only people there at 5:00 in the morning, which was a strange feeling. The whole staff that interacted with me was SO FRIENDLY and nice and made me feel very comfortable. There wasn't a single person who I was displeased with. All the nurses, the anesthesiologist, even the security guard who had to unlock the doors for us--super nice, and helpful.

My doctor had me stay for '23-hour observation' after my surgery, and I'm very happy I did that. I was literally the ONLY overnight patient in the hospital--crazy, right?! But it was fantastic--anytime I needed something, the nurses were right there. I had a catheter in, so I didn't haven't to get up to go to the bathroom at all. The nurses took very good care of me, emptying my surgical drains, getting me water (constantly, I was so thirsty!), even setting up a bed for my husband to stay with me overnight. Dr. Tepper came to check on me after the surgery, and then again the following morning, when she said I could go home whenever I was ready.

I honestly cannot say enough good things about Cottage Hospital.

Post-Op
I have a lot of blog posts about the aftermath of the surgery, but I'll explain the gist of it here.
I had four surgical drains placed during the surgery. The drains are tubes that come out of your abdomen with a bulb on the end that collects fluid (blood, saline from irrigation during surgery, etc) so that the fluid doesn't collect inside of your abdomen. The drains were not painful to me at all--just a nuisance. You have to empty the drains and record the amount of fluid that you empty--and my doctor said she would remove them when they were draining less than 30 cc's per 24-hour period. Three drains were removed on Day 8. The last wasn't removed until Day 17. The removal did not hurt at all, it just felt very strange. It's important to leave them in long enough so that you don't have fluid accumulate and form a seroma, which can get infected.

I also had to wear a surgical compression garment. My doctor gave me a pamphlet at my first appointment and showed me the one she wanted me to order. She said to get two--one in beige and one in black. She told me to bring the black one to my surgery, and I would wake up from surgery with it on. (She said black because it would certainly get stained in the first couple of days, and the stains aren't as noticeable on the black). My garment fit like a pair of granny panties that went up to my rib cage--only very very tight. The garment is actually pretty comfortable, and I liked the secure feeling while it was on. I was told I would have to wear it 24/7 for six weeks (except while showering).

The incisions were very easy to care for. All surgeons have their own instructions, but my surgeon told me that there would be no dressings on the incisions, and I didn't have to do anything special. I didn't have external stitches--she used some sort of Dermabond to close the top layer. In the layers of skin underneath, there were absorbable stitches. There was also a strip of tape on the incision, but I didn't even know this until Day 8, when she told me I could take it off. It was stuck on there really good!
Left picture is WITH tape over incision; right picture is after I removed the tape.

Because my incision went all the way around my body, I was told that for ten days, I would have to lie down or stand--no sitting! I could lie on my sides or my back, or even my stomach if it was comfortable (but I chose not to because of my drains). The reason for not sitting is because it would put strain on the incision across my butt.

I was given Vicodin for pain, but I learned that Vicodin doesn't help at ALL for me. I switched to plain old Motrin after about a week. The pain was the worst the first 2-3 days--it wasn't the incision that hurt, but my abdominal muscles. They were extremely sore, like I did a million sit-ups. After Day 3 or so, the pain wasn't bad at all for me. I still felt sore, but nothing unbearable.

I was allowed to shower from the day I got home from the hospital. She told me to wash gently with the regular soap I always use, and pat dry. The hardest part about showering was the drains--I had to put a chain around my neck and clip the drains to the chain. The first few days, I had my mom or Jerry reach into the shower and hold the drains while I washed quickly.

As far as exercise goes, my surgeon told me that I could exercise whenever I felt comfortable--just no ab work. I had no interest in exercising until about Day 14, but I hurt my knee, so I waited until almost 4 weeks post-op before I ran again.


A few random questions that I've gotten...

*What happens if you become pregnant now?*
Jerry and I are done having kids--we made that decision 'permanent' after Eli was born ;)  I don't know much about this, because it wasn't relevant to me, but I would certainly recommend waiting until you're done having kids to get a surgery like this to get the best results possible. Pregnancy caused a LOT of stretch marks on me, and I'm sure that wouldn't be any different if I'd gotten pregnant after my surgery. But this is something that I would ask a plastic surgeon.

*Why didn't you wait until you were at your goal weight to have surgery?*
I never really reached my goal weight, and when I went to surgery, I was about 15 pounds higher than my goal. However, I had maintained that weight for about a year, and I was comfortable with my size--wearing a size 4/6 prior to surgery. My surgeon said I was at a healthy weight and she had no concerns about my losing weight before surgery, so I went for it.

*Did you pick November for surgery for a particular reason?*
I wanted to get the surgery as soon as possible after my consult, but I had to wait for the insurance clearance, and then I was in my friend's wedding in October, so I had to wait until after that. November was a good time because I would be all healed up by summer :)

*Did you have to wait six weeks to have sex after surgery?*
No, my surgeon told me that whenever I felt ready it was fine to have sex. But I wasn't interested for a while! I waited about 5 weeks.

*Was it embarrassing having Jerry or your mom help you in the bathroom/shower?*
They've both seen me give birth, so helping me in the shower was no big deal :)  I'm not self-conscious in front of Jerry at ALL, and while I was a little embarrassed to undress in front of my mom, it was certainly no time to be modest. I didn't need help going to the bathroom, but I needed help showering (they held the drains). And I felt extremely exhausted, so it was nice to have them there if I felt faint.

*Did you get to see the video of your surgery?*
Not yet--I'm going to ask my surgeon for a copy of it when I see her next week. My surgery was videotaped (with my permission) for educational uses. I didn't think I'd want to watch it, but I kind of do now!

*How was the drive home from the hospital? When were you allowed to drive after surgery?*
I don't remember the drive home very much, but it wasn't TOO bad. My husband was careful going over the bumps :)  I had to recline my seat back as far as it could go. I was able to drive once I was off the pain meds AND it was at least 10 days post-op--because my doctor wanted me to lie down flat for 10 days, only sitting to go to the bathroom. I was driving by day 11.


I think this pretty much sums up all the facts about the surgery. In the next post, I list all "the good, the bad, and the ugly" parts about it!  Click here for Part 2.


9 comments:

  1. WOW! This must have taken forever to put together! On to Part 2!

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  2. I can't wait to read Part 2! This is so interesting to me, even though usually surgery creeps me out! I just am so SHOCKED by what modern medicine can do! Your advice is amazing, and very helpful!

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  3. Thank you for this in depth description of everything you have been through with your skin removal surgery. If I was 30 or even 20 years younger, I might consider having this done. My insurance is not sympathetic to those of us with weight problems however. Every year in January, we get a letter from Blue Cross/Blue Shield of Nebraska telling us that our plan will NOT cover anything having to do with weight loss or treatment for obesity. So, although I have not checked on the skin removal, a few years ago, I did call and talk to them about bariatric surgery and was emphatically told that it was NOT covered, even though my doctor recommended it for me. You are very fortunate that your insurance is more progressive.

    You look beautiful in ALL the pictures, even the ones where I know you were feeling miserable (puking with those sore ab muscles had to have hurt like HELL!!) Enjoy your new body and your new life. My insurance WILL cover knee replacements, and I think that is the next surgery for me--hopefully sometime in 2012!

    Happy New Year Katie!

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  4. What happened with the educational video they did of your surgery?

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  5. You are absolutely gorgeous!!! Thanks for this amazing blog! You give me hope and encouragement!!! You are an inspiration to me.

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  6. Thank you for writing this! I, too, have lost a tremendous amount of weight with Sparkpeople.com. Even though I have no health insurance right now (hopefully after I graduate college), what did you do to prove you lost 100 pounds?

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    1. I didn't have to prove it, but I was prepared to--I had records from my doctor's office that recorded my highest weight. Maybe the insurance company looked at them?

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  7. I just had an extended tummy tuck last week. I'm a triathlete. We have a mutual blog friend who sent me over here. :) Congrats on completing your transformation. I'm 5 days post-op now. And yes, I hate my drains!

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  8. I am searching the Internet to see people's progress as I am 12 days post body lift with liposuction. I am reading your blog and see we had the same surgeon! I also could not have been happier with Dr. Tepper. It's nice to hear another one of her patients stories. Thank you

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I'd love to hear from you! I read all of my comments, and if you have a question, I do my best to respond; sometimes, however, I get busy and forget to go back to reply, so if it's important, just email me! :)