9 days out from abdominoplasty

[Marquis Mark]

Thanks Hilary. The front that I showed is not bad - I got a bit of my waist back! - but it doesn’t show the deflated yet still mongo sharpei thighs, nor what used to be a magnificently steatopygian butt, which is now flat and the skin melted down the back of my thighs. And which has no meat to protect my tailbone.

I’m actually appealing the insurance denial of the butt and thigh lift, on general principles, but I doubt I would do the surgeries even if approved. Too much pain, and far less excuse than the abdominoplasty - I had to have the hernia surgery anyway, and didn’t want mesh.

I’m finding it interesting though (and a relief!) that this experience was so much less distressing and painful than the brachioplasty and lower face lift 9 years ago.

Looks good. Just out of curiosity, why didn't you want mesh?

 

[DianaCox]

1) I’m an adhesion and keloid former - I didn’t want the risk of pain from mesh repair, which can cause all kinds of adhesions.

2) I’ve had multiple abdominal surgeries - odds of having a bowel obstruction higher, and didn’t want mesh in the way, especially of a lap surgery.

3) This was an incisional hernia from a lap port near the midline, probably caused by exercise, and tore into my prior umbilical hernia repair; I have at least 12 lap port holes, an extended hemicircumfertial incision around my old belly button from my DS and the prior umbilical hernia repair, a prior C-section and prior open salpingo-oophorectomy; I was of course formerly morbidly obese and had two full-term pregnancies with large-ish babies, so I had significant diastasis; therefore, doing muscle plication would buttress my abdominal muscles with an internal corset, which should help prevent future hernias.

4) And because of the above, I could leverage a good cosmetic result, including the panniculectomy, which insurance approved without balking.

Since I had to get the hernia fixed anyway, I wanted to finally get my excess skin and diastasis fixed at the same time. One surgery, one recovery, albeit a bit harder. So I pushed to get the plication deemed medically necessary. They denied at first, but then approved.

By the way, I saw the EoB today.
Provider charged: almost $86K
Allowed amount: almost $20K
Insurance paid: almost $19K
Two nights in the hospital @$500/night: $1000 copay.

 

[Marquis Mark]

My h

1) I’m an adhesion and keloid former - I didn’t want the risk of pain from mesh repair, which can cause all kinds of adhesions.

2) I’ve had multiple abdominal surgeries - odds of having a bowel obstruction higher, and didn’t want mesh in the way, especially of a lap surgery.

3) This was an incisional hernia from a lap port near the midline, probably caused by exercise, and tore into my prior umbilical hernia repair; I have at least 12 lap port holes, an extended hemicircumfertial incision around my old belly button from my DS and the prior umbilical hernia repair, a prior C-section and prior open salpingo-oophorectomy; I was of course formerly morbidly obese and had two full-term pregnancies with large-ish babies, so I had significant diastasis; therefore, doing muscle plication would buttress my abdominal muscles with an internal corset, which should help prevent future hernias.

4) And because of the above, I could leverage a good cosmetic result, including the panniculectomy, which insurance approved without balking.

Since I had to get the hernia fixed anyway, I wanted to finally get my excess skin and diastasis fixed at the same time. One surgery, one recovery, albeit a bit harder. So I pushed to get the plication deemed medically necessary. They denied at first, but then approved.

By the way, I saw the EoB today.
Provider charged: almost $86K
Allowed amount: almost $20K
Insurance paid: almost $19K
Two nights in the hospital @$500/night: $1000 copay.

my incisional hernia was repaired with Gore-A bio mesh which is suppose to dissolve within 6-7 months. Is it going to cause issues if they need to go in there again?

 

[DianaCox]

+I didn't realize that was an option - sounds like a good idea. Unless whatever the defect that the mesh was covering doesn't completely heal in a way that isn't subject to recurrence once the mesh dissolves. I'm not sure that would work in my case, because the defect was caused by a prior healed defect (both lap port and prior umbilical hernia from 2003) reopening.

However, I think the stitching of a permanent "corset" into my abdominal muscles ties the various muscles to each other, so it spreads the tension across a wider area. Plus in my case the diastasis caused by pregnancies and obesity are pulled back together, so the guts behind the linea alba can't try to push out.

I've been trying to read and understand my surgery report. My scanner isn't connected right now, so I'll just type it out, highlighting the stitchery:
~~~~~~~~~~~

Initially began by reconfirming my markings of the right flank lipoma. Note it was made in the preoperative area. Additionally, the patient had a prior cesarean section scar with ptosis of the mons. I therefore proceeded with making an incision sharply with a scalpel. This was then taken down to the anterior abdominal fascia with electrocautery. I then proceeded to extend the incision in later directions towards the hip along the area of the patient's underwear line and to remove the inferior hanging skin. I then proceeded superiorly leaving some of the adipose tissue and deep lymphatics along the anterior abdominal wall to try to prevent drainage. This then proceeded superiorly. When I got to the area of the umbilicus, there was noted to be some thickened scar as well as some previously placed sutures. These were able to be removed. I was then able to identify a hernia defect just lateral to the area of the umbilicus that then tracked towards the midline that was consistent with an umbilical hernia. The patient had a prior umbilical hernia. I then made a circumferential incision around the umbilicus using the prior incisions. This was then taken down to the underlying anterior abdominal wall preserving the vascular stalk of the umbilicus. I then using electrocautery further freed up the area adjacent to the hernia. This was completely cleared and was noted to contain omentum. It was then able to be easily reduced just back into the intraabdominal cavity. The underlying area was cleared for approximately 1-2 cm in all directions to avoid any mesh. The defect was only approximately 2-3 cm. I then placed multiple figure-of-8 0 Ethibond sutures reapproximating the fascia. I then proceeded in both superior directions to the area of the xiphoid and the lower ribs, then this laterally to the area of the hips and down to as far as towards the table. On the right side, I was then able to further dissect very carefully through the flank tissue and identify a large lipoma that measured approximately 7 cm. This was then able to be removed very easily in its entirety and passed off as a specimen. We then thoroughly irrigated out the abdomen and hemostaisis was maintained. I then injected additional local anesthetic as well as a combination of Exparel and Marcaine along the prior incisions as well. This was then placed bilaterally in between the transverse abdominis and oblique muscles performing a transverse abdominis plane block for postoperative pain relief. I then began by imbricating the midline as she had a diastasis in both the superior and infraumbilical areas and this was also further buttressed. The patient's umbilical hernia repaired without using mesh. This was done in a running fashion with 0 Prolene suture in both supraumbilical and infraumbilical fashion. This was then further buttressed with additional interrupted figure-of-eight Ethibond sutures. The abdomen was once again irrigated. Hemostasis had been maintained. I then allowed the abdominal flaps to resume a natural position. The abdomen was slightly flexed to permit closure at the previous area of the superior umbilicus. I then marked this and the bilateral lower aspect of the pannus was then sharply excised followed by electrocautery. This was then passed off as a gross specimen. I then began by elevating the mons with a Vicryl suture secured to the anterior fascia, elevating the mons to help prevent any skin irritation in the groin crease area. Once this was completed, a single Prolene suture was then placed in the midline reapproximating the superior flap in the area of the mons. I then proceeded with placing 2 Jackson-Pratt drains. These were placed through the upper central portion of the mons and crisscrossed to both the left and right flank area. These were then secured with 2-0 silk sutures. I then tailor-tacked the remained of the abdominal skin with surgical staples. I then proceeded by closing in 2 layers with 2.0 Vicryl suture of the deep fascia, the superior fascia and anteverted dermis. This was then run with 3-0 Monocryl suture. At the area of the umbilicus, this was marked in an oblique opening that was then cut in a transverse fashion. This was then taken through skin, subcutaneous tissue down to the underlying umbilicus. This was then able to be easily elevated into the wound. This was then reapproximated with 3-0 Vicryl followed by 4-0 Moncryl suture leaving no tension. The umbilical skin was noted to be viable. The remainder of the abdomen otherwise looked good and was closed in a relatively tension-free manner. The abdomen was then once again cleansed off followed by placement of Prineo, 4 x 4s and Tegaderm dressing. The Jackson-Pratts were covered with a Biopatch followed by 4 x 4s and Tegaderm. An abdominal binder was then placed while the patient was still anesthetized.

The patient tolerated the procedure without difficulty. She was able to be extubated in the operating room, transferred to the recovery room in stable condition. The patient will be admitted overnight to medical-surgical floor for observation and pain control.​

~~~~~~~~~~~~~
Pretty cool - if I could understand all of it. Maybe something like the lower center pic in this graphic - which doesn't show where the hernia was fixed or the skin was cut:

 

[Settledownnow]

He had warned me that I might develop a dog-ear at the back, at either of both ends of the incision, and there is one on the right. He said he could fix it later in his office with a local and a few stitches. I’ll worry about that later, if it doesn’t go away by itself.

https://www.realself.com/question/dog-ears-when-referring-result-surgery

Ugh, I have a dog ear from my ventral hernia surgery. My surgeon calls this my "third nipple" because of the location. It is getting fixed with plastics.

 

[bearmom]

You look really good, especially at this stage (I had a ton of swelling by all incisions making it look like a blubber roll all around for months).

I also had trouble seeing your pic at first before fidgeting, but will share my surgery pictures story, as I still feel anxiety when I think about it.
The night before skin removal, I wanted pics so I could compare after, so I just had hubby grab the camera, and instead did a video thinking I could take stills from it later. While I was turning in a circle, and jabbering to the camera, I was also making fun of how unflattered some of the "handling" is by the plastic surgeon during the evaluation (like when they just grab a handful of whatever is floppy, and stretch it out like a bald flying squirrel skin) and emulating that, making undoubedly the grossest, unsexiest video ever made. I capped it off with extra jiggles, and slapping my ass. We agreed that after I took my stills from it, it needed to be burned.

As fate would have it, that camera was stolen from my bag at the airport, with the card in it. I was horrified, but now just hope that the thief's retinas are permanently damaged.

 

[DianaCox]

Oh man - I can only imagine how that felt to lose the camera and card!!

Had another checkup appointment yesterday to get last stitches out, except the stitch that’s sticking out the top of my belly button which he said was the end of a running stitch around the belly button - I wouldn’t want that to come undone! I still have two places that are not healed - my belly button which is still a bit goopy, and the central part of the incision where my old belly button meets the mons, which had a scab on it that was not fully healed. He said I’m still a bit swollen, though it looks fine to me.

 

[DianaCox]

Took pix after my shower (even after 10+ min, the binder marks (imprinting my underwear and high-top stretchy pants) are still showing on my skin - I guess I'm a bit more swollen than I feel):

 

[southernlady]

You're looking good. Keep healing.

 

[DianaCox]

Those pix are too big! So here's the cropped before pic, now that I've figured out how to do it. I can't believe the top of my former belly button is now at the top of my pubes - how could it stretch that far??

 

[galaxygrrl]

Thank you so much for sharing these. And you look super! So, inspirational.

So, I have a couple questions. Will your old belly button disappear? And did you go down a size?

 

[DianaCox]

Most of my old belly button (well, the skin around it) was removed with the swath of redundant skin. The stalk and top of my belly button was pulled through a cut made in the skin that was pulled down.

I have no idea if I’ve gone down a size because I’ve mostly been wearing stretchy pants for a long time. Plus I’m supposedly still swollen.

I still weigh 172 so probably not. But my waist is smaller.

 

[Munchkin]

1) I’m an adhesion and keloid former - I didn’t want the risk of pain from mesh repair, which can cause all kinds of adhesions.

2) I’ve had multiple abdominal surgeries - odds of having a bowel obstruction higher, and didn’t want mesh in the way, especially of a lap surgery.

3) This was an incisional hernia from a lap port near the midline, probably caused by exercise, and tore into my prior umbilical hernia repair; I have at least 12 lap port holes, an extended hemicircumfertial incision around my old belly button from my DS and the prior umbilical hernia repair, a prior C-section and prior open salpingo-oophorectomy; I was of course formerly morbidly obese and had two full-term pregnancies with large-ish babies, so I had significant diastasis; therefore, doing muscle plication would buttress my abdominal muscles with an internal corset, which should help prevent future hernias.

4) And because of the above, I could leverage a good cosmetic result, including the panniculectomy, which insurance approved without balking.

Since I had to get the hernia fixed anyway, I wanted to finally get my excess skin and diastasis fixed at the same time. One surgery, one recovery, albeit a bit harder. So I pushed to get the plication deemed medically necessary. They denied at first, but then approved.

By the way, I saw the EoB today.
Provider charged: almost $86K
Allowed amount: almost $20K
Insurance paid: almost $19K
Two nights in the hospital @$500/night: $1000 copay.

^^^^^Fear of THIS is why I still have a hernia. OMG! But you look wonderful! Glad you are getting the scar strips.

 

[Pattycake813]

You look amazing! I imagine it feels good (even though you’re sore) to have everything tightened back up a bit. AND to get it covered by insurance. You’re a rock star Diana

 

[galaxygrrl]

DianaCox How are you doing. I'm wondering how is recovery going? Are you feeling better yet? Happy with the results so far? And how painful was the tummy tuck.

I really want one. I'm just trying to engage the recovery time.

You look awesome by the way.

Thanks