Need Advice, DS or PS

 (x posted on revision board)    Hi All, I've been coming to OH since about 1999, when I started researching my WLS.  I'm now at a crossroads and I need some opinions.  I'm a big girl.  Almost 6 ft tall, big frame, etc.  At my top weight of 398, I carried it well and people are always shocked that I weighed that much.  I had a RNY in Nov. 2003 with Dr. Dennis Smith in Atlanta, GA.  I almost went with the DS but I knew that I wanted another child and the RNY seemed "safer" at the time, to Dr. Smith and I,  since future  pregnancy was on the table.  Had no problems with the surgery, he is just amazing.  I went from 398 down to 220 and then slowly went back up to about 235.  With my build, I was pretty happy there and stayed stable for 2 years.  I was very healthy and happy where I was.    I got pregnant in 2006, had my son in Spring 2007.   I got up to about 278 with the pregnancy but wasn't stressed, he was healthy,  that is all that mattered.  I've worked my fanny off to lose and have now gotten down to about 255.  I have huge amounts of skin and a very large, heavy pani.  It really strains my back and it getting impossible to deal with.    I came back to OH to start looking at my PS options but now, after reading and researching,  I'm thinking that I may need to think about a revision.  I have large amounts of loose skin, but I also definitely have some fat to deal with that isn't moving with diet and excercise.  I don't know where I should turn.   Should I concentrate on a revision and try to lose another 60-70 pounds or should I get the loose skin and large pani taken care of so that I could excercise more comfortably and get to goal that way?   The fact that I am a big girl and can carry the extra weight well is making the decision tough.  What is my best option?  I would really like to lose more but I have BCBS POS so I'm probably going to be paying out of pocket.  Since I'm not rich, I will have one shot and need to make a wise decision.  What would you do?  A revision?  Go for the PS?    I know that I want Dr. Smith if I choose the revision path.  He is just the best.   Anybody else had to make this decision?   I welcome any and all opinions.  Thanks for reading!!

LauraMom

While Smith is a competent DS surgeon, and I presume RNY surgeon as well, he is NOT, to my knowledge, an RNY-to-DS revision surgeon.  You are going to have to get your advice from someone else.  I would suggest Husted in KY, but his office is currently in utter disarray.  Maybe check out Greenbaum in NJ.

 Thanks Diana.   I've learned that since I wrote the post last night.  I think my problem now is to decide if I should have (some kind) of revision to lose the last bit or go ahead and try and get my skin taken care of so that I have better mobility.  I've been looking at Husted.  Great reputation!!

I had plastics in 2003, a breast reduction and tummy tuck, five years before I had the VSG.  Getting rid of that excess baggage has made my weight loss and recovery sooooo much easier.  If it is a choice of plastics, as uncomfortable as you say you are, or a DS, I'd go with the plastics.  It *would* be possible to lose weight without the DS, but you will never get rid of all that avoirdupois (as my grandmother used to call it, HA!) without surgery.  Best wishes on your decision!      --Dorothy

This is a tough choice, indeed.  

Right now your BMI is close to 35 -- about where you need to be to have insurance cover your procedure if you have co-morbidities (if insurance is a consideration, and if your ins covers revision surgery).  Reconstructive plastic surgery will indeed make you more comfortable, but it will remove sufficient skin that your weight will likely be even lower, making it even more challenging to get insurance coverage for WLS.

I have no idea what the standard of needed weight loss (or "necessary" co-morbidities) is for revision surgery -- please do keep us posted!!!

Good luck no matter which path you choose.

I have not had plastic surgery but if you have more weight to loose, maybe the DS revision would be a better choice for now.  You can still get plastics later.  

My thought is even if you lose more weight you will still have the skin/panni issue.  I know from my experience that having all that extra skin was a discouragement.  It is hard to exercise and well as hard to see that you have been successful with weight loss. 

My other thought would be - how are you eating now.  Can you work on getting back to your RNY rules and if so do you see some pounds come off.

Beside the above comment regarding consulting with an experienced revision surgeon, I would also think that consults with several plastic surgeons would give you and idea of the possible results and would help you decide.

Good Luck!

I'm also wondering if in the interim, prior to PS. maybe try wearing a spanx or other slight compression garment that might help make you a little more comfortable with that panni while doing exercises or walking around.