Having Circumferential Panniculectomy (LBL) next week
ANEWMii
on 4/23/10 4:07 am - Phoenix, AZ
on 4/23/10 4:07 am - Phoenix, AZ
I'm 3 weeks 3 days post op from a lower body lift with muscle tightening. I'd be happy to answer any questions. Feel free to pm me.
Sandi
I'm a whole new Mii! From 273+lbs to 145lbs. and a whole new life!!!
Lost through diet and exercise 
( Praise God and thanks Wii Fit! )
Body by God and Dr. Mazaheri!!!!
1st PS 3/30/10 - LBL/Brachio done by the wonderful Dr. Mazaheri
2nd PS 6/1/10 - BL/Thoracoplasty/Full TL of course with Dr. Mazaheri
Thank you God! I will always be grateful for the change you have made in me! All glory is Yours!
Aloha - This is LONG......
I am 12 weeks out from my circumferential belt lipectomy ( CBL) , breast lift and augmentation ( BL/BA). My surgeon was one who speaks to our WLS group annually ( after interviewing him and 2 others) and is one of the few who does the CBL, and who would do all the procedures at once provided I was in excellent shape. Some of his advice is a little too late for you, but others reading this might benefit so I'm including it.
Long term preparation- (months)-- most PSs want to see you at goal or stable for 6-9 months prior to plastics. Even though your weight may not change once you hit goal, your body composition will change as you continue to work out, and you will (hopefully) build muscle and give your skin a chance to undergo some "shrinkage". Because your skin continues to adjust for months after you reach goal, doing surgery too early may result in having to do a revision later to remove more skin. Also, if you are building muscle, you might not need to do certain procedures that you thought you'd absolutely have to do- like arms. I'm not doing mine anymore since I got great results from lifting weights ( and I had so much extra flesh that I could crack it like a whip and make a snapping noise- the kids called it my "floosh"). The other advantage to building more mucsle ( and losing more subcutaneous fat) is that your healing time is shortened- you have protein stores ( ie muscle) to draw upon for healing even if you don't feel like getting all your protein in, and you are more flexible/strong post op, so it's easier to get up and walk, stretch, use the toilet, get off the couch or out of the car- everything is easier if you are in good shape. Also, no subcutaneous fat means there is nothing weighing down or tugging on your fresh incision- and that's one of the biggest issues with a CBL, that 360` tension on your incision that can cause delayed healing.
Not everyone does this, but I was grateful for the hundreds of squats in all my workouts prior to this surgery- you can't depend on your surgicated core and abdomen to do things like get out of the car, get off the toilet, get off the couch- so strength in your legs makes a huge difference in your mobility post op.
Shorter term preparation ( weeks) - we were told to avoid multivites with Vit E ( can cause clotting problems) and certain meds ( like NSAIDs) for weeks prior to surgery. The more you bleed at time of surgery, the longer you're under anesthesia, and some bleed so much as to require transfusions- a CBL is no minor surgery. I also upped my protein from 100 g/day minimum to at least 125 g/day - I had plenty of muscle built up from workouts but you absolutely must have protein to heal. I will continue to get at least that much in for 6 months post op.
I also did things like :
-move stuff from higher and lower shelves to middle cabinets ( reaching up and down is a little tough the first week or so)
-move my stuff from upstairs to downstairs ( you can use stairs no problem but they'd rather you be assisted on them the first few days). This is also the easiest toilet in my house to use- it's taller, and adjacent to a counter so if you need to pull or push yourself up, you can.
-shopped for everything I needed a few weeks ahead of time- medical supplies like antiseptic soap ( Hibiclens or ther chlorhexidine soap), triple antibiotic ointment, sterile gauze sponges and paper surgical tape, gloves for changing dressings or evacuating drains, chapstick and cough drops ( nothing worse than coughing post CBL, unless it's LAUGHING!). I also loaded up on my favorite protein shakes as I knew I wouldn't feel like eating much, and didn't want to get caught without my favorite flavor.
-filled my prescriptions for pain meds and antibiotics, and also my monthly meds like thyroid, so I wouldn't have to do it post op (you aren't approved for driving til you can move comfortably and be off narcotics)
-got my hair cut and colored, pedicure, etc- stuff I wasn't going to care about for the next 6-8 weeks
-gathered some samples for scar reduction products ( I used one called KeloCote that my suregeon recommended.... but he said I was healing so well, it wasn't going to make a difference- get that protein in!)
http://www.amazon.com/Kelo-2dcote-Advanced-Formula-Scar-Gel/ dp/B00022AUOC
I also purchased TemperPedic pillows in recommended shapes ( a large triangle to lean/sleep against, a smaller triangle for under your knees, and a neck pillow). If you have a recliner, you can use that ( remember your body will be in a W-like shape to heal- legs slightly bent and sleeping inclined on your back- for many weeks post op). I felt this was more portable than a recliner as I was setting up my recovery downstairs by the TV/kitchen. When I was done with my pillows, both my kids had their wisdom teeth out and used the same set up for recovery, and now my friend who had a double mastectomy last week is using the set for her recovery- I am definitely recouping my $300 investment and the covers are easily unzipped for washing. The option other than a recliner or body pillows is renting a hospital bed. I did not feel the need for this, but as I said, squats helped me immensely post op and some people need the assistance of a hospital bed. Most do with recliners.
It might be important to have the person helping you recover go to the last pre op appointment with you- for example, if you are going to have drains in, your caregiver might never have seen such a set up before, and not be familiar with emptying them, activating them or what type of drainage to expect, or when to call the doctor and when to head to the ER. I'm a vet, I took care of my own drains since I know about sterile handling, etc- but it would have completely baffled my husband.
Immediately pre op ( days) -took pictures and measurements the night before, packed the camera to document all the ink marks on my body that morning
-pulled out some comfy elastic waist clothing like boxer shorts, sweats, loose tank tops and sweatshirts that zipped up the front - because post op you have drains in and you are swollen , so you might need to go up a size or two in the immediate recovery period. My waist was 2 inches bigger when I got home, but my hips were 2 inches smaller! I was shocked at having to wear some of my clothing from 10 months earlier! Now everything is smaller, but it took about 4 weeks for all the swelling to go down.
My best friend for post op pain was a wonderful gadget called an OnQ Pain Blocker-
http://www.askyoursurgeon.com/onqsolution.php
It's a pressurized sterile system filled with a long acting local anesthetic ( like novacain) that enters your abdominoplasty incision though a catheter ( like one of the drains coming out, but this one puts stuff IN). It takes about 5 days to empty, and it does a phenomenal job of pain relief without constipation or grogginess or dependency issues ( like narcotics) or bleeding issues ( like NSAIDs). Basically keeps your freshly tightened/cut abdomen muscles numb. I loved mine and just wanted them to fill it up again when it was empty- unfortunately, the FDA has not approved it for refilling but man, what a difference it made. Also, people forget about physical pain relief ( instead of just chemical**** packs on my breasts ( I used bags of frozen berries) before I massaged them was the best way to get through that discomfort ( you need to massage them for an hour each day for a month to keep the scar tissue/contracture from making them hard). Forget about this is you are not doing your breasts. My husband and kids gave me daily foot massages- a little nurturing goes a long way, and when your anxiety level is down, pain matters less.
Getting up and moving from the get go helped alot, not only for avoiding blood clots but for easing stiffness. Staying ahead of your pain rather than trying to gut it out is the smart thing to do, as is using multimodal pain relief ( like narcotics plus NSAIDs plus ice plus a local anesthetic) - it decreases the amount of any one pain med alone. Make sure you follow your doctors instructions on OTC and RX meds! I had a notebook where I documented when I last took my pain meds, how much tylenol I took ( you can harm your liver if you are taking OTC tylenol or acetominophen plus a prescription narcotic that includes it as well). I also wrote down measurements for drainage in a 24 hour period from each drain since I had 7 of the suckers, and the doctor wasn't pulling them til they were producing less than 25 cc in a 24-hour period.
OK, I've rattled on enough. The first few days will be the hardest, then it will get easier, and boy oh boy will you be glad you did it. I timed surgery so I would miss a slow time at work, and more importantly be healed for a trip to Cabo over spring break- I got to do everything I wanted from swimming in the ocean to snorkeling to ATV and Jet Ski riding - and I got to do some of them in a 2 piece! Who the heck woulda thunk THAT 2 short years ago???? I did tape my scars with surgical paper tape and sunblocked the heck out of them - no sun on your scars for a year post op- and did not have any problems. Remember- get that protein in no matter what, and good luck to you! Very VERY exciting! XOXOLori
I am 12 weeks out from my circumferential belt lipectomy ( CBL) , breast lift and augmentation ( BL/BA). My surgeon was one who speaks to our WLS group annually ( after interviewing him and 2 others) and is one of the few who does the CBL, and who would do all the procedures at once provided I was in excellent shape. Some of his advice is a little too late for you, but others reading this might benefit so I'm including it.
Long term preparation- (months)-- most PSs want to see you at goal or stable for 6-9 months prior to plastics. Even though your weight may not change once you hit goal, your body composition will change as you continue to work out, and you will (hopefully) build muscle and give your skin a chance to undergo some "shrinkage". Because your skin continues to adjust for months after you reach goal, doing surgery too early may result in having to do a revision later to remove more skin. Also, if you are building muscle, you might not need to do certain procedures that you thought you'd absolutely have to do- like arms. I'm not doing mine anymore since I got great results from lifting weights ( and I had so much extra flesh that I could crack it like a whip and make a snapping noise- the kids called it my "floosh"). The other advantage to building more mucsle ( and losing more subcutaneous fat) is that your healing time is shortened- you have protein stores ( ie muscle) to draw upon for healing even if you don't feel like getting all your protein in, and you are more flexible/strong post op, so it's easier to get up and walk, stretch, use the toilet, get off the couch or out of the car- everything is easier if you are in good shape. Also, no subcutaneous fat means there is nothing weighing down or tugging on your fresh incision- and that's one of the biggest issues with a CBL, that 360` tension on your incision that can cause delayed healing.
Not everyone does this, but I was grateful for the hundreds of squats in all my workouts prior to this surgery- you can't depend on your surgicated core and abdomen to do things like get out of the car, get off the toilet, get off the couch- so strength in your legs makes a huge difference in your mobility post op.
Shorter term preparation ( weeks) - we were told to avoid multivites with Vit E ( can cause clotting problems) and certain meds ( like NSAIDs) for weeks prior to surgery. The more you bleed at time of surgery, the longer you're under anesthesia, and some bleed so much as to require transfusions- a CBL is no minor surgery. I also upped my protein from 100 g/day minimum to at least 125 g/day - I had plenty of muscle built up from workouts but you absolutely must have protein to heal. I will continue to get at least that much in for 6 months post op.
I also did things like :
-move stuff from higher and lower shelves to middle cabinets ( reaching up and down is a little tough the first week or so)
-move my stuff from upstairs to downstairs ( you can use stairs no problem but they'd rather you be assisted on them the first few days). This is also the easiest toilet in my house to use- it's taller, and adjacent to a counter so if you need to pull or push yourself up, you can.
-shopped for everything I needed a few weeks ahead of time- medical supplies like antiseptic soap ( Hibiclens or ther chlorhexidine soap), triple antibiotic ointment, sterile gauze sponges and paper surgical tape, gloves for changing dressings or evacuating drains, chapstick and cough drops ( nothing worse than coughing post CBL, unless it's LAUGHING!). I also loaded up on my favorite protein shakes as I knew I wouldn't feel like eating much, and didn't want to get caught without my favorite flavor.
-filled my prescriptions for pain meds and antibiotics, and also my monthly meds like thyroid, so I wouldn't have to do it post op (you aren't approved for driving til you can move comfortably and be off narcotics)
-got my hair cut and colored, pedicure, etc- stuff I wasn't going to care about for the next 6-8 weeks
-gathered some samples for scar reduction products ( I used one called KeloCote that my suregeon recommended.... but he said I was healing so well, it wasn't going to make a difference- get that protein in!)
http://www.amazon.com/Kelo-2dcote-Advanced-Formula-Scar-Gel/ dp/B00022AUOC
I also purchased TemperPedic pillows in recommended shapes ( a large triangle to lean/sleep against, a smaller triangle for under your knees, and a neck pillow). If you have a recliner, you can use that ( remember your body will be in a W-like shape to heal- legs slightly bent and sleeping inclined on your back- for many weeks post op). I felt this was more portable than a recliner as I was setting up my recovery downstairs by the TV/kitchen. When I was done with my pillows, both my kids had their wisdom teeth out and used the same set up for recovery, and now my friend who had a double mastectomy last week is using the set for her recovery- I am definitely recouping my $300 investment and the covers are easily unzipped for washing. The option other than a recliner or body pillows is renting a hospital bed. I did not feel the need for this, but as I said, squats helped me immensely post op and some people need the assistance of a hospital bed. Most do with recliners.
It might be important to have the person helping you recover go to the last pre op appointment with you- for example, if you are going to have drains in, your caregiver might never have seen such a set up before, and not be familiar with emptying them, activating them or what type of drainage to expect, or when to call the doctor and when to head to the ER. I'm a vet, I took care of my own drains since I know about sterile handling, etc- but it would have completely baffled my husband.
Immediately pre op ( days) -took pictures and measurements the night before, packed the camera to document all the ink marks on my body that morning
-pulled out some comfy elastic waist clothing like boxer shorts, sweats, loose tank tops and sweatshirts that zipped up the front - because post op you have drains in and you are swollen , so you might need to go up a size or two in the immediate recovery period. My waist was 2 inches bigger when I got home, but my hips were 2 inches smaller! I was shocked at having to wear some of my clothing from 10 months earlier! Now everything is smaller, but it took about 4 weeks for all the swelling to go down.
My best friend for post op pain was a wonderful gadget called an OnQ Pain Blocker-
http://www.askyoursurgeon.com/onqsolution.php
It's a pressurized sterile system filled with a long acting local anesthetic ( like novacain) that enters your abdominoplasty incision though a catheter ( like one of the drains coming out, but this one puts stuff IN). It takes about 5 days to empty, and it does a phenomenal job of pain relief without constipation or grogginess or dependency issues ( like narcotics) or bleeding issues ( like NSAIDs). Basically keeps your freshly tightened/cut abdomen muscles numb. I loved mine and just wanted them to fill it up again when it was empty- unfortunately, the FDA has not approved it for refilling but man, what a difference it made. Also, people forget about physical pain relief ( instead of just chemical**** packs on my breasts ( I used bags of frozen berries) before I massaged them was the best way to get through that discomfort ( you need to massage them for an hour each day for a month to keep the scar tissue/contracture from making them hard). Forget about this is you are not doing your breasts. My husband and kids gave me daily foot massages- a little nurturing goes a long way, and when your anxiety level is down, pain matters less.
Getting up and moving from the get go helped alot, not only for avoiding blood clots but for easing stiffness. Staying ahead of your pain rather than trying to gut it out is the smart thing to do, as is using multimodal pain relief ( like narcotics plus NSAIDs plus ice plus a local anesthetic) - it decreases the amount of any one pain med alone. Make sure you follow your doctors instructions on OTC and RX meds! I had a notebook where I documented when I last took my pain meds, how much tylenol I took ( you can harm your liver if you are taking OTC tylenol or acetominophen plus a prescription narcotic that includes it as well). I also wrote down measurements for drainage in a 24 hour period from each drain since I had 7 of the suckers, and the doctor wasn't pulling them til they were producing less than 25 cc in a 24-hour period.
OK, I've rattled on enough. The first few days will be the hardest, then it will get easier, and boy oh boy will you be glad you did it. I timed surgery so I would miss a slow time at work, and more importantly be healed for a trip to Cabo over spring break- I got to do everything I wanted from swimming in the ocean to snorkeling to ATV and Jet Ski riding - and I got to do some of them in a 2 piece! Who the heck woulda thunk THAT 2 short years ago???? I did tape my scars with surgical paper tape and sunblocked the heck out of them - no sun on your scars for a year post op- and did not have any problems. Remember- get that protein in no matter what, and good luck to you! Very VERY exciting! XOXOLori
Sherrie,
Lori gave you such a wealth of important information (especially nutrition), I don't have too much to add.
The first two days were the hardest as far as pain and movement. I didn't have a lot of pain, per se, just discomfort from the muscles being tightened and the lipo. I am not familiar with a "circumferential panniculectomy" so I don't know if this includes the muscle tightening and light lipo usually included in an LBL. I will speak only to the LBL I had.
It is important to remember to walk bent over, "walk like an old man" but with your head looking straight forward. You don't want to attempt to straighten and put stress on your sutures. My nurse told me to make sure you look forward, not down as this will keep you from getting light-headed and that your body will naturally begin to straighten and you'll be walking almost fully erect without even realizing it.
Remember that this is a Major Surgery. My surgeon warns that some go through a period in the beginning thinking "what in God's name did I do to myself" and there may even be a period of depression. If you experience these, IT IS NORMAL and mostly a result of the lengthy anesthesia and shock to your system from the surgery. If it happens, it will pass, and knowing that it is a possibility prepares you for it instead of it hitting you from seemingly nowhere and scaring you. I think I may have had a small bout of depression, but I know I had the what did I do to myself feeling. I had one of my drains in for 30 days and it was weighing on me. I just told myself, "Okay, I knew this could happen and it will all be okay." It was; it passed.
You will likely have 4 drains. It is important to strip them everyday before you empty them as this removes clots and really keeps a good vacuum. Your nurse should show you how to do this. Some people find it easy to use an alcohol swab in your fingers to strip the tubing. Please remember to hold on to the tubing to stabilize it where it exits your body then pull with the other hand. It is not unusual for some serous fluid to leak from the drain site, especially in the first few days.
Wear that binder! Compression is especially important if you've had muscle tightening and lipo as the tissue has been removed from the fascia/disturbed by the cannula and proper compression helps it reattach in the correct position. If you've had lipo, gently massage the area to avoid the tissue becoming hard.
My surgeon had me continue my multi-vitamin as we need some vitamin E, and it had no where near the amount that would thin my blood. He gave me an upper limit (I don't recall off the top of my head--I want to say 100mg, but mine contained only 30mg). Your surgeon or his/her office should tell you what they prefer. I was also placed on additional Vitamin C two weeks before surgery, bromelain three days before surgery and I took bromelain, quercetin and arnica montana for three weeks after the surgery, along with the extra C. The C is for skin health and healing, bromelain and quercetin are to reduce swelling and bruising, and arnica montana is for swelling, pain and bruising. Many surgeons sell these formulations by VitaMedica. Since I have a lap band and can't take big capsules, they directed me to GNC to purchase pills and tablets that I could cut. They also ended up being much lesss expensive. Again, your surgeon will instruct you on what they prefer you take and for how long.
I was in a recliner for about 4 days, then on the sofa in our bedroom for two, finally progressing to the bed. I would have been in it sooner but for the fact that it is high. It's good to have the Tempurpedic pillows. I had the half-neck roll which worked wonders in the recliner. I used small pillows once in the bed to elevate my arms as I was so propped up my arms felt like they were falling behind me. I had pillows under my knees too. Once I started being able to sleep on my side, I had a pillow between my knees, one against my back for support and hugging one in front for support. You'll find what feels best for you. Until I was moving around more often, I kept my TEDS socks on and remembered to exercise my calves and ankles every hour to avoid clotting.
Don't over-exert yourself or lift anything beyond the weight limit your doctor gives you. He has a reason for setting those limits: pulling sutures and messing up that beautiful work. My doc allowed me to walk on a treadmill at two weeks. I was not allowed to lift anything over 5 pounds until then. At five weeks, I was released to go back to working out, "listening to my body."
The final thing I can tell you is this: The surgery changed my life. I feel so much more healthy, confident, physically fit and physically attractive. I am so happy that I made the decision.
Best wishes for your upcoming life-change. Please feel free to PM me if you would like to ask me anything.
Terri
Lori gave you such a wealth of important information (especially nutrition), I don't have too much to add.
The first two days were the hardest as far as pain and movement. I didn't have a lot of pain, per se, just discomfort from the muscles being tightened and the lipo. I am not familiar with a "circumferential panniculectomy" so I don't know if this includes the muscle tightening and light lipo usually included in an LBL. I will speak only to the LBL I had.
It is important to remember to walk bent over, "walk like an old man" but with your head looking straight forward. You don't want to attempt to straighten and put stress on your sutures. My nurse told me to make sure you look forward, not down as this will keep you from getting light-headed and that your body will naturally begin to straighten and you'll be walking almost fully erect without even realizing it.
Remember that this is a Major Surgery. My surgeon warns that some go through a period in the beginning thinking "what in God's name did I do to myself" and there may even be a period of depression. If you experience these, IT IS NORMAL and mostly a result of the lengthy anesthesia and shock to your system from the surgery. If it happens, it will pass, and knowing that it is a possibility prepares you for it instead of it hitting you from seemingly nowhere and scaring you. I think I may have had a small bout of depression, but I know I had the what did I do to myself feeling. I had one of my drains in for 30 days and it was weighing on me. I just told myself, "Okay, I knew this could happen and it will all be okay." It was; it passed.
You will likely have 4 drains. It is important to strip them everyday before you empty them as this removes clots and really keeps a good vacuum. Your nurse should show you how to do this. Some people find it easy to use an alcohol swab in your fingers to strip the tubing. Please remember to hold on to the tubing to stabilize it where it exits your body then pull with the other hand. It is not unusual for some serous fluid to leak from the drain site, especially in the first few days.
Wear that binder! Compression is especially important if you've had muscle tightening and lipo as the tissue has been removed from the fascia/disturbed by the cannula and proper compression helps it reattach in the correct position. If you've had lipo, gently massage the area to avoid the tissue becoming hard.
My surgeon had me continue my multi-vitamin as we need some vitamin E, and it had no where near the amount that would thin my blood. He gave me an upper limit (I don't recall off the top of my head--I want to say 100mg, but mine contained only 30mg). Your surgeon or his/her office should tell you what they prefer. I was also placed on additional Vitamin C two weeks before surgery, bromelain three days before surgery and I took bromelain, quercetin and arnica montana for three weeks after the surgery, along with the extra C. The C is for skin health and healing, bromelain and quercetin are to reduce swelling and bruising, and arnica montana is for swelling, pain and bruising. Many surgeons sell these formulations by VitaMedica. Since I have a lap band and can't take big capsules, they directed me to GNC to purchase pills and tablets that I could cut. They also ended up being much lesss expensive. Again, your surgeon will instruct you on what they prefer you take and for how long.
I was in a recliner for about 4 days, then on the sofa in our bedroom for two, finally progressing to the bed. I would have been in it sooner but for the fact that it is high. It's good to have the Tempurpedic pillows. I had the half-neck roll which worked wonders in the recliner. I used small pillows once in the bed to elevate my arms as I was so propped up my arms felt like they were falling behind me. I had pillows under my knees too. Once I started being able to sleep on my side, I had a pillow between my knees, one against my back for support and hugging one in front for support. You'll find what feels best for you. Until I was moving around more often, I kept my TEDS socks on and remembered to exercise my calves and ankles every hour to avoid clotting.
Don't over-exert yourself or lift anything beyond the weight limit your doctor gives you. He has a reason for setting those limits: pulling sutures and messing up that beautiful work. My doc allowed me to walk on a treadmill at two weeks. I was not allowed to lift anything over 5 pounds until then. At five weeks, I was released to go back to working out, "listening to my body."
The final thing I can tell you is this: The surgery changed my life. I feel so much more healthy, confident, physically fit and physically attractive. I am so happy that I made the decision.
Best wishes for your upcoming life-change. Please feel free to PM me if you would like to ask me anything.
Terri
LBL/BL 12/11/09; BL Revision, Quad Bleph 07/16/10. Larry H. Lickstein, M.D., F.A.C.S.
It's not how fast you go, but that you're moving in the right direction!
Most Active
Recent Topics
