Pain with plastics for RNY patients

Only my second time posting here...

My heaviest was 397 and I'm 35.  I cannot see my skin getting any better but I'm trying with weight training...not working though.  I was so big for so long and I'm older so I know this skin is not going to bounce back.
I still am 60 away from goal.  Once I reach that (God willing) I will wait a while and seriously consider plastics.
My worst area IMO is my arms.  I always had bat wings even before WLS but now...they are unslightly, horrific messes.  I want to be able to wear a tank top and not feel terrible.  If there is one PS I am seriously considering, this one is it.
I also don't like the way my butt  and hips have wrinkles...similar to a shar pei dog.  My stomach is terrible and hangs horribly in wrinkles of skin and damage from stretch marks.  I've never had a normal looking belly button...ever.  Looks more like a huge frown.  My thighs look like gigantic deflated balloons.  And my boobs...they are not symetrical (almost a half to a cup difference) and they look like small lemons in tube socks.  I think shoved into a bra they make up a B cup.

So, now that I've run all that down to you.  I have questions.
1- How painful were each of the surgeries I'd be looking at? (upper arms, boobs, entire tummy/butt, thighs)  I do not have a high tolerance to pain.
2- What pain meds did they give you and were you able to tolerate them with an RNY?
3- How long is recovery...low long until you feel semi-normal again?
4- What surgeries could I piggyback together safely?
5- With the "rash claim" how many do you think I could realistically get covered under Medicare insurance?
6- Any good docs in the Delaware, Pennsylvania, New Jersey, Maryland (New Castle County or Delaware County) states you can refer me to?
7- Any other information you think I should know?

Thank you for your responses.  This will really help me down the road.  Also, if you have any pics to share from your experiences please friend me so I may see them.

Thanks again!!!

 Hello,

I will try to address your questions but some of them just don't have a definitive answer. Each of us are so individual and have different pain tolerances, etc. There's no set recovery time and it's difficult to give specific answers. Plastics are definitely not a one size fits all category.

1- How painful were each of the surgeries I'd be looking at? (upper arms, boobs, entire tummy/butt, thighs)  I do not have a high tolerance to pain.
You will see some people say that one particular procedure was far worse than another and others say just the opposite. For me it was by far the inner thigh lift. It was challenging and took longer for recovery. I would say that the muscle tightening with my tummy tuck would rank 2nd as most uncomfortable. The question gets asked here a lot about how painful is it. That's such a relative question. Pain for one person might just be an annoyance to another.

2- What pain meds did they give you and were you able to tolerate them with an RNY?
I don't have an RNY. I had the DS but I was given percoset after all of my procedures.

3- How long is recovery...low long until you feel semi-normal again?
Again, this varies widely amongst us. The worst stage is the first week or so. Some people have returned to desk jobs after 2-3 weeks while others need much longer. If complications arise it can throw a kink into the recovery time and process.

4- What surgeries could I piggyback together safely?
You will get different opinions from different surgeons. They all have thier own protocol as to what procedures they prefer to combine.
My stages were like this....1st) Anchor cut extended tummy tuck and Breast Lift and Augmentation.  2nd) Inner thigh lift and brachioplasty with slight revisions to tummy tuck incisions.  3rd) Mid face lift, upper and lower eyelids and neck lift.  4th) Upper flankplasty.
My surgeon prefers to stage the procedures while others will combine it all. It's just a matter of your comfort level and the risks associated with how long you will be under anesthesia.


5- With the "rash claim" how many do you think I could realistically get covered under Medicare insurance?
I was self pay and have no experiences to offer concerning insurance coverage.

6- Any good docs in the Delaware, Pennsylvania, New Jersey, Maryland (New Castle County or Delaware County) states you can refer me to?
I don't have any references to offer. You might want to ask your RNY surgeon if he can refer you to someone. You can also go to www.realself.com and locate surgeons and even ask them questions.

7- Any other information you think I should know?
Take your time and research. Make sure you have a list of questions prepared when you go on consultations. Make sure you choose a surgeon that has extensive experience operating on weight loss surgery patients. Ask if some of his/her patients can contact you personally so that you can ask them questions and get feedback.

I have pictures on my profile if you care to look. Best of luck to you and keep asking questions!

I attend the St. Francis and PMRI support groups and Julia MacRae comes to those meetings and does a talk about plastics.  She and the 2 other surgeons in the practice are right across from Christiana Hospital. Dr. Macrae will be doing my plastics this summer at WIlmington Hospital.  I really like her and she is easy to talk to.

We have agreed to do a couple seperate surgeries instead of a full lower body lift.  I will be doing tummy tuck, inner thigh lift, and outer thigh lipo.  THen in December I will do my outer thigh lift and butt lift.  I am also having my arms done by themselves a few weeks before my first surgery.

- How painful were each of the surgeries I'd be looking at? (upper arms, boobs, entire tummy/butt, thighs)  I do not have a high tolerance to pain. Thus far I have had a breast lift (no implants) and brachioplasty together and then 6 weeks later a LBL.  painwise... I woke up from my LBL thinking oh man what did i do?! (if you look through my recent posts you'll find my recap of the procedure).  Even though I personally think the pain might have been worse from the LBL than with the brachio/BL I feel like I bounced back  and felt overall better post LBL- a lot of this I think has to do with being able to use my arms more- with the brachio the worst part was the limited mobility and stinging armpits.  For the LBL it was the muscle tightening, per my surgeon he really didnt have to do much there at all bc I already had strong abdominal muscles- I'm 3.5 weeks out from my LBL and I only get a muscle twinge every now and then and sneezing can be a little uncomfortable, I still have some discomfort in my hips to- but overall I feel pretty good.  Both were an easier recovery than I had anticipated and pain was manageable with meds.   
2- What pain meds did they give you and were you able to tolerate them with an RNY? I took percocet 5/325 and had no issues tolerating it post RNY.  I was actually given percocet 10/500 for my RNY and never took them; I had to crush pills at that time and i was already so nauseated the crushed percocet was intolerable so I just skipped the pain meds all together and felt like garbage for a good week post-op.  With no pain meds andbeing SMO, I think RNY might have actually been a tougher recovery than plastics; being far more healthy this time around has made a huge difference in my post op progress I'm sure. 
3- How long is recovery...low long until you feel semi-normal again? about 2.5 weeks post LBL wsa the major turning point for me I think- I'm def not 100% yet and am not attempting exercise at this point, but I feel pretty good.  It was probably about the same after my BL/brachio
4- What surgeries could I piggyback together safely? I think this all really depends on the patients individual needs.  After discussing with my surgeon we decided to do breast lift/brachio (jan 18th), LBL (he also did a slight revision of my axillary incision  (march 3rd) and hopefully early may I willdo my inner thigh lipo/lift.  Per my surgeon he did not want to do the inner thighs with any other procedure because this would be the recovery with the greatest risk of complication- it also seems from reading on these boards many others found thighs to be the toughest.  That being said there are some who have dont many procedures together or within a couple days of one another; especially if they traveled out of the country for plastics; I am personally happy I split the procedures up.   
5- With the "rash claim" how many do you think I could realistically get covered under Medicare insurance? I can't answer this but I do think there have been a few posts recently regarding medicare so try scholling back over the past couple months. 
6- Any good docs in the Delaware, Pennsylvania, New Jersey, Maryland (New Castle County or Delaware County) states you can refer me to? I live and had surgery in NYC @ Mt. Sinai I am unfamiliar with other PS but i would reccommend talking to your bariatric surgeon as their might be someone many of his patients in the area have used. 
7- Any other information you think I should know? Best advice I have is to be as physically fit as possible when you have palstice it will make a big difference in your recovery- both cardiovascular and strength training.  work the core muscles and butt/legs. 

Thank you for your responses.  This will really help me down the road.  Also, if you have any pics to share from your experiences please friend me so I may see them.  I'm sending a friend request with the plastics PW

Good Luck!!

Is medicare your only insurance? You might want to look into another insurance if you have that option.

There have been many posts about medicare covering plastics - you can do a search to find them. Here is one where a plastic surgeon who kindly and helpfully posts from time to time medicare insurance

Thank you all for your responses.  I really appreciate all the imput and advice.  Also, yes, Medicare is it for me right at the moment.  I will look into it. 

You guys are great!