Plastic Surgery Consult Appointment notes from Yesterday, July 29 2013

Here are my notes I took from my plastic surgery consult appointment yesterday. Sorry so long, I had lots of questions!
Plastic Surgeon Consultation 7/29/13 3-4:15pm

Plastic surgery prices: This is the list of prices for the procedures at the Bari Plastics program in my town if you are a WLS patient and have been referred to that program
Bilateral Mastopexy (2 breast lifts) $6692
Bilateral Augmentation Mammoplasty/Mastopexy with implants $12,098
Bilateral Augmentation Mamoplasty with implants $6566
Barchioplasty (Bilateral Arms) $6232
Body Contouring:
Abdomnioplasty: $8052
Thigh lift: $6892
Hip/buttock lift: $6292
Mini face lift $6327
Full face lift $9389
The price includes the surgery fees for the surgeon, anesthesia and hospital charges (including 23 hour observation stay if needed). If a hospital stay is longer than 23 hours there is an additional $450 charge per night for this.

How many times have you done plastic surgery on former WLS patients?-10-15 people a year
How many years?-11 plus years

Ask to see before/after pics of patients of my size/frame that lost the amount of weight I have to see results?
Go to Springfield Clinic of Plastic Surgery to see pics. 

How long should I wait till I have first procedure?-As long as I am at my weight I am happy with and have maintained that weight for 3 months plastic surgery can be done now.

Does abdominoplasty include paniculumectomy?-Yes

Panniculectomy vs tummy tuck vs. fleur de lis Tummy Tuck what is the difference and do they offer all these here?-Yes all offered here but tummy tuck or fleur de lis Tummy Tuck would be best for me. Dr. thinks the fleur de lis might be done for better results. Might do a circumferential tummy lift.

What is the difference between a Bilateral Mastopexy (2 breast lifts) $6692 Just a lift
Bilateral Agumentation Mammoplasty/Mastopexy with implants $12,098 Lift with Implants
Bilateral Augmentation Mamoplasty with implants $6566 Implants only, no lift
He thinks I need both, would do lift first and later do the implants. 

Complications and rate of complications?-Not a smooth incision line when healed, Unfavorable scaring, fluid collection, wound opening up, dog ears-These don’t happen a lot but can happen. It won’t be perfect, they try to make it look perfect but there will still be unsmooth lines with the scaring.

Proposed results? Where would incisions be on these procedures?-upper arm-This could be done in combo first surgery since it bothers me the most. Incision would be in inner arm. Would be able to take all loose skin off from under armpit to right at elbow area.

Boobs-This could be done with upper arm surgery in combo surgery. Would just do a breast lift now and do implants later.  Incision might be above breast or at nipple and down the center of breast.
Tummy- fleur de lis Tummy Tuck might be best for me or he could do just tummy tuck but would make sure to tighten up ab muscles under tummy or he might do a circumferential tummy lift.   Part of surgery combo 2 with hip butt lift.  If does a circumferential tummy lift would also lift upper back area too. Incision would be on bikini line and possible an incision up and down too if fleur de lis was done.
hip/butt-Butt would still be flat but wouldn’t be wrinkled would be done with surgery combo with tummy surgery.  This would also help with loose skin around lower back area by waist line also.  Incision would be along waist line.
upper thighs-Incision would be at leg line would be part of surgery combo 3 with breast implant surgery. 
Implants-Would be done separately from breast lift and part of surgery combo 3 with upper thigh surgery. Incision would be along nipple and down center of breast

Will you need liposuction in addition to the skin tightening? Surgeon didn’t think it would help me any so no lipo would be done.  It usually doesn’t last that long is why he doesn’t see at as doing it on me.

Drains how many/how long in?
upper arms-2 in each arm/1-2 weeks left in
boobs-no drains for lift or implant surgeries
tummy-2 drains/1-2 weeks left in
upper thighs-2 drains in each leg/1-2 weeks left in
 hip/butt-Forgot to ask but probably 2 drains and left in 1-2 weeks

Recovery time? I have a desk job how much time would I have to take off for diff procedures?
Boobs,  tummy, upper thighs, hip/butt-Since I have a desk job probably 2 ½ weeks. Have surgery on a Wed and then go back to work in 2 ½ weeks.

Is a pain ball an option for post-op pain? No not usually with his practice or at Memorial Hospital

How many lbs of skin does he think he can remove?-Not as much as you would think, maybe a total of 5 pounds if all procedures were done. Tummy 3 lbs, Back 1 lb, arms 2 lbs, just estimation.

Does he recommend compression garments? If so, do they provide them to you in cost work up or do you have to pay for them?  Special wraps/binders/Vest/sleeves are given to the person after surgery is done and you were those home and keep wearing them and are part of the cost work out.   Eventually he would send me to Macy to buy Spanx or that type of compression garments to wear for 6-8 weeks after different areas of surgery that I would have to purchase on my own.
Very important question is to ask about revisions. Sometimes things don't go as planned and you may need a revision-ask if it's covered by him/her or if you'll have to pay. What if I lose weight after Plastics will revision need to be done? How often do revisions occur with your patients?  If revision is done he usually will do it when he is doing another combo surgery of mine. Sometimes an additional cost but it depends.  Revisions sometimes happen. Depends on the person and their skin and how it heals up.

Lifting restrictions/working out restrictions, how long?-6-8 weeks for most surgeries.  Walking can begin right away but weight lifting and stuff like that has to wait till 8 weeks.  Water exercise could start in 3 weeks depending on the activity level.
I have a hernia that needs repaired could this be done at same time and save money if my insurance would pay for that part of it?-Yes it could either Hammer/Icazza could do it or even he could do it when the tummy area is worked on.

How do they go about that with the bill? -My insurance would be billed surgeons time on the bill that would go to my insurance co.

Does your office take care credit?-No
financing options?-At this time, none but they are working on some.  He doesn’t know what Memorial Bari Plastics programs offers for financing options so I would need to call them to see if they have any.

Is excess skin donated to Memorial Burn Unit?  Discounted cost for this?-No, they use cadaver skin. No most hospitals don’t do this anymore. No discounts either.

23 hour observation stay also included in cost so do you usually go in and stay overnight or come in early in the morning have surgery and leave that night?-The observation stay time doesn’t start till after the surgery has occurred and you are admitted to the hospital

Can your office check to see if my insurance would cover any plastic procedures?  I have tried to look it up but gotten no luck since it’s a new insurance is why I ask. -In his experience, most if not all insurance companies will not cover these procedures I am thinking about because it is cosmetic type surgery with no medical advantage to having them done.

Lab work, EKG, Chest xray are all include in Memorial Bari Plastics Quotes also so price is all inclusive unless have to stay longer in hospital.

Complications and costs-many times they have been able to get the person health insurance to pay for the cost of bills if complications.   He said to not quote him on this but usually they can get insurance to pay for this. 

Surgery 1:
Bilateral Mastopexy (2 breast lifts)       $6692
Barchioplasty (Bilateral Arms)              $6232
Estimated cost total                               $12,924

Surgery 2:
Abdomnioplasty                                    $8052
Hip/buttock lift                                       $6292
Estimated cost total                              $14,344

Surgery 3:
Thigh lift                                                                    $6892
Bilateral Augmentation Mamoplasty with implants   $6566
Estimated cost total                                                  $13,458

Total cost of all surgeries                   $40,726

After reading over my notes a few times I am now leaning on having upper arms done and tummy done first if possible in one combo surgery.  My upper arms bother me the most and then my tummy. A bra will always hold the saggy boobs up and clothes cover my saggy, wrinkled butt and saggy upper thighs.  If I was to only be able to do/afford one surgery I would do arms and tummy and then go from there if I ever could afford more procedures in the future.
I am waiting to hear from Bari Plastics group for "firm" prices since the above are just estimates. I will also ask if they could do arms/tummy combo as first one. Was looking at my work calendar and I could take off Dec 18-Jan 1 to be 2 1/2 weeks off and use vacation time and we are closed at my office for some holidays during that period also.   I need to figure out where the $$ is gonna come from also.  Must pay 10% down to get a surgery date and then rest is all due 2 weeks before surgery date. 

Hi - It is great that you are doing so much resear*****hoosing your surgeon. Bravo! I just wanted to share a few thoughts with you for your consideration. I, too, have been looking into these surgeries extensively and I have interviewed a few really good bariatric plastic surgeons in-depth and they have taught me much. I am trying to be helpful to other patients by sharing what I have learned with them. That said, I strongly feel it is your body and your decision and I support you in making that decision for yourself once you are fully informed. So, here is what I have learned...  

This is an important consideration: These surgeons do not have a great deal of experience with WLS patients; in my opinion 10-15/yr is not much. These procedures can be achieved in two surgeries by a more experienced bariatric plastic surgeon in my opinion. Finally, the prices seem high. BTW, It looks like you have the breast lift quoted twice - once in surgery 1 and then again in surgery 3??? 

The surgeon that I use, Dr. Capella, is doing similar work on me and can do it in two surgeries versus three. Plus his price is significantly less expensive. He also uses CareCredit. 

What is more, he does the best body work that I have ever seen. 

It doesn't hurt to give him a call... and the consult is free. 

Good luck in your transformation! I am super excited to complete my journey!

I am just in the researching of surgeons right now. This plastic surgery group is the one that my WLS group refers people to through their bari plastics program due to them having the most experience with WLS people in my city.  There aren't alot of plastic surgeon groups in my town and frankly if I have anything done I won't be going out of state to have it done or even a different city in IL cause I don't want to drive while hurting or stuff like that after the surgery.  The Price is for everything, surgeon fees, hospital fees, labs, ekg's , chest xrays, all fees are included in that price.  One is a breast lift and then the breast implant would be done separately at another time. He said he could do both at the same time but I would have better results if I had the lift first and the implant later.  They don't like to combo more than 2 types of surgeries together since they don't want you knocked out for more than 5-6 hours total.   

I think your Dr is on East Coast, I live in Central IL and I don't think it would be wise to travel 1/2 across the country for surgery.  Thanks for the information.

I am in Indianapolis and I am comfortable traveling back to NJ for the surgeries. That's just me. I know some people are comfortable going to Mexico; I am not. We each have different priorities and comfort levels of what we are willing to endure.

Ideally, I would like to be located in the same state - no doubt about it. But - for me - having the best surgeon I can afford is my highest priority. I have wanted Dr. Capella to do my surgery since 2006 when I first consulted with him. As I've already gone through so much research/interviews of surgeons, I do not want to start all over simply because I did move out of NJ (one week after my tummy tuck with Dr. Capella), when I already have a surgeon that I trust and respect. I have been examined by a few surgeons here in Indy and had bad experiences. And I did a virtual consult with a very good surgeon in Houston but he was significantly more expensive and did not perform the surgery in a hospital (which is important to me).

I think that you will know the right surgeon when you find him/her. Good luck to you on your exploration! 

The prices are not great and the before/afters are not great, either. The breast pictures are horrible, in my not so humble opinion. I think you should consider traveling for better results. Surely there is a city close by with better surgeons. I know several people who traveled from overseas to use my surgeon. This is the rest of your life you are talking about. A little travel now would be worth it.

I know going out of country isn't for everyone but, Dr Sauceda works on 70-80 a year, most of those are multiple procedures to get everything done at one time.  His inclusive price includes 2 compression garments, 12 day stay in the Hampton Inn and a 24/7 clinic and if your cost is over 7k, up to $600 off on your airfare.  The nursing care is fantastic.  There are 3 or 4 ladies down in Monterrey now. 

You can click on Dr Sauceda in my siggy line and it'll take you to his group here on OH.  His results are great.

Seeing all this makes me super grateful for Dr. Sauceda being skilled enough and able to do all the procedures at once. i couldnt do 3 seperate recoveries - yikes!

Did you ask if he had a medical/professional reason for doing the lift and implants separately? I mean..if they are cutting it open, why not do it al at the same time? Seems like a money seeking move to me...but Im nothing close to a dr or expert. Id never go with a doc that wanted to cut my boobies twice!