Question:
Redo the Tummy Tuck?

I'm 8 weeks post op TT and hernia repair. At my doc appt today the PS said he is not happy with the way my tummy is looking. Me either, I thought the puffiness was swelling. From the belly button down is great looking but over the navel is a "bulge/roll". I also had an issue about an overhang of skin left on one hip. So now the doc is going to write another letter to the INS asking for approval for a revision. So how often does this happen? If this is approved, he's going to pull down the skin and make another new belly button. Says this can be fixed as an outpatient and will take about an hour. I didn't ask if I get the dreaded drains again. Wonder how long I'd be off work. Vacation time is gone.    — jocelyn (posted on September 29, 2004)

September 28, 2004
I was told at 8 weeks I would stil be swollen and to wait at least 3 or 4 months to see the final outcome. I dont know but I would think maybe he didnt cut enough or pull tight enough, and maybe should correct the problem without charge to you or your insurance co. Im curious to find out what your insurance co will do. Didnt he move your belly button the first time? Good luck to you.
   — wizz40

September 28, 2004

   — ELIZABETH C.

September 28, 2004
I went to my surgeon on Monday. I'm haveing the same issue. Ins paid for the belly button down and I paid for the belly button up. He told me that he wants to wait until Dec. and see where we are then. Since I paid cash for the part I'm not happy with there will be no charge for a redu. I hope everything works out for you. Sarah
   — sarah C.

September 28, 2004
You know,I think the insurance company just might have an issue with a revision this soon. You might just check what your policy says. I know mine has an exclusion for that sort of thing - unless it is to correct a functional problem. Hope it works out. I am 2 months post abdominoplasty and I still have a little bulge of skin on one hip. Oddly enough, the bulge on the other hip was worse initially, and now it is flat! (From the sound of it, I doubt you will have drains this time.) I have to agree with another poster to some extent that you shouldn't have to pay for the revision, but on the other hand, I am sure it can't be easy to judge how your abdomen is going to look after the swelling goes away and you are upright, when you are laying on the OR table.
   — koogy

September 29, 2004
I don't know the answer to the insurance question, but I do know that when you are a self-pay, revisions such as the one you describe are often included in the original surgery price (mine was, and my revision will be done in the office without extra charge when the time comes). It's kind of a head-scatcher to me that revisions wouldn't be covered either way, regardless of whether you're a self-pay or not, except for that funny line between medical necessity/reconstructive surgery (covered by insurance) and cosmetic (theoretically not covered by insurance). Yet, if you'd been luckier, and hadn't had a need for a revision, you'd have also enjoyed the cosmetic benefit of your reconstructive surgery. Hmmm. That seems kinda arbitrary to me.
   — Suzy C.

September 29, 2004
This is a common problem when you have a roll of skin above the navel or waist. It is difficult to pull down skin from this far up. Many surgeons will do an anchor incision to get good results. This upper section is usually considered cosmetic only. Insurance may not cover a redu . The surgeon should fix it for minimal or no cost. If you need to have the skin undermined and pulled down, this is not an office procedure. My PS said he would refine my abdomen at no charge but there would be facility and anesthesia fees if I had to be put under. I am having a medial thigh lift in November and he will refine the abdomen then-I have an odd little skin flap around my new navel. I had a LBL and was told that final results would take 3-6 months.
   — dianne E.

September 29, 2004
I had a TT and Breast Lift 5/04, and everything is fantastic EXCEPT for that roll above my belly button! My Dr. told me that it is extra skin that does need to be removed and he'll do it free--except for the fee of anesthesia!! He explained something about if you lift the breast so much then pull the belly down so much not much skin is left(in surgery) but as time passes our skin stretches!! He also said even though he is going to remove it --that doesn't mean the skin won't restretch over time! But I still want to have it done-hey it's free! Although I worry about my new scar..my old one has already faded!! Good Luck in whatever you decide to do!
   — kelley G.

September 29, 2004
Jocelyn: I'm sorry about your results. I too am not thrilled with either my pre rny breast lift/reduction or my post rny tummy tuck. I think it's important for everyone to know that revisions are likely considered cosmetic and won't be covered by insurance. At least that's the information I was given by a second surgeon when I wanted him to do my revision. And even if a doctor does accept responsibility and doesn't charge for a revision, do you think it's likely they will also pay out of pocket for the other charges like hospital time and the anesthesiologist? So hopefully insurance will cover it for you, otherwise you're looking at a big expense even if the doctor doesn't charge, unless you are going to have other things done in the future and combine. To people considering reconstructive surgery, the safest thing to do is get the surgery that is most likely to need a revision first so it can be revised in conjunction with any follow up surgery. I think it's common for people to get the surgery that bothers them the most done first. I stress going with the most likely to have problems because do you really want a surgeon who did a less than perfect job doing follow ups? I'd rather have a revision or touch up done by another surgeon who I have more confidence in. Most surgeons say wait for six months before you decide on needing a revision, and it can take up to a year before all the swelling is gone. My surgeon started out saying wait eight months for final results or before getting a belly button ring etc. When I pressed her on did she really think all that excess skin and swelling would go completely away? She agreed it wasn't likely. I'm now over eight months post TT, and sure enough I have a chunk of extra skin that's still there. So even though it's true at eight weeks you aren't where you'll end up, it's still likely to be obvious if there's a problem that will need addressing. Anyway, those are my thoughts on that matter. I would also like to say for any pre op WLS people that you may think anything would be better than being over weight. But like complication that happen to other people, I don't think you really realize just how odd all the extra skin will look until you have it on you. So a heads up that you need to be prepared for the possibility of not liking the way your body looks even after you lose your weight. Good luck whatever you decide. Sherry
   — sherry hedgecock

September 29, 2004
Just my thoughts, but I think you need another plastic surgeon. Sounds as though he didn't do the best job, that should have been done. I will be 12 months post op from a Breast Reduction/Lift on Nov 17th and a Full TT on April 28th and I'm still tight/flat from the TT. I'm surprised a revision is being discussed this soon after your surgery. Full results take at least 6 months are more with this procedure. Your surgeon wanting to do a revision this quick is a dead giveaway...He messed up! A bulge/roll and overhang of skin on hip... This is why they mark you pre op. All I can say is Good Luck! Please research your surgeons and see pics as a pre op and talk to patients of the surgeon. This is your body and you must explore surgeons with a fine tooth comb and get the very best for the best outcomes! (((HUGS))) Be prepared to pay $$$$$$$$$$$$$$$$$$$$$
   — Hazel S.

September 29, 2004
I forgot to add...I had stomach muscles tightened, also.
   — Hazel S.

September 29, 2004
My guess is insurance will say no because to fix it is truly cosmetic. There is no functional issue with how things are. I have a similar situation, but it is not because my PS did not do a good job to begin with, as someone else indicated. It has to do with the quality of skin I have after being stretched out for almost 30 years beyond repair. He removed tons of stretch marks but there still are tons left. It's just that now the ones that used to be in the back and on the sides are in the front. LOL <p>I had to have the upper roll removed in a separate procedure from my LBL because my waist had never stretched out and there was no way they could pull all that skin down past my waist. So insurance approved it being done in 2 procedures. The lower belly is nice and tight a flat still, after 7 months. Although I had a minor revision done on the area right above the pubic bone when I had my 2nd PS done. It was done at no charge because they were able to bury the time in the charges that went to insurance and the doc did not charge anything for the work. <p>The 2nd PS which removed the roll and huge blobs on my back, under the bra line, was very tight after surgery. However, by about 4 weeks it was starting to sag a little and now, 4 months later is sagged a lot in the front. The back area, where the most skin was removed still looks quite good. That was the area he was most concerned about. I am having my legs done in about 6 weeks and my PS will revise my torso. He plans to do lipo in the back area/waist to provide more shape and then also lipo the roll in the front. He will then take a wedge of skin out again and pull everything back up again and anchor it to my ribs again. However, he said this time he is going to anchor to much deeper tissue and I will likely have a dimple or two under each breast, but it won't be seen without lifting the breasts up. He feels this is the best way to anchor it and get the best long term results. I suspect even with all this being redone, that over time the skin will relax a bit again because of the existing stretchmarks. However, this time he should be able to cut out the large ones that are right under the breasts, which I am hoping will help long term. There just isn't any stability to that tissue. <p>The more you lost and the more your skin was very stretchmarked the greater the chance of not having perfect results. The docs can only work with the quality of skin we give them. Why do you think no burn clinic wants the skin, because it's not real resilient. I intend to wear a long line bra for about 4-6 months this time to help anchor that skin down and keep it from stretching. I wore one about 2 months last time but it obviously wasn't long enough. <p>The last comment I have is that your PS should be redoing the revision work for free, at least his part of it. If it can be done in the office, then totally for free. If it is done in his surgery center, then you should only have to pay for the anesthesiologist. If it is done in an outside clinic or hospital then you would need to cover the hospital and anesthesia charges but that's it. I will be paying for the surgery center and anesthesiologist for the revision. I will also have to pay for the lipo work but the surgeon reduced his fee on the legs to cover the cost of the lipo, so he has gone out of his way to minimize the additional cost to me. It's an extra $1400 but $600 of that is for donating a unit of blood. So I'm getting a lot of work done for only an extra $800. My surgeon is very pleased with the new me that is emerging and he wants to do what he can to help achieve the best possible results. He's obviously in it for more than just the money! <p>P.S. You probably won't get drains again because he's not doing nearly as much work and undermining the skin, which is what causes the pockets. The only drains I had from my 2nd surgery were in the new area done. None of the revision work got drains.
   — zoedogcbr

October 2, 2004
Your problem is not unusual. Getting a nice result in post-WLS skin is very difficult. Just back from an international meeting on the subject...EVERY surgeon there has this issue. Why? The skin has been that way a LONG time in many cases, it is usually stretched WAY beyond what a 9 month pregnancy would cause, and some us feel that the skin has simply lost too much of its elasticity. I too have had sagging of my lifts, and now try and prepare my patients for touch-ups as part of a staged surgery plan. Seeing a second surgeon is a problem for many reasons...it usually results in a lot of negative feelings for the patient, old doc, and new doc. Extra expense too! The "extreme makeovers" on TV that are done in one marathon session and result in everything being fixed at once simply are not the reality for WLS patients. I feel that staged reconstructions with touch-ups are the norm that doctors must explain, and that WLS patients must expect.
   — DrL

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