Question:
Abdominoplasty and BR, when still 200 +???

Ok I have been approved by the insurance company for a breast reduction and abdominoplasty.However I am kicking out an extra 4 grand because the PS said that the abdominoplasty just covers the removal of skin, not the tightening of muscles and lifting of the pubic area and such and he will only complete the abdominoplasty if everyhting is done because he does not like just the results of the abdominoplasty. Also I am wondering what exactly is a lower body lift and should i try and get the insurance company to approve that also? I started at 388 and am down to 235 -I want to lose this last 40-50lbs and am going to try and get as much off as possible before my abdominoplasty which I tink i'm going to schedule for the second week in may? Am I giving myself enough time and has anyone out there found that even when they were in the 200's and had their stomachs done and flattened they were happy with the size that they were? And even if i decide to lose more weight after the abdominoplasty will my skin sag again? BTW I'm 5'6 235 wanting to get to 200 be4 surgery? Any thoughts. advice,etc???    — TotallyTori (posted on February 23, 2005)

February 23, 2005
For the best results, you would want to be within 20 pounds of your goal weight before having plastic surgery. If you have surgery and then lose 40 pounds, you will have some excess skin but no where NEAR what you currently have.
   — Patty H.

February 23, 2005
I was in virtually the identical situation, 5'6" down from 475 to 235 when I had my abdominoplasty, third attempt at hernia repair and brachioplasty (upper arm skin removal). With the exception of the hernia repair (the hernia has since recurred)I've been very pleased with the results. I'm still in the 220's and struggling to lose but a lot of my weight is in my lower legs and thighs and butt, notoriously difficult spots. But I looove the way my torso looks! After having that huge belly most of my life, to have this tight, flat tummy that salesgirls half my age have remarked at has made as big a difference in my self-esteem as the original bypass. Go for it. Even if you do lose more weight, or even after the swelling goes down, and there is a little "looseness" to the area it doesn't compare to dragging around a hideous abdominal apron.
   — Anna S.

February 23, 2005
wait; and also get a new PS later. The pubis should be free and as far as muscles that YOUR decision. I was over 45 and didnt care to have it. Also if you loose another 40 -50 it will GREATLY affect how the skin is. MOST surgeons want your weight stable and have you STOPPED loosing before doing this surgery.
   — star .

February 23, 2005
If you are still losing weight you should hold off until you are somewhat stable.
   — SJP

February 23, 2005
Sounds to me like your surgeon did not submit for approval correctly. He should have submitted with an andominoplasty code and not a panniculectomy code. The abdominoplasty will pay out higher and therefore cover the work of the muscle tightening and usually some mons pubis work. I had a full extended abdominoplasty as part of a LBL and insurance covered that portion. They said the lateral thigh portion was cosmetic, so I paid for that. I do not see where it should be an additional $4000 for the muscle tightening and pubis work. Seems quite high to me. <p>As far as your weight you will likely have a chunk of skin removed that could weigh quite a bit. I had 19 lbs removed with the LBL. My goal weight was 200 lbs and I went into surgery at 217 and theoretically came out of surgery at 198, but it took 2 months for the scale to reflect it due to the swelling etc. If your goal weight is like 180, then I would not do PS at 235. You could do it at about 210 and most likely be happy with the results long term. What I have found is that the weight floating up and down a few lbs is not a huge issue. For me it is the quality of skin I have left. It tends to sag some all on it's own because it is so severely stretchmarked and has been for about 30+ years. In your case being so young you have a much better chance of having tighter skin and no sag even with as much as a 20 lbs loss. I know most people believe you should have stable weight for a while before PS but I didn't follow that rule and I do not regret it. I lost 9 lbs the 10 days before surgery, which I was trying to do. I had been losing an average of 20 lbs a month for the first 20 months and then somewhat slower before the PS, but I never got down to the 2-3 lbs a month, but then again I wasn't willing to wait for that. I was not trying to get into a 4 or 6 or even an 8. So there was no need to lose anymore. I was afraid if I kept waiting I would get lower than I really wanted to. I am pretty much skin and bones from the gut up now. I could stand to lose another 20 lbs but only in the legs and I haven't figured out yet how to do that. I could not stand to lose another 20 lbs all over my body and be comfortable in my body. I have never been a small person and 12's is about where I am happy at. My rib cage has no fat on it and if it's a fitted jacket I wear a 14. No amount of weight loss will change that. The ribs aren't going to shrink. So trying to get smaller will look horrible on me. Like I said, smaller legs would be nice but not much hope there. I've already had leg surgery which removed the hanging skin on the inside but I still have significant volume to my legs. I do need the lateral thigh and butt lift redone and hope to have that this fall. My surgeon is doing it for next to nothing, bless his sole. He's been very helpful financial wise with revision work. When you had as much to remove as I did, some revision work is inevitable. <p>Be careful of getting yourself run down by trying to lose 35 lbs before surgery. Recovery is hard on your body and you need to be in top notch condition. Here is the address of my PS pics if you care to see them. Good Luck! <p>http://pg.photos.yahoo.com/ph/zoedogcbr/album?.dir=dea0&.src=ph&store=&prodid=&.done=http%3a//photos.yahoo.com/ph//my_photos
   — zoedogcbr

February 27, 2005
Hi. Lose your weight and get stable first. Youe WLS doc should help decide what is your stable weight. As for the surgery costs, all patients will have out-of-pocket expenses for plastic surgery. Code 15831 is "removal of excess skin." That procedure takes about 45 minutes and looks awful. It is NOT a real abdominoplasty. As a plastic surgeon, I refuse to do just skin removal. To look right, many other procedures have to be done and insurance does not even have (and never will have) codes for these "cosmetic" things.
   — DrL