Question:
When should I see a surgeon about a tummy tuck?

I will need to have a tummy tuck. I know this because 1. the doctor already told me I would have problems with hanging skin and 2. I had a hanging panni. before surgery so I know it will be worse after I'm done loosing weight. My insurance wouldn't pay for the RNY because of an exclusion so I self paid. They only do reconstructive that is medically necessary. I get skin infections and back pain before surgery and now. So I am trying to prepare for the battle with my insurance now. I am 2 months post op. What I'm wondering is should I see a plastic surgeon now - so that as soon as I'm a year out I can have it done or what can I start doing NOW to make sure they don't do me with the panni. like they did the WLS. I already have been to the doctor twice for a rash under my breasts and stomach. Also, another question. I have either a birth defect or suffered an injury when I was growing up. It caused one of my breasts to be much larger than the other. I know that is normal. But mine is about 2 cup sizes larger, and when I had my children I didn't even get milk in the small one. I am wondering if this is reason enough for a breast lift or to have a breast reduction of the other one. Anyone know the answer, I'd appreciate it.    — [Anonymous] (posted on November 5, 2001)

November 4, 2001
My surgeon recommends that his patients wait 18 months until they pursue reconstructive surgery. Many patients will be fairly close to goal by this time, and the rate of weight loss will have slowed dramatically. If you have the plastic surgery when you still have many pounds to lose, and are still dropping pounds rapidly, you will likely be disappointed later when you realize that you could benefit from further "tightening" in those areas. It's normal to want "the finished product" as soon as possible, but it will be in your best interest to follow the guidelines of your surgeon and plastic surgeon. I am 19 months post-op and have endured looking like a Shar-pei for several months. My insurance providers approved an abdominoplasty and arm lift surgery (brachioplasty) based on chronic back pain, constant yeast infections and irritations in the skin folds (an increased problem with diabetes), and also on the basis of the full frontal and profile pictures submitted by the plastic surgeon. Those terribly flattering pictures told the whole story, I'm sure! My secondary provider approved the surgery without hesitation. My primary denied the surgery initially, but after appealing the decision, I received an approval right away. In the appeals process, I submitted my own two-page letter and included letters of medical necessity from my PCP, bariatric surgeon, and plastic surgeon. I also included a copy of the 1996 Position Paper from the American Society of Plastic Surgeons on the "Treatment of Skin Redundancy Following Massive Weight Loss"... (http://www.plasticsurgery.org/profinfo/pospap/skin.htm) Sorry, I can't help with any information about the breast surgery, but it seems logical that you could appeal for reconstruction based on chronic back pain (from the weight of pendulous breasts), skin irritations, and the "emotional distress" caused by the inequality of size. Good luck!
   — Diana T.

November 4, 2001
Since you posted anonymously, I couldn't email you, but I have what is known as Poland Syndrome. My right breast is much much smaller than my left because I am missing my Pectoral Major muscle on my right side. (It is the muscle above your breast and it goes straight to your underarm.) If you would like to email me about this, click on my name and email me. Dawn
   — Dawn H.

November 5, 2001
My plastic surgeon likes to see us at each 1/3 of the weight loss, because he says he can tell a lot about your body as it changes that will help him come surgery time. I am only 7 weeks post-op, but I am down 52 lbs out of 150, so I saw him last week. He took photographs of me naked(ugh) and he said that this will also help with insurance approval. I will see him again at about 100 lbs down and then at goal, whenever that comes, we will schedule my surgery. He also wants to see as many teenage and young adult photos as possible, especially if you were at a normal weight back then as I was. <br><br>As for your breasts, there is probably some biological cause; there's a syndrome whose name I forget where the milk ducts on one side do not develop; if you had that, they should definitely cover reduction/enlargement surgery as reconstructive. Good plastic surgeons are great at working the insurance system to get stuff like that covered. I would ask around to find out who people around you have used because good plastic surgeons are so much better than average ones.<br><br>Good luck with your weight loss and your future surgeries.
   — Julia M.

November 5, 2001
I used the same surgeon as Julia is now seeing. I started looking for a surgeon when I was about two months out, because it was very important to me to find one I was comfortable with. Going so early helped me decide, because I was able to rule out those surgeons who took one look at me--clothed--and said they wouldn't operate for at least another year. Why? Because I knew then that my body type is highly irregular, and I didn't trust any surgeon who did not or would not take that into account. It wasn't the time frame that bothered me so much as the immediate dismissal. Those whom I chose to speak to a second time all took a very close look at me, unclothed (scary!), asked about my history (what I looked like 5, 10, 15 years ago), and gave me information based on that. By the time I was 4 months out, I'd chosen my surgeon; by six months, I had an abdominoplasty. Doing it that early is <i>extremely</i> unusual, but my odd body type allowed for it (of my 100 pound weight loss, easily 85 pounds of it came entirely from my abdomen). Regardless, I am very happy with my choice. I went in well before I knew I was ready for plastics so I'd have the time to make a clear, informed choice.
   — Suzanne B.