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[Bethi]

I had my RNY on Halloween 2008 so I am nearly 18 months out and I have lost about 105 lbs. I am weight stable and have been for the last 4 months. I typically bounce between 140 - 145 now.

My heaviest weight was 340 lbs about 15-16 years ago and I was 320 lb when I married my DH in May of 2001. I had both of my kids while I was obese (they are nearly 28 & 29 years old now). I was about 245 when I went into surgery. So I have done a number on my body. Of course the worst areas hit is my middle, the belly and upper thigh area.

I have always been "big". When I was in high school, I was built like a brick house, solid but large. I was about 150 - 175 lbs though HS. So at 5'3", I was obese then. So at nearly 49 years old, I am at my smallest right now.

So here is my dilemma, from a lifetime of being fat I have that ugly flap of skin & fat on my belly & hip area that makes tucking in a shirt impossible. When I look at myself in the mirror, I can see that I am thinner. BUT when I look down at myself, it all looks the same to me as it did before the surgery. It's really mind blowing to look in the mirror and see one thing and look at myself and see something else. In my mind I know it could have been worse and I can live with my arms a bit flabby (I am blessed and do not have the "bat wing" problem, just some minor looseness). And I can live with the upper thighs, I'm too old for mini-skirts and "daisy" dukes anyway  But I don't think I can live with the belly flap. I'm still not comfortable in my own skin!

I am not overly worried about the pain, I have a high tolerance and that's what they made pain meds for. I get very sick from the anesthesia, like throwing up sick - took the hospital three different meds to stop my dry heaves after my RNY (as LoriAnn925 said - not fun throwing up with staples in your belly). But I am more worried about complications that insurance won't cover than anything else.

I am a lucky girl that my husband loves me not the outer package. BUT I truly just don't want him to touch me and when he does, I need to keep a long shirt on to cover myself. My DH is very supportive and has been neutral about a TT, so it's really my choice.

My family (5 out of 6 sisters & father) has already said that there is no reason for me to have a TT. I don't have "enough" extra skin. But what constitutes enough? I am going to be in this body for another 20 years hopefully more, so does what they think is "enough" matter? My youngest sister said I wasn't fat enough for the WLS in the first place. She's also the ONLY one who has not said anything about how I look now (strange, huh) And she is about 20 - 30 lbs overweight (and 15 years younger than me) , but she has not been that heavy her whole life only in the last 4 years. So I feel like I can not tell them about this, with one exception - my sister Kelly in California would not be judgmental. She has been my biggest supporter through this whole process so far. I think that she will understand.

I have an appointment for a consultation for a local surgeon that did a co-workers TT about 3 years ago (and arm lift nearly 2 years ago) on March 16th. That way I will have a concrete cost, not just a guess or based on what someone else paid for the surgery. And I can ask the questions about complications and deaths related to the TT in his experience. And what other advice I need.

I can get the money for a TT from my 401K (loan) but it will add to my already tight budget. Is peace of mind worth it? Is self-esteem worth the $6,000 or so. It's it worth the physical risk? Can my transformation from an obese woman to a "normal" woman be complete without the TT. My emotions, my heart and gut say NO, my brain is not so sure. But I know I'm not getter any younger or any richer, so the time to decide is soon.

[McNee]

First off, I think this is probably as much of a "personal decision" as it is to have WLS (and which type).

going in to this, I don't know that I was even worried or concerned about PS down the line, but 185 pounds and a year + later... well, after doing some push-ups without a shirt on and glancing down... yea... it's in the back of my mind now.

Obviously I can't speak to the pain, the costs, etc... but... "Is peace of mind worth it? Is self-esteem worth the $6,000 or so." I'm gonna hazard a guess and say yes.

Just as WLS makes changes to the body to help us lose weight, it doesn't fix the brain. We need to fix that part on our own in order to make the WLS "worth it".  And for some people... the only way to get that final piece of the puzzle that completes the picture for us physically and mentally is plastic surgery.

And ya know what? There's nothing wrong with that.

[cyndy40]

As Rob said it is very personal choice. Would I like to have my panni removed, my thighs lipoed (sp), my batwings clipped, and my boobage out of saggage?  You bet!  Am I going to do it?  For me, no.  I can't ask my husband and daughter to endure one more surgery with me/for me.  Not only would my insurance not cover anything, I am not willing to put my family on hold for several weeks to months for me to heal and recover. I have decided just to work on the head issues that this presents and move forward.  I have an RNY friend who had a lower body lift.  She emphatically told me not to do this to myself.  But as I said before this is a very personal decision.  God speed in whatever you decide.

[kristopia]

It is a very personal choice, and what Rob said is a great answer.  Will this improve how you feel about yourself and make you less awkward when intimate with your husband?  Can you afford it?  Are you willing to take any surgical risks involved?  If so, go for it. 

[dv8rn]

I had a lap band done in August. I wound up in ICU on a ventilator for a week. My sons (25 and 29) were supportive and encouraged me to have the lap band and terrified that I would not survive it.
I am glad I did it as I am feeling much better now than I did pre-op. Before I was even out of ICU, my insurance company was calling my son and asking about how I was going to pay for the ICU stay. Luckily he told them that it was, in fact a pre-existing problem that caused the complication, or I could have had 10's of thousands of dollars to pay.
I am telling you this because I want you to be prepared. It never occured to me that a complication might not be covered.
You are an adult, you know the risks. You know your family loves you no matter what you do. You are the only one that can weigh the pro's and con's. Whatever you do, you have my support.

[MelsReturn]

I can only speak for myself.  I HAD to have the plastics.  I was at the emotional point where I would have kept on losing weight just to get rid of the "fat" (which was NOT fat but loose skin and a hanging panni).  It was at the point where I was obsessing over it and kept seeing myself as obese because of the panni.  Here is  a link so you can SEE what I am talking about...  http://www.recoveringfatty.com/category/plastic-surgery/ . 

If you can live without being distressed over your body, that's wonderful and you probably don't "need" plastics.  But if you, like myself, become distressed to the point where its really a problem, then I would say it may be worth strongly pursuing but again, this is just my own thoughts from my experience... 

[patti55444]

About 8 years ago I lost 88 lbs. and I was left with a huge pannis resting on my thighs. I so wanted a tummy tuck and went for a consult with a plastic surgeon. He examined me and commented that I truly needed a tummy tuck but he didn't know where to stop as my backside was just as bad. He recommended a total lower body lift which I did end up having.

Fast forward a few years and I had regained all of my weight plus more (of Course). This was so dangerous because my skin was now so thin! The hardest part was I felt like someone had tightened a belt around me and there was no way to loosen it! It was so painful.

I had my RNY and lost all of the weight again plus more and I swear I will NEVER regain it again. The good thing about my loss this time is I didn't have a lot of skin hanging in my midsection anymore. I did however have horrific hanging skin on my arms and in my breasts because when I regained my weight it all went on the upper half of my body bacause the surgeon had removed so many of my fat calls from the lower half. I was before RNY a size 18 on the bottom and a 26 on the top. My bra was a 46 triple D with 2 bra extenders. Ladie's will know what that means.

On December 7th 2009 I had my arms and breasts repaired and it is going to be a good thing someday, right now I'm still healing.

I do want to mention that 1 year after having my lower body lift, I had a tattoo put on the scar, so I have a band of roses around my middle like a belt. I do like this a lot! Every "older" woman should have a tattoo!

I might post a picture of it if there is any interest in seeing it.

Patti

[kristopia]

Me!  Me!  I wanna see the tat

Mel - I'd never seen your plastics pics before - thank you  for sharing the link!

[Bethi]

Well for now I am going to wait to see what the surgeon says.    If the pieces fall together then I would plan for early May for the TT so that I can still enjoy the summer w/o the my panni! Happy Mothers Day to me 

I looked at Mel's pictures (thank you) and even showed them to my DH as the before are similar to what I look like now. He's asked about the risks and I have explained the best I can (he's Deaf and sometimes translation into ASL is difficult) but he knows that I could die in any surgery. So until I see the plastic surgeon, I am just reading people stories and looking at before & after shots, wondering how it might me for me.

Thanks for the input.

[BariJude]

I am a veteran of THREE rounds of plastics –

Nov 2008 Tummy Tuck  (about $7500 total)
Feb 2009 Breast reconstruction & Bat-wing-ectomy (about $13000 total including $1000 for the implants)
Oct 2009 vertical removal of the final pesky roll that couldn't be smoothed out pulling up or down in the previous 2 surgeries. ($2900 total)


For all of these surgeries I took 1 week vacation and worked 1 week from home.  I could have used another week on the second one.


So I’ll give you my long winded 2 cents worth:


Absolutely a personal decision.  However, as with all the RNY horror stories that we all hear (everyone knew someone who knew someone who's aunt died after their RNY)....we hear more about the bad outcomes than the good.  Look at the news tonight.  You'll see stories on all the car crashes but NONE on the totally uneventful trips.

I had good outcomes.  I was incredibly lucky that with some creative savings before and moving some other things, I was able to do a self pay.  I had no hope insurance would pay and since life is short, I took a leap of faith and just did it. Didn’t want to fight insurance for 2 years and then end up having to self pay and wasting that 2 years.   I was also worried about the possibility of a bad outcome requiring additional hospitalization and $$$, but I was in very good health going into it so I took the gamble. 

Am I glad I did it?  Yes.  Would I do it again?  Obviously yes - -I had 3 rounds (though round 2 was quite difficult due to the arms…)  Am I done?  Yes.  Could my derriere use some work?  I suppose, but I don’t spend a lot of time looking at my arse in the mirror so I don’t care and am not even considering it. 

Why did I do it when others said “it’s not that bad” and “others are worse”?  Because it had nothing to do with other people’s perceptions or other people’s outcomes.  I did this for ME.  I wanted to feel comfortable in my own skin (FOR THE FIRST TIME IN MY LIFE) and if that meant I had to have my size 22/24 skin whittled down to actually fit my much smaller size then so be it.  The best example that this was solely for me, was that it literally had not occurred to me until about 4 days before my breast surgery that a difference might be obvious when I went back to work.   

Any regrets?  No.  I wish the scars from the bat-wing-ectomy were a bit shorter and weren’t still so red a year later, but they’re fading pretty good now.  Just taking time.  That’s it.

What did it get out of it?  A contentment that I didn’t know was possible.   Having been heavy as small child, I never knew what it was like to “be okay” with the body I was walking around in.  There are certainly still flaws but the excess skin seemed to be a constant reminder of what I HAD been and prevented me from truly letting go of that and just being what I am now.  As I said in another post –I can still sometimes feel a “phantom” fat roll, but handling the ghost is easier than the real thing. 

Also – just a suggestion to those considering plastics – talk to a few different surgeons.  I interviewed 3 surgeons.  Each had a different perspective on what I “needed” and their costs varied greatly.  I clicked immediately with the third one as he was able to take what I said I wanted, give me some critique to refine it and then we went forward.  The first two seemed more interested in giving me their “standard” and didn’t seem to listen much. 

Good luck on whatever plan you come up with! 

[ttowe]

All great advice from Everyone. Thanks everyone for jumping in.

I'll just add my two cents.

i had a breast lift. Going from a 42GG to a 34D was one of the best decisions I made. I can tell you my decision was made more on "functionality" of my breast then aesthetics, because I too have a husband that is wonderful enough to tell me he loves me no matter what. 

The day my breast "rolled" out of my bra at work....I knew I had to do something.

I have a minor panni....what I mean by that is two kids and 100lbs over weight for years left me "not so good" in the tummy area.  But I can tell you that over time, it's gotten better and I will not seek a tummy tuck. My minor panni looks fine in pants and with somewhat supportive underwear so I don't feel the need for surgery. I only mention this because it took a few years for me to get used to it.

Toni

[patti55444]

Wow BariJude, Great post!

Patti

[abbienormal]

Hey-
I'm in the same boat Toni- I also have a minor panni. I hate the way it looks and would love to be rid of it but I'm still up in the air about another surgery and the cost. The boobs will definately remain sagging and the arms as well. But I would really love to have that tighter belly. My doctor is having a plastics guy come to a support group soon, I'll see what he says.
Abbie

[kiersti]

OK - so I am definitely going to have PS.  It is a matter of figuring out how to pay at this stage and waiting for my loss to stabilize.  At minimum I want t o have my arms done and breasts at the same time if I can.  Might as well get it over with at once if I can. 

And if I am lucky - I will have a tummy tuck too. 

I think in the end my legs and tush will recover enough for me to be OK with them but I have NEVER EVER worn a tank top in public and would really like to have that option. 

This is completely an exercise in vanity, my husband loves me fat, thin, flabby or firm, but I have decided I don't care - I want this. 

Some people are surprised that the first surgery I want and the only one I will insist on is the arms.  But for me this has been a lifetime battle of shame around my weight and I always focused on my too fat arms.  I can't imagine the freedom to put on a tank top or something strapless and feel beautiful.  I want that.

After the arms I'll think about the breasts and tummy....but arms first.  Definitely.

[kristopia]

I'll definitely have PS after reaching goal, if and when I can afford it (will probably go to Mexico again after looking for a good surgeon, just because the cost is so much lower - I'll see about a referral from my Mexican surgeon - Dr. Joya - who did my VSG). 

I will probably have:
Breast lift and tummy tuck
Neck lift

I MIGHT have:
Bat wing removal
Inner thigh skin if it is as loose as I think it might be


But the boob lift, tummy tuck, and neck lift (my neck is getting all wrinkly, and I hope it springs back, but ick) are on my wish list

[Kierie]

Its your decision but if it's goign to make you feel good feel like you do it!

After we have kids I told the hubs I want at least a panniculectomy and a boob lift (not sure about implants I'm still a D!)
 Not feeling comfy in your body isn't sexy

[kristopia]

I won't have implants.  I'll probably be a C cup when I'm at goal (I've gone from a DD to a D so far), and that's good enough for me.  I have a silicone sensitivity, so implants are not my thing

[MacMadame]

I've been thinking about PS off and on. I can really identify with the OP's thoughts. I am not really that big and I look pretty good in street clothes, as long as I wear Spanx and 3-quarter or long sleeves. But...

When I first decided to have WLS, I said "no way I'll have PS. PS is much more dangerous than WLS and I'm already nervous enough about that." I also didn't think I'd have big problems with loose skin. I was only planning to lose 90 pounds and I've been fairly blessed genetically in the skin department. Plus, I'm in my 50s and had two kids so I figure a certain amount of sag goes with the territory.

But then I experienced it! It's so different on this side of the fence.

What drives me the most crazy isn't my panus, which is what I thought would bother me. It's my ARMS. On the one hand, I haven't got big bat wings. My arms actually look better than some people's AFTER arms. OTOH, I have so much loose skin that when my arms are at rest, I have wrinkles like I've been in the water for 5 years. Or maybe like I've got the skin of a 100 year old woman!

Plus, when I run, my arm skin FLAPS around like people's faces when they jump out of planes! I also have a lot of loose skin on the sides of my breasts that flaps over my bra.  It's really hard to hide too. My thighs also jiggle when I swim and also have that "jumping out of an airplane" look.

Then, I seem to have a second rear end under my real rear end. Luckily, I don't look at my butt too often. But when I do, it's all wrinkled and has that second section.

My other big issue is the big flap of skin between my breasts and my belly button. When I bike, it flaps in the wind! Yes, it MAKES A SOUND. And no amount of "sucking in my tummy" sucks it in because it's not fat, it's skin.

The other thing is, I spend a lot of time in exercise clothes. So, while I look good in street clothes, I don't look good in spandex and lycra, especially the stuff with no sleeves. I also spend a lot of time hang out with majorly buff people. I work as hard as they do and I have a low body fat percentage like them, but I look like I could lose 10 pounds because of the skin.

So the bottom line is that I don't look like a normal person and I don't feel like my outsides reflect the true me and -- worse --they minimize my accomplishments.

Which makes getting PS awfully tempting. I think I won't feel "done" until I have it.

However, it's all theoretical because I can't afford it anyway. I'm hoping we'll get our finances in order and I'll be able to afford it next year, but I'm not counting on it.

[Kate]

It seems a lot of people think of plastics in terms of appearance only.  In my case, I have a lot of pain and discomfort, skin infections, and physical restrictions.  I've lost about 100 lbs since my RNY, lost 65 between the time I started blogging and my RNY, and probably another 40 before I started blogging, so in the past three years I've lost probably in the vicinity of 200 lbs.

Right now I've got to pull my thighs out of the toilet before peeing.  I wear a size 34/36H bra, and that's difficult, because my bat wings kinda merge into my breasts (think of a flying squirrel).  Pants are a nightmare, because size and fit depend on how I stuff my skin into them.  I'm having trouble at the gym with some of the machines because the hanging skin gets in the way.  I have headaches and back aches from the distortion of weight on my body.  Even though I bathe twice a day and use anti-fungal powders, my skin is still raw under my breasts and my "skin skirt".

All in all, I'm a lot better off than I was 200 lbs heavier, but the skin issue isn't just a matter of appearance.  Being on Social Security, insurance coverage for my problems is an issue, but at this point it looks like they're ready to begin... at least with the upper body.  I have an appointment with the surgeon at the end of the month.

For some of us, it's more than an appearance issue... it's a medical issue. 

I look forward to having more of my life back when this is done.  I know it's risky, and I'm scared stiff... but then again I was also scared stiff of having my RNY, and it's changed my life profoundly.

[Lady_J_2008]

When I can afford it... I am having plastic surgery.  I have found a doctor that has an excellent reputation in our area and I will get a consulation when my weight stabilizes or I reach goal.  Then I will get an estimate of charges and start saving.  I need my breasts done and maybe my arms.  I hate the deflated feeling and appearance.  Unfortunately, the cup size is the same but they are not as full.  For me own sense of self, it is important and I will do it.  Good luck with your decision and know that what is right for you is the right decision. 

[kiersti]

So, I met with my first plastic surgeon and we chatted it up.  I was THRILLED to learn that I had enough breast tissue left that I could get away with a lift and did not feel I needed implants.  YAHOO!  I was not looking forward to implants myself... I just want to tighten things up.

Now.. figuring out how to pay.

And - a recent issue has emerged in my skin health.  Despite my best intentions I have developed some sort of raw, rub rash or raw skin right at the top of my booty crack.  This part hangs over a bit and must be rubbing together or something because when I get into the shower it screams with pain for a few minutes.  Anytime I lay on my back when working out or going to bed, pain.  I am going to ask my DH to take some pictures so I can document it...maybe this will help get some of the surgery covered by insurance, I ask hopefully...

If anyone has dealt with insurance and skin removal...where do I even start? 

I specifically have Blue Shield of California if that makes a difference.

[baka]

Kiersti make sure you get your PCP to document it as well as taking the pics.

As luck would have it my PCP I've had for the last 10 years has worked with my COE for years and I wasn't aware until I read his name on their literature.

When I told my PCP I was seeking surgery we talked about me wanting to lose 254lbs and the loose skin aspects..... He told me that he would start documenting everything to make my case stronger down the line to get the insurance to help with the costs as we should be able to prove "medical necessity" with enough ammo.

So, needless to say if I see a rash I make an appointment and get him to record it along with pics and any cream he may prescribe.

I figure I'm at least 12-18 months from any plastics so we should have plenty to throw at the insurance when the time comes.

Ian

[MacMadame]

This discussion prompted me to post my own video....

http://fattyfightsback.blogspot.com/2010/03/to-ps-or-not-to-ps.html

Look for a cameo by Mini-Mac! 

[ttowe]

Love the video bombing by little mac.  Very brave video girl.

Thanks for sharing it.

t

[patti55444]

Great job on the video! Love the daughter too!

Patti