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Abdominoplasty bulletin board questions and answers

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Abdominoplasty (Tummy Tuck) Abdominodermatolipectomy

Explore what others have to say about surgery of the abdominal wall (abdominoplasty) with answers by Dr. Michael Bermant, MD part 3.

Michael Bermant, MD
Board Certified by the American Board of Plastic Surgery

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This is the page where you can review questions and stories from patients, view the opinions of lay persons, and see answers from Dr. Bermant and other physicians. Do you want to ask a question, post an answer, or make a comment? Information E-mailed to me will be considered for posting.

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Subj: Re: tummy tuck comp

I think your web site is great!
I just wanted to add some insight into full tummy tucks. I had a full tummy tuck last August. It was a nightmare to say the least. A little background on me: I was 57 years old when the surgery was performed. I am the mother of four grown children. I had a stroke in 1987 and a heart attack in 1993. I also have had gall bladder surgery and complete removal of all my female organs. So, it's apparent that I have had my share of pain; however, the tummy tuck was without a doubt the worst pain I have ever experienced in my life. I really thought I was going to die. The pain after surgery was unbearable. I had four incidents of infection. I was living on antibiotics and pain medicine. My temp. rose to 104.6 on several occasions. The doctor had to open the incision on two separate occasions (because of infection.) My incision was open for three months. I spend a fortune on surgical pads and tape. I hope no one has to endure what I went through. I had an excellent doctor that treated me with outstanding care. His staff was exceptional also. He answered my calls for help in a very professional manner and tried very hard to provide me with the best of care. I know it was not his fault but the pain was beyond anything I have ever experienced. I really didn't think I would live to tell this tale but I did and now I am getting back to normal. I just want to caution anyone who is considering this type of surgery that not everyone survives this surgery without extreme pain and suffering. Even with the best doctor, and I consider the doctor that performed my surgery was the best, complications can happen and do happen when you least expect it.
Thank you for reading my E-mail.
A

Dr. Bermant responds:

Thank you for your kind words about http://www.PlasticSurgery4u.com and your story about your abdominoplasty.

Your experience however, is not typical for this operation. My patients have never reported such an experience to me nor do they generally take much pain medication after this type of surgery. Many patients have abdominoplasty and go home the same day (lesser operations). My patients have a 23 hour stay arranged to see if they will need injectable pain control. A few need it and stay a day or two longer.

Infection and other complications DO occur even in the best of hands. But your experiences are way out of typical for this operation.

I hope this information proves of some use. If my office can be of further assistance, please let us know. We can be reached at: (804) 748-7737. My staff and I try to ensure the comfort of our out of town guests during their consultations and procedures.

Michael Bermant, MD

Subj: Re: panniculectomy

Dear Dr.

What exactly is the difference between a panniculectomy and abdominoplasty? I have found very little research on panniculectomy. My gynecologist wants me to have a panniculectomy before I have a hysterectomy due to complications of wound healing from a previous surgery. I lost 60 pounds after the first surgery; and have about another 60 to go. I am aware of what the panniculus is, however, mine does not hang down below the knees. After four months of appeals, my insurance has finally agreed to pay for the procedure.

Dr. Bermant responds:

A panniculectomy is a type of abdominoplasty. Extra skin and fat are removed, but due to the large amount of skin, the scars are often placed in a different fashion. The massive amount of extra skin can result in a poorer blood supply to the skin flaps. With the compromised skin we cannot always put the skin incisions in places of minimal visibility. Panniculectomy surgery is often less for the beauty than for the function. The best way to learn what plastic surgery has to offer is during an in office consultation and evaluation.

I hope this information proves of some use. If my office can be of further assistance, please let us know. We can be reached at: (804) 748-7737. My staff and I try to ensure the comfort of our out of town guests during their consultations and procedures.

Michael Bermant, MD

Subj: Re: abdominoplasty

Hi-- I am currently recovering from my 3rd C-section. My Dr. told me that my abdominals appeared very thin and weak and did not know if I could ever get them flat again. I had an abdominal hernia, several abdominal adhesions and the surgery report stated "the rectus muscles were found to be avulsed from their tendinous insertion". She said the left side was better but my right side was kind of shredded at the bottom, I guess where it attaches to the tendons. This was all in addition to a uterine rupture and bladder laceration. Needless to say, I am not having any more pregnancies. I am not overweight and I do not have excess skin or fat that needs to be removed. My only problem is the muscles themselves. What can plastic surgery do for me that my OB surgeon couldn't fix at the time of delivery? Please respond. Is there any hope for me? I very much desire to have flat, strong abdominal muscles. Thank you for your time.
---A

Dr. Bermant responds:

Muscles can be damaged in many ways. The nerves come into the rectus muscles from the sides, so injury to the bottom of the muscles may still leave functional muscle behind. The shape of the abdominal wall is more than just that of the skin, and fat. The muscles and the fascia (strong tissue) as well as the amount of what is under them (fat and abdominal contents) are also factors. Abdominal hernias or weaknesses in the abdominal wall also play an important role in the shape of the abdomen. During a delivery there are many other important factors to deal with that some repairs are better deferred. Without an examination and evaluation, I cannot comment on your particular case.

I hope this information proves of some use. If my office can be of further assistance, please let us know. We can be reached at: (804) 748-7737. My staff and I try to ensure the comfort of our out of town guests during their consultations and procedures.

Michael Bermant, MD
http://www.plasticsurgery4u.com

Subj: Re: abdominal contour

Dear Dr. Bermant,

A little over two months ago, I underwent a transabdominal hysterectomy for pelvic pain and dysfunctional uterine bleeding. During the course of my hysterectomy, my surgeons had to place a 15 x 7.5 piece of meshing in my abdomen, due to a large ventral hernia, which was forming, which resulted from my three previous c/sections.

Immediately following my surgery, I noticed a large lump on my left side. At first my doctors thought it was a hematoma, and then after it did not resolve, I was told that it was granulomatous tissue which was forming as a result of the meshing being placed there. This did not make any sense to me, as it has looked this way ever since I awakened from my surgery.

Anyway, since my husband is in the military, I have returned to our local army hospital several times, asking the surgeons who performed this surgery what this was and what could I do about it. They have basically told me that this is a "contour" abnormality, and that there was nothing that they could do for at least one year. In addition, the plastic surgeon at the hospital told me to wear a compression girdle and to exercise (which I have already been doing daily). She told me to return in three months, at which time she would consider doing liposuction. Since speaking to the plastic surgeon, I have consulted with several of my friends who are O.R. techs and R.N.'s, all of whom have advised me that liposuction is not the solution to this problem. These individuals have advised me that I should have a "tummy tuck."

Please let me know what you think. I realize that you have not examined me. Do you think that liposuction can be the answer to this abnormality, or should I get a second opinion from another plastic surgeon who, hopefully, may consider doing a tummy tuck? Is abdominoplasty a procedure normally used to correct such a problem? Does insurance usually cover this procedure, when it is used to repair a problem which occurred during this surgery? To be quite honest with you, I feel that my surgeons did not properly sew my meshing in place correctly (since it has looked like this ever since the surgery), or that I may possibly be forming a very large ventral hernia. I am a small framed woman, about 5'3", with a weight of 125, which makes this contour look even more obvious, even when I am wearing loose-fitting clothes.

Please e-mail me at .... I am a fellow Richmonder also, but currently in Fort Bliss, Texas with my husband who is in the Army.

Thank you!

W>

Dr. Bermant responds:

Contour abnormalities can happen as a result of abdominal wall hernia reconstruction. This can become a more significant factor in thin skinned individuals. Liposuction and abdominoplasty (tummy tuck) surgery are both recontouring operations. Each is better suited for different issues. Liposuction is better for localized collections of fat. Abdominoplasty is better for skin and fat disproportions. In other cases both tools are used. Waiting for tissues to heal and scars to mature is usually prudent when dealing with some issues. An in office examination and evaluation is necessary to determine what is the better treatment for any one person. We see patients from further away than Texas, but there are excellent doctors in that state.

I hope this information proves of some use. If my office can be of further assistance, please let us know. We can be reached at: (804) 748-7737. My staff and I try to ensure the comfort of our out of town guests during their consultations and procedures.

Michael Bermant, MD
http://www.plasticsurgery4u.com

Subj: Re: diastasis recti

dear dr., i have been just diognsed with diastasis recti, i am going for a second opinion on monday, can you send me some information on this condition, my doctor tells me that i will definately need surgery, it is getting larger every week, and more discomforting. i am at my wits end. please e mail me back at ... when you can with some information that may make me more at ease with the whole thing, thanks, l

Dr. Bermant responds:

A diastasis recti condition is the spreading of the rectus muscles of the stomach wall. These muscles are those that help with sit ups. Some spreading may not be a major problem. Major spreading can result in a ventral hernia - a defect of the abdominal wall. You need an in office evaluation to explore the possible treatments and extend the basic discussion found on my website.

I hope this information proves of some use. If my office can be of further assistance, please let us know. We can be reached at: (804) 748-7737. My staff and I try to ensure the comfort of our out of town guests during their consultations and procedures.

Michael Bermant, MD
http://www.plasticsurgery4u.com

Subj: Re: abdominoplasty

I have had a distended stomach ever since I was a little girl thru my whole life. I am currently 44 and have had 3 pregnancies w/2 live births. While growing up my grandmother believed that if I didn't have a bowel movement at least once a day that there was something wrong w'me and gave me exlax to induce one. I have had constant problems as an adult and was wondering if this was the cause of my distended stomach or if it's just fat left over from the pregnancies that have made it worse. I have had lower GI's with no significant results. I hate my stomach and even when I was in my 20's, 5'9-1/2" tall and weighing 114 lbs. I had this stupid stomach. Should I see a plastic surgeon or someone who deals with colons/intentines??? Thanks for your help.

Dr. Bermant responds:

I cannot comment "which would be better" for a patient I have not examined nor evaluated. There are many possible reasons for a large abdomen. Plastic surgeons can help with extra skin and some extra fat. We can also help with some abdominal wall hernias and the spreading of the abdominal rectus muscles called "diastasis recti". For large stomach due to what is behind the abdominal wall, you would need to get help elsewhere. Generalized obesity is also not a condition that I as a plastic surgeon can help with.

I hope this information proves of some use. If my office can be of further assistance, please let us know. We can be reached at: (804) 748-7737. My staff and I try to ensure the comfort of our out of town guests during their consultations and procedures.

Michael Bermant, MD
http://www.plasticsurgery4u.com

Subj: Re: Abdominoplasty

Dear Doctor Bermant,
I am seriously considering having a "tummy tuck" done, I was evaluated by a Board Certified Plastic Surgeon in Ohio last year, and am moving to your area of the US soon. At the time of my assessment, I was told loose skin in my stomach area would have to be cut away. I am 48 years old, 145 pounds ,5'4" tall and in perfect health. I am primarily concerned about the "down time" generally needed for recovery (i.e. being bed ridden) as I am also moving to a new position (I do sedentary work as a counselor). Any general info. on this recovery time issue? (P.S.In my opinion, your Web site is far superlative to all the others in the reconstructive surgery realm)-
Many thanks in advance for you feedback. Respectfully- M

Dr. Bermant responds:

Time in bed after abdominoplasty varies depending on what is done, and the individual patient. I have had mini abdominoplasty patients with no after surgery bed rest. I have done full abdominoplasty on patients that have been back up and about out of bed the next day. Those patients having massive Panniculectomy abdominoplasty are in bed 2 to 5 days. Other patients may take much more time for recovery. Time to vigorous activities is longer than time in bed and averages from 2 to 4 weeks. Recovery from anesthesia to clear thinking takes from 1/2 day to 2 days.

Thank you for your kind comments about my website.

I hope this information proves of some use. If my office can be of further assistance, please let us know. We can be reached at: (804) 748-7737. My staff and I try to ensure the comfort of our out of town guests during their consultations and procedures.

Michael Bermant, MD

Subj: Re: abdominoplasty

Dear Dr. Bermant:
I am scheduled to have an abdominoplasty with ventral hernia repair in two weeks. I am very nervous that I will have to undergo general anesthesia. I prefer local with sedation, as I have had this type of anesthesia two times before and recovered well. Can this procedure be done safely under local with sedation? Thank you for your time.

Dr. Bermant responds:

It depends on the surgery. Please check out my Tumescent Tummy Tuck where I use local anesthesia with sedation for my abdominal sculpture. This sounds like a good question for your doctor. For my patients we would have already covered that topic during our in office consultations.

I hope this information proves of some use. If my office can be of further assistance, please let us know. We can be reached at: (804) 748-7737. My staff and I try to ensure the comfort of our out of town guests during their consultations and procedures.

Michael Bermant, MD

Subj: Re: tummy tuck

Hi, my name is J. My wife had a tummy tuck surgery 2 months ago. Up to now, she is still having poblem at her stomack, like feeling discomforts, swellings, etc. some liquids also come-out from the stiches (surgery). she had also checked for diabetes, and the result was negatif. the doctor had repair her stiches twice, it seems that the stiches was not good, and the skin is not join properly. Would you give your opinions and suggestions what happend to her , and I also wonder if her skin may become smooth again, especially from the stiches (surgery) . thank you very much for your kind helps. bye.

Dr. Bermant responds:

The course of events you describe are not typical after abdominoplasty (tummy tuck) surgery. Some healing problems may occur requiring some resuturing in an occasional case. Opinions and suggestions about any patient require an examination and evaluation. Ask your doctor these questions. If you still do not feel satisfied, you may need to see another doctor to get another opinion. But in general, a doctor needs to examine a patient to render an opinion.

I hope this information proves of some use. If my office can be of further assistance, please let us know. We can be reached at: (804) 748-7737. My staff and I try to ensure the comfort of our out of town guests during their consultations and procedures.

Michael Bermant, MD

Subj: Re: abdominoplasty

Hello,
I recently had a complete tummy tuck 14 days ago,I live in northern B.C. Canada. I really don't know what to think,my doctor did a wounderfull job, But..my stomic is flatter but hard and tight. Is this due to swelling? and will it go away and how long(on average).My clothes almost fit me tighter and due to the upper mussles being so stretched and pulled down I feel fatter and widder. I am a short woman now weighing 109Lbs.Will things eventually relax and unswell, I hope you know what I mean.
Waiting for your responce
In the north

Dr. Bermant responds:

Abdominoplasty surgery involves a tightening of several structures of the abdominal wall - the muscles and the skin. There is frequently some swelling that also is part of wide tissue dissection. Only a doctor who has examined you can answer your specific questions. Why not ask your doctor?

I hope this information proves of some use. If my office can be of further assistance, please let us know. We can be reached at: (804) 748-7737. My staff and I try to ensure the comfort of our out of town guests during their consultations and procedures.

Michael Bermant, MD

Re: Tummy Tuck

Dear Dr. Bermant,
I am African American, I've had 5 pregnancies and I am in my late 50's. I had a tummy tuck about three months ago. My stomach is still swollen, not as much as before, but it looks as though I have a pot-belly. Is this usual? How long will it be before my stomach is flat, as I expect it to be? I have seen before and after pictures on several websites and their stomachs seem to be flat even after 3 months. When I walk over a long distance, I feel as though my stomach is enlarged. I wear a girdle and this gives me some support but I am concerned.

Dr. Bermant responds:

For my abdominal sculpture techniques, most of the change happens during the surgery as shown on the many typical images on my website. Tissue evolution after surgery depends on the original problem treated, what was done, your surgeon's techniques, and how you heal. There is only so far some deformities can be sculpted. This is living tissue and a blood supply must be protected.

Such issues are best discussed with your doctor. We are glad to help patients explore such concerns during a second opinion consultation. For what does not evolve, liposuction or revision surgery sometimes is an option. If interested please call our office staff to set up an appointment for an evaluation. Copies of your operative report, photographs before surgery, and doctors office notes can be of help during this consultation.

Michael Bermant, MD
Ironbridge Medical Park
11601 Ironbridge Road Suite 201
Chester, Virginia 23831
(804) 748-7737

Board Certified
American Board of Plastic Surgery
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