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The following was written in August, 2004, and needs some updating. There is now a page of pictures illustrating the adventure which will illustrate the text more clearly. At this time I plan to have the surgery redone in late May 2005, as the stitches in the upper part of the belly, above the belly button, all pulled out internally. By February of 2004, 10 months after my lapband surgery, I was nearing my goal of 199 pounds. At the end of February I was at 215, exactly ten months after surgery. I was comfortable at that weight except for the large flaps of skin and fat that were hanging off my lower abdomen. Since I knew that it took a long time to get in to see plastic surgeons, and since I wanted to pick carefully, I started scheduling several local consultations with recommended plastic surgeons. I also investigated getting the surgery done in Tijuana or in Costa Rica, since both had lower charges for the surgery than most US doctors, just as is the case with the band and many other elective procedures. However, after investigating the local costs, it turned out that by the time I traveled to the distant surgeon and paid for ten to fourteen days in a hotel, plus associated costs, the local surgeons were less expensive and much more convenient. Many others have found excellent plastic surgery services in foreign countries, but it didn't turn out to be the right option for me. For those who are banded and interested in plastic surgery of all types, there is a Yahoo group for that purpose, BandsterPlasticSurgery, where you can get information on both domestic and foreign options. I met with four local plastic surgeons to learn about what they could do, how and where they did the procedures, what they'd recommend for me in particular, and whether they were willing to perform the surgery on someone with a lapband and port. I received quotes from $5800 to $8300 for the complete surgery package. I excluded one because he was very put off by the idea of the port being in my upper abdomen. I excluded another one because he only spent three minutes with me, and never examined me to even palpate the skin and fat he'd be dealing with. I finally chose a surgeon who gave me a thorough examination, who felt the flab he'd be dealing with, and wasn't put off by the port. We also discussed the option of an Inner Thigh Lift, but I finally decided that my thighs weren't that bad and they'd not be seen by anyone but my wife, and she didn't care. That also saved five thousand dollars and lots of extra recovery issues. In addition he explained the procedure very thoroughly to me in the half hour he spent with me. His total package fee was $6850, to be paid in advance, naturally. I scheduled the surgery for Monday, June 28, 2004, exactly fourteen months after my banding. Two weeks before surgery my internist gave me the required EKG and the results were sent to the plastic surgeon. Five days before surgery I met with the surgeon and one of his nurses to go over the final preparations and to learn the details of dealing with Jackson-Pratt drains, the catheter and collection bag, and the pain pump. The surgery was done as an outpatient in the doctor's surgery suite adjacent to his office in a medical building a block from one of the local hospitals. I'd warned the doctor and the nurse anesthetist about my UP3 surgery and the aspiration problems I'd had with the band surgery. They assured me that they'd take care of things, and they did. I went in to surgery about 130 PM and was out by 400 PM or so, they tell me. All I remember after the surgery was asking them if they'd done a vertical incision as well as the horizontal (they did) and how much they chopped off (over six pounds). After that I remember, vaguely, a neighbor helping Gail get me into the house about 630 PM. My next memory is the next morning waking up in my recliner at home. I knew the surgery would be rugged, and it indeed was. They'd warned me that I'd come home with a catheter and a pain pump, as well as two drains. I'd balked at the idea of a catheter, but they assured me that I'd be in no condition to make my way to the bathroom for a couple of days. They were right, of course, and I removed it on the third afternoon, when I felt I could make it the thirty feet to the bathroom with some help. On the fourth day I went back to the doctor for a checkup; they removed the pain pump (a ball-shaped device that hung between my legs, and was connected to a small tube going into the central incision site) and said all was going well. I was off of most of the serious pain drugs, but taking lots of ibuprofen. Quite simply, everything hurt. The minor aches and pains of banding were trivial in comparison. I'd planned to return to work on the Monday 14 days after surgery, but I was still draining a bit too much. I finally got back to work on day 16. That night I woke up in the middle of the night soaked in drained fluid. I was so soaked that at first I thought I'd wet the bed. The holes around the drains had leaked profusely but the drains being almost empty. The next day the doctor removed my drains, as they weren't effective any more, since the drainage was coming from areas other than where the drains were. Fortunately, the drain incisions closed up quickly and easily. At this point I was back to working full time, and the fourth week went pretty uneventfully. During the fifth week I started to have some swelling on the lower central part of the incision. The area got hot and swollen and I developed a fever. On that Wednesday, day 31, I went to the doctor and he drained over 700 ml (24 ounces) of fluid from that hematoma and gave me a prescription for an antibiotic. The next day it was swollen up again so I returned. They drained over 250 ml further, and since we'd planned to leave two days later for a ten day trip, they put in a small drain in that hematoma area. This drain tube was much smaller than the two placed during the original surgery, and the collector could be tucked into underwear discreetly, so it wasn't a lot of trouble. Unfortunately, the drain was placed right at my belt line, and wasn't very comfortable. .The trip went well, though, and I was able to remove the drain after it had been in for seven days. Once again, things seemed to be back to normal recovery. However, early during week seven the lower drain area where the hematoma had been opened up again, and I also developed a cellulitis high on one side, near one of the original drain sites. The drainage has been continuing to drain until now, early in week nine. This too shall pass, but it is frustrating. Why have things taken so long? First, I'm 61 years old, and we all heal more slowly as we age. Second, I've always been a "reservoir of bacteria" and have been susceptible to all sorts of infections, particularly sinus and bronchial. We all have bacteria in us at all times, and my "extra juicy body", as the plastic surgeon put it, makes a particularly inviting place for them to grow. Some have asked if the tummy tuck was really worth all of this. Yes, it has been, although the results aren't quite as good as I expected, and the recovery has taken longer than most. Tomorrow, day 59, I'll be back to some simple workouts in the gym, despite still having to avoid working the abdominals. The abdominal muscles they stitch together as part of the surgery are still very tight, and it will take more weeks for them to stretch out. I'm still not able to stand or walk perfectly erect, but can move much more effectively than a few weeks ago. I know it'll take quite a bit of time to get back into things in the gym, where I formerly worked out four to six days a week. Since I was out of the gym for two months before surgery due to two bouts of bronchitis and some extended travel, the total of four months of almost no exercise will be tough to come back from, but I know I can and will do it. What has the impact of all this been on my weight? I reached 215 at the end of February, and due to lack of exercise and lots of travel and stress, was back up to 219 the day of surgery at the end of June. That wasn't a big increase so I didn't get too excited. A week after surgery, despite the removal of over six pounds of tissue, I was up to 223 due to post surgery fluid retention. Now, eight weeks later, I'm down to 209, which I'm pleased with since I've had essentially no exercise during that time period. I'm a firm believer that for the band to be successful we must exercise regularly, as well as have a properly filled band and eat sensibly. The tummy tuck wasn't important to me for vanity reasons. In fact, I'm not sure I look better than I did before. I do look different, and feel different. At my age I'm not trying to impress people with my physique and know I'll never be on the cover of a muscle magazine. However, the extra pounds of tissue hanging off my abdomen were in the way for many athletic activities and kept bouncing in a very irritating manner. In addition, the loose skin was very prone to irritation and infection, particularly since I have very sensitive skin. Yes, I'm sure it was worth the time, money, pain, and irritation. I also believe I'll be even more positive on it after a few more months, when I'm able to be back to full mobility and rebuilding my muscles.
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