All About My Abdominoplasty Surgery!

Surgery Blog....Finally! 


It has taken me forever to write this blog partly because my recovery took so long, and I wasn’t in the mindset to write it. However, mostly it was because I don’t want to pretend to be an expert on this surgery or for you to think that the way my surgery was done is the “right” way. Or for you to think that all the information you need can be found in this blog. Plus, I am only 3 months into recovery, and I don’t REALLY know how I am doing other than I have a much flatter stomach. 

So, I decided to write this blog into two parts. The first part is what I believe is universally important, and the second part is about how MY surgery was performed and why my surgeon thought that was best. But, again, that doesn’t mean it has to be that way for you. 

Finally, I also recognize that the advice I am giving you in this blog is full of privilege. Hiring a full time nanny for 3 weeks, opening a no interest credit card to pay for surgery, and paying for out of pocket physical therapy was stressful but doable. However, if you are able to make such a huge emotional and financial investment, then I want you to be able to make fully informed choices. So here we go….

Part 1: 

Pelvic floor physical therapy and picking a surgeon

A.            Physical Therapy: 

·       Everyone would benefit from doing prehab and rehab with a pelvic floor physical therapist. I cannot suggest this enough. I have felt so good in my rehab after this surgery because of ALL the time I spent with rehab after my second pregnancy. It has helped me so much when doing those mentally difficult exercises because I can remember how it is supposed to feel. It has given me a confidence that has helped in so many ways. 

·       If you haven’t rehabbed after babies, now is the time to get some help.  Get strong, learn your tendencies in movement, and empower yourself before you undergo a really hard recovery. 

·       Prehab and rehab is something that RARELY happens with this surgery. If you think it is rare to get good postpartum care, post tummy tuck care is basically non-existence; so you have to be ready to fight for it. 

·       Finding a pelvic floor physical therapist can be tricky for the reasons listed below, there is a free download on my website with interview questions and search engines to help you navigate this process. 

It might not be easy, but it is very important work; it is YOUR body for the rest of your life. 

·       Most surgeons may think that is silly to do physical therapy before surgery because you are getting surgery anyway. 

·       Most surgeons don’t send you to physical therapy after this surgery. You get “cleared” at 6 weeks. Yes, our bodies are amazing and adaptive but support from a physical therapist will make that go a heck of a lot better. ⁣

·       Some physical therapists don’t know what to do with extreme Diastasis Recti cases

·       Many physical therapists have only worked with post surgery cases that had some sort of issue and rarely get to work with someone that is being proactive, so it may be new to them. However, the therapist that is the right fit for you will be ready to help with lots of ideas no matter the situation. 

·       Most likely you’ll want to try different therapists and not just settle for one perspective.

B) Choosing a surgeon:                                                                                                                                                         

Consultations 

• I would recommend that you get 3 consults or more, bare minimum of 2. I did 3. I felt like the second surgeon was my guy, but I am SO glad I still went to the 3rd consult. I still learned a lot from that experience, and it also solidified that #2 was my pick. The more consults, the merrier, in my opinion. This surgery is a big deal; don’t let yourself feel rushed.

• Start early. It took me 2 months to get in for a consult and I had to book my surgery 5-6 months out. You might not need to plan that far ahead but you DO need time to process and see what surgeon makes you feel the most comfortable. It also gives you time to come up with more questions to ask as you digest it all. 

• Be prepared for them to take a full naked picture either before or after your consultation, even if you aren’t sure if you are booking with them. I cried after my experience; it can be a lot. I posted my belly for all to see all over the internet but it was something about being in that office and taking that picture that really got me. I wasn’t ready for it the first time. 

• Come with a list of questions, so you don’t forget anything. Personally, I always got nervous, so having my list was key. I have some lists up on my previous blogs if you want to guidance on where to start (I had no clue when I began), but different things are important to different people. You need to figure out what is most important to you and create your own lengthy list of questions. 

• Don’t let anyone rush you in an appointment and don’t leave until all your questions are answered. 

• I found my paid consults were much better than the free one, but that was just my own experience. All kinds of scenarios when it comes to this type of thing. Just be prepared to pay for some of them. 

• Every surgeon does the surgery differently. It will drive you crazy if you are trying to find the “right” way. Trust me. I went crazy a number of times, and I just wanted a “right’ way. However, you need to find the right way for you and your goals (athletics, aesthetics, etc), along with finding a surgeon you trust.  This process is NOT easy and took me almost a year to navigate. 

• Once you choose a surgeon, don’t be afraid to go back and ask more questions before your surgery. I did that 2 times, so I saw him a total of 3 times with lists of questions. 

Plastic Surgeon vs General Surgeon

Hernias

• If you have an umbilical hernia also being repaired, consider having a plastic surgeon that is also a general surgeon do your surgery. However, having both a plastics and a general in the surgery happens all the time, too. Personally, I just didn’t want to go that route for a few reasons. As always, do your own research and see what is right for you. 

• I had a suspected umbilical hernia, so this is why this was a consideration for me from the start. However, when they opened me up I didn’t have an actual hole, just extremely thinned fascia. But it just goes to show that you never really know what is going on in there until they open you up. This is why you need to trust your surgeon, in case he/she has a decision to make during surgery. 

• The lack of a hernia saved us a lot of money. Since I had it done at the University of Michigan, they billed out separately for the hernia and made the whole thing so much more expensive. Even though this part was covered by insurance, we have a high deductible so it didn’t really matter. However, if you go to a plastic surgeon that has his/her own practice or isn’t attached to a huge university and is also a general surgeon, then they well often just repair the umbilical hernia as part of the abdominoplasty and is MUCH cheaper than getting a general involved and billing insurance. 

Diastasis Recti Repairs

• Laparoscopic or robotic procedures sound less invasive and are often covered by insurance and so are the surgeries done by a general surgeon. The general surgeon I saw told me that he could repair my DR and get it covered by insurance, but he said I should have the plastic surgeon do it instead since that is their specialty. There seems to be more complications when women get their DRA repaired in these alternate ways. However, as always, do your own research. This is just what I think after doing mine. 

• Talk to other women that have similar goals as you. See how they are doing and how their doctors did their repairs. Talk to physical therapists that understand this surgery and get their perspective. If there is no one local, book a distance consultation with someone else to discuss. It is hard because everyone is different and has a different body, but I also feel like there is a HUGE lack of information about these surgeries. You really have to work hard and dig deep to prep those lists of questions for the consultation.  Be careful in Facebook groups, people mean well but it can also be a place full of misinformation and just individual experiences that might not apply to you.  

• After my journey, it is hard for me to trust anyone. BUT at some point I had to do it.  You need the right amount of skepticism without playing Dr. Google. Find trusted sources and don’t get wrapped up in the rest. 

Ultimately, after going crazy for a while, this is why I choose my surgeon: 

♦️I believe he is one of the best surgeons in MI⁣ 

♦️He was also a general surgeon since I thought I had a hernia. 

♦️I got numerous recommendations for him from other medical professionals.⁣

♦️He is an athlete himself⁣.

♦️He likes working on athletes.⁣

♦️He understands my CrossFit goals⁣.

♦️He spoke my language. ⁣

♦️He told me my return to fitness was up to ME, not him. ⁣

♦️He was patient with me and had great bedside manner. ⁣

♦️He told me I was his dream patient. ⁣

♦️He liked when I came to appointment with typed lists of questions & was happy to answer them. ⁣

♦️He has fixed tummy surgeries gone wrong. ⁣

But he still thought the fact I flew around to see physical therapists was silly. And, that is OK for all the reasons mentioned above. Everyone has his/her lane. AND, until this medical world actually starts working as a team YOU need to know what to do to take care of YOU. This applies to any injury, surgery, or issue that you may be experiencing. 

Navigating this process is hard because surgeons often say there is nothing to do but surgery.  And physical therapists can have a negative view of surgery since they often only see the problem cases. You need to find your own middle ground. Separate and Advocate is my new motto. Don’t put everything into one person. Take people for their own specialty and build your TEAM before you go under the knife. 

C) Body Image 

My final piece of advice before you get surgery is to learn to love your body even if you don’t like the way it looks. This is no easy task and it takes time, which is good because it keeps you from rushing into surgery! It also gives you time to strengthen your mind and your body before dealing with a really hard recovery. 

Tissues can take up to 2 years to fully heal after having children. It can take up to 6 months for hormones to re-regulate after weaning.  My kids were older and didn’t need to be picked up. I was sleeping more and less exhausted. And, during that time of waiting, I ended up getting stronger than I ever thought was possible with a severe diastasis. When surgery came I wasn’t desperate; I was ready. 

Part 2: 

The details of my surgery.  

I will provide information on how MY surgery was done, but I am NOT a surgeon or an expert in this surgery. You need to feel comfortable asking lots of specific questions to your surgeon and learn more for yourself. Take your time. 

GET THE DETAILS: Call and get a copy of your surgery report ASAP, along with a script for physical therapy. 

MESH: For my particular case, after doing some consults, I learned that mesh was not necessary. So, it was important for me to find a surgeon that would not use mesh. And, even though I knew my surgeon did not like using mesh and told me he wouldn’t use it, I still confirmed this on the day of surgery. I won’t lie; I felt like I was being annoying, but I knew that I shouldn't let that stop me. So, do not feel bad for asking and confirming. IT IS YOUR BODY. 

SUTURES: Different kinds, different methods

• Dissolvable sutures vs. permanent sutures - fishing line, barbed wire, or actual wire. 
• Different patterning of sewing you up- corset style, interrupted, and more..
• Different ways of closing the incision site using different sutures and methods of sewing 

My surgeon used permanent (fishing line type) sutures in my fascia of the rectus muscles and sewed me up using the corset style. He explained that dissolvable can work great, but he has no control over how my body responds to that type of suture, or when it would dissolve, so permanent was the best choice for me and my athletic goals, in his opinion. He does like to use the least amount of permanent as possible to avoid extra scar tissue build up. He ending up doing 2 layers for me because when he sat me up I was bulging with only one layer.

He also stated that folding the rectus in on itself would change how the muscle behaves and be hard on the rectus, so he doesn’t do it that way. He didn’t want to change the length and tension relationship, which could impair function. 

LIPO: I wasn’t interested in it and none was suggested to me, so I did no research on this procedure. 

SKIN: They took off over a pound of skin. They pulled it down and some of my stretch marks that were on the top of my tummy are now around my belly button and below. They explained how this would work beforehand.  

INCISION: It was a full tummy tuck, so I had the hip-to-hip incision. I was so obsessed with the function of my rectus that I never asked about detailed on this part. I knew I had a very good surgeon and that part just didn’t worry me at all. I was lucky and didn’t have any issues; however, looking back on it, wound care is so important and often overlooked. I should have asked more questions, since I know other women that had issues with their incision sites. 

BELLY BUTTON: He was able to keep my original belly button, and it looks a lot different after surgery than it did after the two pregnancies! The other surgeons I saw suggested that I would lose my original belly button, so I was surprised when he said I could keep it. This wasn’t important to me, but I know might be important for some people!  

It is really hard to find information and support about this surgery because there is a stigma around it. Support for the return to fitness is basically non-existent. And, sometimes, what women find in support groups can do more harm than good. Women mean well but there is so much misinformation out there about diastasis and about these surgeries. 

But so many women are getting abdominoplasties, so it shouldn’t be such a fight to get the education surrounding it. I am sick of it swept under the table. Not talked about. Women are ashamed. Surgeons not sending women for physical therapy even after changing their actual body anatomy. No education surrounding what happens to women’s bodies’ during/after pregnancy and/or after surgery.  

I am working with my pelvic floor physical therapist, Nancy Boyd.  I am using all the strategies I have learned over the years and not rushing anything. As I always say, I am SO grateful for the strategies I have learned the past few years as they are second nature to me, and I can draw upon those when I need them in my fitness. As prepared as I was, I am still struggling. I cannot imagine how women feel that did not have this support. 

I am on a mission to change all of it, but I can’t do it alone. Join the movement! Please share my website. Share your own stories. Become a P&PA coach. Speak out. As always, let me know how I can support you!