Dr. Schulman

Insurance coverage for this is a very compicated issue. Insurance will cover a hernia repair. Sometimes, insurance will also cover the removal of excess skin at the same time because the argument can be made that the apron of skin must be removed in order to allow the surgeon to repair the hernia......However, this is a panniculectomy, not an abdominoplasty. A panniculectomy is removal of the excess skin, or "pannus", than hangs. An abdominoplasty is removal of the excess skin, repair of muscles, and replacement of the belly button. So, insurance should pay for the hernia repair and the time in the operating room to do this (about 1 hour). They might pay for a panniculectomy(reconstructive), but will not pay for an abdominoplasty (cosmetic). Because of the hernia repair, insurance shuold also pay for an overnight stay in the hospital. Check with your insurance carrier about the specifics. Also check with your surgeon and do not be surprised if you have to pay some out of pocket. Oftentimes, the surgeon does not know if the insurance will pay for the procedure until after it is done. A pre-authorization is not a promise to pay, and insurance companies can "change their mind". I told you it can be comlicated...

Regarding the "sagging" skin.... The amount of excess skin after weight loss has to do with several things: 1. The amount of weight lost (greater than 100 pounds is considered "massive weight loss" by the bariatric community) 2. The time over which the weight is lost (from a physiologic standpoint, massive weight loss over the course of 1-2 years is considered "rapid".) 3. Your skin quality (In general, older skin that has been subjected to multiple weight fluctuations is most likely to "sag") 4. The type of bariatric procedure you have (this is related to the amount of weight lost and the speed of weight loss) So, yes, it is true that people who undergo gastric banding tend to have less "sagging" than compared to other bariatric procedures. This is likely due to a combination of slower weight loss, less overall weight loss, and a better nutritional state during the weight loss which leads to better skin quality. Good luck and congratulations on your first step in the weight loss process.

A "fleur-de-lis" involves a vertical (up and down) incision in the midline, in addition to the traditional abdominoplasty incision. It allows better contouring of the abdomen because it allows the surgeon to remove skin "side to side" in addition to "up and down". The result is a slimmer waistline and better shape. The tradeoff is a lone visible scar in the midline. It is a great operation for the following people: 1. people who had a prior abdominal surgery and already have a midline incision. 2. people with massive amounts of skin which might result in a "boxy" midsection after a traditional abdominoplasty incision. 3. people who want the optimum contour and shape, and are not concerned with scarring. Regarding body contouring after weight loss, there is always a balance between achieving the optimum shape and minimizing visible scarring. To see an example on my website of a woman who had significant skin, a midline incision from an open gastric bypass, and underwent a procedure with a midline incision, go to "Lower Body Lift" | Madison Avenue Plastic Surgery She is only 6 weeks post operative, so her scars will continue to fade over the next several weeks.

I can't make that decision for you. I generally tell my patients that they will feel like they were "hit by a bus" for the first few days, and at 1 week they will feel well enough to walk around and "socialize" without being too uncomfortable. I think that 2 weeks is a good estimate for how long it takes people to begin to feel like they are getting back to normal. These are just generalizations and everyone heals differently, and everyone has different levels of discomfort. It is impossible to predict how you will feel 3 days afterwards - and alot depends on what the specifics of your surgery are (muscle repair, a lot of skin removal, aggressive tightening, whether or not your surgeon uses a post operative pain pump, etc.) While the decision to postpone the party is entirely up to you and your family, I suspect it will be much more enjoyable for you (and everyone else) if you allow yourself to heal more. Talk to your surgeon and your family about what everyone thinks is best. Also, you might get some good feedback from other people on this site who have undergone the procedure. I wish you all the best and a speedy recovery.

Obviously, you should check with your surgeon.......but to me, 3 days after surgery may be a little ambitious to "hang out." You will likely have drains, and discomfort (especially if your muscles are tightened as is usual in a tummy tuck). As long as you have people helping you durign the party, your "hanging out" will probably just consist of relaxing in a chair.