I thought that this might be a good place to post questions to me, so that other people can see your questions and my answers. I will continue to answer questions from those of you that private message me, but this is a nice way to share the information with others - since many of your questions are relevant to other people.

I will try to answer the questions as quickly as possible, and include links and pictures when appropriate.

I am obligated to add this disclosure.....any information provided by me is my opinion and cannot substitute for an actual consultation with your qualified physician.

Dr. Schulman,

i am about 44 lbs away from my goal weight. I have stabilized within a pound or two up and down. I am still trying to get down and i am wonder if it is to early to start looking into ps? I am interested in a tummy tuck as opposed to a pannilectiomy (sp?) i have bcbs of michigan and i have went to my doctor already for an infection of the belly button. And i have low back degeneration, which my chiropractor says that the excess skin is aggrevating. Do you know what has to be supplied to get bcbs to pay for the surgery?

you have to chck with BCBS of Michigan to find out specifically what they require. Keep in mind, they will only cover a panniculectomy - a TT is always cosmetic. This may mean that if they cover the panniculectomy, you will be responsible for TT portion (check with you PS about what the cost difference is).

For documentation, check with BCBS, but expect them to require that the pannus hangs to the pubis, documented infections, documented back pain or letter from chiropractor that pannus is worsening a pre-existing condition.

You should schedule a consultation with a PS and they will help with the insurance submission - this may take several months, which is why you should start early.

Dr. Schulman, if a person gets TT will the skin be less resilient? Example, if a person within 30 lbs of goal gets a TT and then loses more weight after the TT, will there be loose skin requiring yet another TT?

The skin will be a bitmore resilient - because the "new" abdominal skin is better quality skin that was at the upper part of the abdomen. But, weight loss after a TT (which is very common) may make the skin hang a bit - this is usually not anywhere as bad as before the original TT, but you will have to decide if it is bad enough to warrant another surgery -usually it is not a repeat TT, but a much smaller operation that just removes the skin (like a mini panniculectomy) so the recovery is much easier.

Dr. Schulman,

I have been advised to have the lap band proceduer, I need to lose about 50 pds., my problem is that I have NASH, and it has turned into cirrhosis, I want to make sure this is not going to hurt my liver anymore than it already is, any information would be appreicated.

Bradley 18

I responded to your pm, but for everyone elses benefit, I will comment again briefly.

Any surgery can worsen liver problems - this is mostly because of anesthesia and the stress of surgery. Also, liver problems increase the risk of bleeding and infection. I am not aware of any specific risk of the lap band to the liver, but just the fact that it requires abdominal surgery and general anesthesia is a risk. You need to speak to your GI doc and Bariatric surgeon to see how significant the risks are to you -depending on your specific liver tests and other history. I can't comment more specifically without knowing more information, and liver is also not my area of expertise.

Dr. Schulman, thank you for being on this forum and being so generous with your time and advice. I wish you practiced in Houston.

Dr. Schulman, thank you for being on this forum and being so generous with your time and advice. I wish you practiced in Houston.

I Second that thought!!! Thank you for your response Dr. Schulman.

Dr. Schulman, thank you for being on this forum and being so generous with your time and advice. I wish you practiced in Houston.

There seem to be a lot of you from Texas on this site.... a Texas office may not be such a bad idea

Where are all my New York people at?

Dr. Schulman, Come on down! I vote for a Dallas office.

Dr. Schulman,

I wonder if I could potentially have breast reconstruction (left breast lumpectomy 7 years ago, with chemo and radiation therapy now cancer-free) and effectively have a tummy tuck at the same time. I chose not to have any reconstructive breast surgery initially, but since my lap band weight loss, I'm interested now. What do you think? Thank you for addressing my concerns.

Dr. Schulman,

I wonder if I could potentially have breast reconstruction (left breast lumpectomy 7 years ago, with chemo and radiation therapy now cancer-free) and effectively have a tummy tuck at the same time. I chose not to have any reconstructive breast surgery initially, but since my lap band weight loss, I'm interested now. What do you think? Thank you for addressing my concerns.

The two procedures can be done at the same time. Depending on the specific amount of breast reconstruction that you require, it is possible to use the tummy skin and fat to reconstruct the breast. This procedure is referred to as a TRAM flap and has been used in breast reconstuction for about 15 years. The fact that you now have loose abdominal skin after your reconstruction makes you a great candidate for this procedure.

Where are all my New York people at?

we moved to TEXAS!!!! .... LOL. been here 15yrs, i second txbecky - a dallas office would be fantastic!!!!:cursing:

How about a compromise? An office in Houston AND an office in Dallas. Lots and lots of southern ladies who've been eating too much of the good southern food down here in Texas. Housotn was voted the fattest city in the country a couple of years ago. Lots of work here for a plastic surgeon.

Dr Schulman-

Thanks you for offering your expertise. I have a question.

I’m going to have a breast reduction and I think I should probably try to have it about 40 more lbs from now. I’m guessing I’ll lose another 5lbs or more from the surgery process. I won’t have any problems w/ins. Shoulda and Coulda done it years ago when I was still young and skinny. I know I will have to have my yearly mamo. I also know that sometimes they find cancer that didn’t show up on the mamo. If cancer IS present---does it become more dangerous (spread faster) because it has been opened to the air or disturbed by the surgery?

Dr Schulman-

Thanks you for offering your expertise. I have a question.

I’m going to have a breast reduction and I think I should probably try to have it about 40 more lbs from now. I’m guessing I’ll lose another 5lbs or more from the surgery process. I won’t have any problems w/ins. Shoulda and Coulda done it years ago when I was still young and skinny. I know I will have to have my yearly mamo. I also know that sometimes they find cancer that didn’t show up on the mamo. If cancer IS present---does it become more dangerous (spread faster) because it has been opened to the air or disturbed by the surgery?

Occassionally, breast cancer is found in the breast reduction specimen. This is rare, and it is still unclear if it even matters if there are some small cancerous cells in it - some people argue that we all have some small amount of cancers cells inside of us and our body is constantly fighting it off...

Regardless, it depends on the size, type, and location of the cancer that is found. Sometimes, the breast reduction is all that needs to be done - think of it like a large "lumpectomy." Having a breast reduction and the cancer "opened to the air" does not make it more aggressive. It may change the options a bit, because the surgery disrupts the normal lymphatics and will make lymph node mapping more difficult.

Like I said, cancer is very rarely found on the breast reduction specimen if it was not seen on a pre-op mammogram. In this rare case, usually it is small (because it didn't show up on mammo) and contained completely within the specimen...meaning it is all out, and nothing more needs to be done.

Dr. Schulman--

Thank you for your quick response. I will mostly likely have an additional question or 2 as I move through the process.

Thanks again.

Dr. Schulman:

What a great service you are doing, thanks so much.

I am planning a Breast Reduction, I am really worried about the incision

under my breast. Reading different sites they are complaining about their

bra rubbing on the incisions? Are they just talking about right after surgury? Or is this an on going problem? Is there new ways of doing it so this problem goes away? New techniqes are are found all the time.

Thanks for your help.