However I can comment that your situation is not unique and there are options for improvement including creating a new umbilicus (tummy/belly button).
I suggest you make several consulative appointments with experienced Plastic Surgeons who are Certified by the American Board of Plastic Surgery and ideally a member of the American Society for Aesthetic Plastic Surgery (denoting by membership as having met additional criteria and a focus on Cosmetic Plastic Surgery).
It really depends if the recti muscles will be plicated (sutured together to create a smaller waist). If they are the postoperative pain is comproable.
Asumming gentle surgical techniques here are several intraoperative procedures to reduce postoperative pain.
LOCAL INJECTION OF MEDICATION:
2) Exparel is along acting injectable Bupivacaine .
Price difference is significant.
Both can be injected locally.
NON NARCOTIC PAIN PUMP
A pain pump us a mechanical device where there is a external "pump" through which thin catheters are inserted into the surgical site. For the next several days the local anesthestic agent (usually Bupivacaine) is release at constant flow. Thin catheters need to be removed in 3-4 days .
Contrasting the two:
1)one time local injection
2) works only where injected
3)longer 1/2 life of Bupivacaine (effects last longer)
Non narcotic pain pump
1) a external delivery system through small catheters
2) can diffuse throughout the surgical site: in breast augmentation or abdominoplasty the anesthestic (Marcaine) fluid can disperse throughout the entire surgical pocket and theoretically cover more area in contrast to direct injection of the Exaparel or Bupivacaine in certain ares thus is only effective where locally injected.
3) Some pumps have a "on demand" function where additional local anesthetic volume can be intermittently delivered (with a corresponding lock out period so as not overdose).
I personally perfer the pain pump for long term pain relief (3-4 days) and perform local injection of local anesthestic on almost every surgical case. I provide a pain pump to all my abdominaloplasty patients. The pain pump is optional for all other procedures.
I suggest you discuss postoperative pain control with your chosen Plastic Surgeon.
I trust you have chosen a experienced Plastic Surgeon who is Certified by the American Board of Plastic Surgery and ideally a member of the American Society for Aesthetic Plastic Surgery (denoting by membership as having met additional criteria and a focus on Cosmetic Plastic Surgery).
The following document is what I give all my Abdominioplasty patients prior to surgery.
Please find below information that I believe you will find helpful as you prepare for and recovery from your Abdominioplasty.
a. 30 Days Before
1) Start iron pills 325 mgm (can purchase directly over the counter) start taking a day (builds up blood). May turn stools black and cause constipation.
2) Start a multivitamin (provides nutrients for healing) no mega E; it can cause bleeding.
3) Stop any hormonal birth control or post-menopausal female hormones (increased risk of blood clots).
4) Stop any over the counter supplements (can cause unknown problems).
5) If you have had Bariatric surgery (weight loss surgery) start on 100 grams of protein per day.
6) Stop smoking. No exceptions.
7) If over age of 45 or medical issues our surgery center recommends a preoperative clearance by your primary care physician with basic laboratory data.
b. 14 Days Before
1) If over the age 45 or medical issues, provide preoperative clearance letter with laboratory data for your surgeon.
2) Preoperative appointment with Dr. Hardesty and his Physician Assistant who will provide prescriptions (for before and after surgery), counseling and educational materials. Discuss what medications are ok to continue or stop. Bring list of questions.
3) Complete final payment of procedure prior to leaving the office after the pre-operative appointment is concluded.
4) Stop shaving around pubic area (razor blade shaving causes small cuts that can harbor bacteria and increase infection rate).
5) NO aspirin, Aleve, Motrin (can interfere with normal clotting) use only plain Tylenol (will not interfere with normal clotting) or pain medication prescribed by your regular provider.
6) Make arrangements for drop off, pickup and child care.
c. 4 Days Before
1) Start bromelain and arnica as directed (anti bruising and swelling).
2) Purchase 2 large bags of frozen peas or corn (Costco size). Can have one in pillow case and place over abdomen and change out with second one (in freezer) when thawed.
3) Purchase any needed food, supplies and verify with your postoperative support team yours/their schedule.
4) No shaving of pubic area (can increase infection rate) Operating Staff will clip pubic hair if needed.
d. 3 Days Before
1) Start anti-bacterial decolonization showers.
2) Topical antibiotics (prescription will be given) to be applied in ear canal, nostrils, and umbilicus (tummy button).
e. Day Before
1) Have ALL prescriptions filled.
2) Bed, recliner, pillows, and foam wedges etc. ready.
3) Make sure you know the location of surgicenter, see if you can obtain any of Surgicenters required preoperative paperwork to fill out prior to arriving on the day of surgery.
4) Call surgicenter for you expected time of arrival.
5) Have or purchase bell to ring (if you need assistance after surgery) to notify your support team.
f. Night Before
1) Make out a list of any "last minute" questions, your needs, wants desires and expectations of the surgery.
2) Complete a preoperative enema (decreases fecal load) for postoperative constipation (from pain meds) and potentially reduces risk of blood clots (hard stool pressing on intra-abdominal veins during tightening of the
3) Take a shower with antiseptic solution and scrub entire body well.
4) No alcohol containing drinks.
5) Nothing by mouth after midnight or 8 hours prior to surgery (unless instructed so by surgicenter).
II Operative Day
1) Awake and take second shower and scrub the surgical area
2) Check your list (bring model photos demonstrating your desires).
3) Place anti-nausea patch behind ear (prevents nausea).
4) Take all necessary medications with sips of water.
5) If anxiety begins, may take 5 mgm of Valium with a sip of water.
6) Remove all piercings, jewelry, "bobbie pins" from hair and body.
7) No make-up and remove nail polish (intraoperative monitoring).
8) Button down or zipper blouse/shirt, sweat pants or stretchable pants.
9) Go over your list with Plastic Surgeon and Anesthesia provider.
10) Reaffirm with surgicenter when your postoperative care provider should be at the surgicenter for postoperative education and instructions.
11) To prevent deep vein thrombosis (DVT) you will be given 5,000 units heparin injection, thrombo embolic device (TED) hose, and sequential compression device (before, during and after surgery).
1) Communicate with your recovery room nurse (pain, nausea, etc.).
2) Do what you are asked to do.
3) Doctor will provide an abdominal binder (adjust tightness to comfort).
1) Anti DVT (blood clot in leg) program: leg/foot exercises, TED hose, and (you will be sent home with) portable Sequential Compression Device (SCD) to be used for two weeks after surgery. Get out of bed and walk around house every 1-2 hours while not sleeping. Leave SCD on while sleeping or resting for next two weeks.
2) Incentive spirometer every hour after surgery (improves breathing) after general anesthesia.
3) If drains used measuring cup and chart for recording out-put as directed.
4) Foley catheter: doctor will insert into patient prior to leaving surgericenter and have patient remove 6 hours after surgery (some patients develop urinary retention while general anesthesia wears off and will require re-catheterization.
5) Walking in hunched over position. Doctor will provide a "loaner" walker for patient.
6) Bed position "lazy boy" position (use recliner, hospital bed or pillows/foam wedges).
7) Diet progressive to prevent nausea: clear liquids (Gatorade, broth, tea) for first 8 hours, liquid diet next 8 hours (soups, pudding, and yogurt), and soft diet for next 8 hours (well-cooked oatmeal or pasta) after 24 hours regular diet.
Start stool softeners and anti-constipation program.
8) Pain management: Doctor will inject long acting local pain reducers into the surgical area and provide a postoperative non- narcotic pain pump reliever that lasts several days. It is ok to start using aspirin, Aleve, Motrin AFTER surgery and alternate with oral narcotics. Do not take pain medications on an empty stomach. Crackers before and after medications (to prevent nausea and upset stomach).
9) Incentive spirometer: helps open up the small breathing units found within the lungs that collapse during general anesthesia. Use once an hour while awake until you are able to obtain preoperative values.
c) First Four Postoperative Days
1) Wear SCD's 24 hours a day, anti DVT exercises every hour.
2) Use incentive spirometer (it opens up small breathing units in your lungs) once an hour until you reach your preoperative values
3) Walk hunched over (use walker provided) and sleep in the "fetal position" using recliner or wedges/pillows.
4) If unable to have a bowel movement; start over the counter laxatives and stool softeners.
d) 5th day to two weeks Postoperative
1) No restrictions in sleeping position or standing up straight. Use walker only as needed.
2) Non-narcotic pain-pump to be removed.
3) May shower but keep incision and drain exit sites dry (let shower spray back side and sponge bath front side of body.
4) May remove SCD during ambulation (walking upright) but wear at all times when not.
5) Progressive ambulation (walking upright) and stretching to point of pain and fatigue.
6) Wean off narcotic pain pills and replace with Tylenol, Motrin or Aspirin like over the counter medications.
7) May drive as tolerated (must be off narcotics).
8) May switch from provided binder to "spanks" like garment for comfort and support.
9) May return to work as tolerated.
e) After two weeks
1) Exercise to point of pain or fatigue.
2) SCD not required (may continue).
3) Report to office when individual drainage less than 25 cc in a 24 hour period for serial removal). May shower without restrictions when drains are all removed.
4) Start anti scar programs: Embrace and silicone gel strips.
f) After six weeks
1) No restriction on exercise (use good judgement).
2) Continue to wear "spanks" like garment for support and swelling (only as needed).
3) It will take 2-3 months for the majority of the swelling to be gone.
4) It will take 9 + months for the scars to "mature" (soften and lighten)
5) Enjoy your new body.
I trust you have chosen a Plastic Surgeon who is experienced and Certified by the American Board of Plastic Surgery. In addition ideally a members of the American Society for Aesthetic Plastic Surgery (denoting by membership as having met additional criteria and a focus on Cosmetic Plastic Surgery).
R. A. Hardesty, MD, FACS
Diplomate and Certified by the American Board of Plastic Surgery
Awardee: Real Self Top 100
4646 Brockton Ave
Riverside, Ca 92506