"Operation Fix Me"

For several years, I have hemmed and hawed about having reconstructive/plastic/cosmetic surgery to remove excess skin on my upper and lower abdomen and a breast lift.  Recently, this has come to the forefront of my mind and I had two consultations today.  I am scheduled for a third consultation next week, but I am fairly certain that I will cancel that appointment.  

If you are interested in seeing my thoughts and other info on each of the surgeons, feel free to keep reading.  At this time, I will be referring to the surgeons as "Surgeon 1" and "Surgeon 2".  This is simply out of respect for them and my decision-making process.  Once I select a surgeon and set a date for the surgery, I may decide to provide more information.

Here goes:

1.  Are you board certified and by what medical board? If so, how long have you been certified?  Both surgeons are members of the American Society of Plastic Surgeons, American Society of Aesthetic Plastic Surgery, Southeastern Society of Plastic and Reconstructive Surgeons, North Carolina Medical Society, and North Carolina Society of Plastic and Reconstructive Surgeons (Surgeon 2 is past president of the NC Society of Plastic and Reconstructive Surgeons)

2.  Where will my surgery be performed? If the surgery will take place in a freestanding surgical center or in the surgeon's office, your operating room accredited? If so, by whom?  May I see it?

• Surgeon 1 - All procedures for those that are "healthy" are done in the office surgical suite.  The office has 2 full operating rooms.  I did not ask about accreditation and was offered to see the surgical suites if I selected their practice to perform my surgery.
• Surgeon 2 - All procedures are performed at Rex Hospital.

3.  Do you have hospital privileges? At which hospitals? If not, did you lose those privileges?  Both surgeons have privileges at Rex Hospital, Wake Med (Raleigh) and Duke Health Raleigh Hospital.  

4.  Can I see before-and-after photos or your patients?

Both surgeons showed me an extensive photo library of patients. 

5.  How extensive will my scars be and where will they be located?

Both surgeons reviewed their proposals for a breast lift.  Both proposals were just as I expected them to be - and no different than any research I had done on the Internet.

Surgeon 1 - The proposal would be to do a "fleur de lis" (right picture) abdominoplasty.  This would combine the use of the regular lower abdominal incision and a midline vertical incision.  He explained that this procedure was reserved for those that needed extensive skin removal.  

I was pretty uncomfortable with this proposal.  The extra incision increases the risks associated with the surgery.  This would also lead to another very large scar.

Surgeon 2 - The proposal would be to do a traditional abdominoplasty, with a slightly longer/wider incision.  He basically said the incision would be "bed to bed" (hip to hip?) and would allow him to get the most tightness possible.  I asked about the possibility of his doing the "fleur de lis" type incision and he assured me that he could achieve the desired results without the extra incision.  

  

6.  How long will the surgery last and how long will I be under anesthesia?  Both surgeons said the surgery would be between 5 1/2 and 6 hours.

7.  Who will administer my anesthesia?  Both surgeons use a CRNA (nurse anesthetists) for anesthesia. 

8.  What would you do if I were to have a complication?

• Surgeon 1 glossed over this question.  He stated that in all the procedures he had done in their offices surgical suite, he had never had a problem.
• Surgeon 2 reminded me that my surgery would be done at Rex Hospital.  While I would be his patient while in the hospital, the hospitalists/surgeons, etc. at Rex are willing/able to assist if the need arises.  

9.  What types of medications will I be given and which pain medications do you normally prescribe?

• Surgeon 1 prescribes two oral narcotics for pain management - oxycodone and hydrocodone.  
• Surgeon 2 uses a "pain pump" for all abdominoplasties.  He believes that the use of well-placed long-acting pain relief is best for the initial 24 hours after surgery.  This does not eliminate the need for oral narcotic pain medications, but limits the need.    

10.  If I need anything after normal office hours postoperative, how will I be able to get in touch with you or your staff?

• Surgeon 1 stated that the three doctors in the practice work very closely and one was always on call.
• Surgeon 2 is in practice by himself.  He requires that patients having 1 or more procedures in a day stay at the hospital overnight.  This allows him to monitor progress during the most difficult period of the recovery (first 24 hours).  After leaving the hospital, he and his nurse remain available to patients.

11.  How long do you recommend I take off from work, school, etc. to heal properly?  Both surgeons suggested being physically out of the office for 2 weeks.  After about 1 week, I can work from home some but need to remember to take it easy.  They both suggested transitioning back into work with a part-time schedule for about 1-2 weeks.

12.  How long after will I be able to walk, exercise, run, or participate in contact sports?  Both surgeons said that I will need to be up and trying to walk regularly within hours after the surgery.  As far as running, etc., I am looking at somewhere in the 3-5 week range.  Surgeon 2 was very matter-of-fact and said that some of this is "...just plain 'ole common sense..."

13.  How much will my surgery cost, total?

• Surgeon 1 - Total of $13,547.50.  This includes: extended abdominoplasty ($5,800), mastopexy ($3,187.50), plus anesthesia and facility fees  (This does not include an overnight hospital stay.  My surgery would begin around 8 a.m. and I would depart the office around 3 p.m.)
• Surgeon 2 - Total of $12,318.  This includes: extended abdominoplasty ($3,850), bilateral breast reduction/mastopexy ($3,000), plus anesthesia and facility fees (This amount includes an overnight stay at the hospital.  I will be in my room around 2 p.m. and would depart around 2 p.m. the following day.)

14.  Are there any hidden costs that I should know about, such as for lab work, postoperative check-ups, additional medications, and postoperative garments?  All charges are covered in the fees above.

15.  Do you offer financing? Do you expect full payment up front?  Can I pay in installments?

• Surgeon 1 required a $75 consultation fee.  A deposit of $500 is required to schedule the procedures.  All payments must be made 14 days in advance of the surgery.  There is financing available with M-Lend Financial.  
• Surgeon 2 required a $50 consultation fee.  A deposit of $500 is required to schedule the procedure.  Payment in full must be made 21 days in advance of the surgery.  Financing is available through CareCredit.