Friday, March 22, 2013

Second Pregnancies and Plastic Surgeons

If you're looking for pictures, ain't gonna happen. I am not ready to go there again. If you're curious how I fared and what I learned at the plastic surgeon this week, read on my friend.

Second Pregnancies

My diastasis is unchanged as a result of my second pregnancy. As in, it is not better and it is not worse. I actually felt somewhat pretty while I was pregnant because it was the first time I could comfortably wear t-shirts and tank tops in almost two years.

My weight gain with Lola was pretty standard -- 30 pounds -- and even though I carried the majority of that weight in my belly while I was pregnant, the strain of her growing inside me did not create a larger gap between my muscles. I did however "pop" much faster and it seems as though I have another hernia as a result of the pressure of her pregnancy on my insides.


I was back down to my prepregnancy weight at 16 weeks postpartum. Now, at 23 weeks postpartum, I have actually lost another 5 pounds bringing me down to my pre-IF weight. If it wasn't for my FUPA I would feel pretty good right about now. Losing more weight hasn't done anything to bring my abdominals in and my belly button is still detached. Although, as a result of the weight loss I do wake up with a nearly flat stomach. However since I have more than 5" of separation between the muscles, the fascia stretches throughout the day with normal consumption of water, coffee and food. There is no correction for muscle laxity that is this severe.

I want to repeat that again, because I get many emails about this. And I get where people are coming from because they are frustrated and sad and angry and hopeful that there is a non-surgical solution. So, once again...


Second Plastic Surgery Consult

On Tuesday I had my second consult for abdominoplasty. My first consult was at 5 months postpartum from the twins. So the timing is exactly the same, I just have one more pregnancy under my belt. The first surgeon was a tan, self-righteous prick with an awful bedside manner. This new guy that I saw was *nothing* like that (thankgod).

The staff was wonderful, he was wonderful. Many of them had also undergone IVF which made me feel a sense of camaraderie and connectivity on a personal level. Which, let's be honest, is helpful in being comfortable with choosing a facility.

I do not have enough extra skin to perform a traditional abdominoplasty wherein the surgeon would cut horizontally, repair the abdominal muscles, reattach the belly button, drape the skin that was previously above the belly button down to the surgical cut line and create a new hole for the belly button to stick through. My skin is loose from my stretch marks, but I do not have an excess of skin. As a result, I have two options for corrective surgery, one is more invasive (if that's even possible) than the other but it will also yield better results. This surgeon in particular automatically does liposculpting as part of the procedure to help with the overall post-surgical aesthetic.

Surgical Option 1

Cut horizontally and cut the belly button from the stem (a procedure called floating the belly button). This allows the surgeon to separate my skin tissue from the muscle and access my upper abdominals to repair the separation. He would then reconnect my belly button to the stem and remove any excess skin from below the belly button to the surgical cut line.

With this option I would keep all of my stretch marks that were above my belly button. Which is fine by me. This procedure is also slightly less invasive. Also fine by me. However, because I have stretched and looser skin above my belly button once my abs are pulled back the stretched skin will be more pronounced and may even look bunched. The effect will be somewhat loose skin above the belly button and tight skin below. Cosmetically speaking, this isn't the best option.

It would have been if my stretch marks had not gone all the way up to my rib cage. But with the steroid cream I was on as a result of my PUPPPS my skin broke wild and free around 33 weeks. (I am certain it would have broken regardless, but the steroids thinned my skin dramatically and it broke with reckless abandon within a week of using it. Then again, I probably just have shitty genetics and blaming steroid cream makes me feel better.)

Surgical Option 2

Cut horizontally, cut vertically up to the belly button and cut around the belly button leaving the belly button and stem in tact. Stitch the belly button back in place (right now it is herniated), repair the abdominal separation, pull the skin down to the surgical cut line over the existing belly button and create a new hole for it. That leaves a circular hole and vertical cut at the surgical line. The surgeon would sew the hole (that was from where they cut around my belly button) together and sew the vertical line together as well.

So I will have a roughly 1.5-2" vertical scar in addition to a horizontal scar with this option. The scar is a scary thing to me since I have never had a major surgery and I have no idea how my stomach will heal. However, cosmetically this will achieve the best look overall.


The surgery will take approximately 2.5 hours and is done as an outpatient procedure. The surgeon uses twilight anesthesia, which I liked because it means I will not have to be intubated. After the surgery is complete I go home wrapped up tight with a pain pump and two drains. The stitches are all internal so there is no need to come back and have them removed, there is just surgical tape that will fall off over time. The drains come out between the first and second week.

As for the pain pump, I don't remember how long it stays in for. It is novocaine that automatically disperses over the surgical area throughout the day to help with pain management, thus alleviating the need for the use of excess pain narcotics. It is $275 extra and worth every penny, since the pain meds will constipate you and who really wants to strain to take a shit after being sawed in half? Not this girl.

The first three days will be the worst in terms of the pain and the WTF was I thinking doing this? type of in your own head questions. After a week I will be able to be relatively mobile. However the doctor told me that I would need to take it easy for the first two weeks as much as possible. He also told me that the more active/on your feet you are for the first 4-6 months the worse that your swelling will be. I guess there are issues with the surgical sight retaining fluid from overactivity. I've read about this through various support sites as well.


My umbilical hernia will likely be covered by insurance, shaving nearly $3k off the total cost of surgery. The remainder will be out of pocket. For the surgery, operating room time, anesthesia and pain pump the surgery will cost $7800.

Typically the second option, which is the one I am electing to do, would cost more but since I am a skinny bitch he doesn't think they will need to do liposculpting with the procedure. So the extra time with the skin issues offsets the time gained with eliminating the liposculpting and in the end it's a wash.

My insurance company does not cover diastasis repair as it is considered a cosmetic procedure.

Next Steps

I honestly loved this surgeon. I had the pleasure of being able to talk to another one of his tummy tuck patients who is a friend of a mutual friend (if that makes sense?) and she raved about him and was very happy with her results. And this particular surgeon is married to my old pilates partner. I had no idea, I found out right before doing my consult there. I am 99.7% sure he will do my surgery when the time comes. But because this is a big decision, I am meeting with two other surgeons in my area just to make sure I am choosing the right person.

When the Time Comes

So what the hell does that mean? I really have no idea. In my little type-a head I have a plan, but like all well-laid plans it is destined to fail miserably. But since I have the plan mapped out I might as well share it with all of you.

I plan to nurse Lola through to a year (i.e. October). Then there is a series of craziness that ensues at our house. Joe's birthday, Lola's birthday, Halloween, Thanksgiving, Christmas, and the twins' 3rd birthday. I host the twins' birthday parties on MLK weekend because it is a holiday (i.e. long) weekend and so it makes travel for our families easier since they are all out of town. I am hoping to have surgery the week following the twins' birthday party.

The timing will be good because all of the holiday/birthday hustle and bustle will be over with and it'll be in the middle of January so hunkering down in sweatpants and compression garments won't be too unbearable (all things being relative). I am hoping to convince my mother-in-law to stay after the kids' party through President's Day -- so 2.5 weeks total -- to help take care of the kids. Joe will be able to take a the week of my surgery off as well. By week two I should be partly mobile and between him at night and my MIL during the day, I should be all set.

Now onto the complicated part of all of this...

My last frostie. A 4BB blast vitrified on day 5. If we had multiple embryos we would be donating them to research. Because we only have one embryo it is not eligible for research donation. We will not consider donation to another family. Which leaves me with two options: an FET or disposal. Literally going to my RE's office and pouring my embryo down a sink myself, because the office does not dispose of embryos as part of their policy.

The problem is I've seen what a little blot on a paper like that can become. And it's not inconceivable that I could have one more child.

I feel like our family is complete. I feel like I am done with this phase of my life. I feel like I am ready to move on. But it's really not that easy. And then there's the little thing called my marriage that I need to take into account. Some days I am not sure it'll survive the life we're living already. Forget about bringing in another tiny human. I'm also not sure my sanity would survive.

Then again I am not sure my sanity would survive if I just tossed that embryo down the sink. Cause I am a what if kind of gal.

So That's That

Once upon a time ago, someone commented on this blog and asked me if I felt like I had defeated IF. I think it was right after I conceived Lola. The answer is a resounding NO! Because when you still have to make decisions like this -- whether to have more kids or dispose of an embryo, you are still somehow in the trenches. Not the childless ones, not those. But the ones where the decisions are still difficult. I am ready to be past this stage. So ready.

So there are a lot of what ifs and a lot of things to think about. But for now I know that I will have a few more consults, I will have surgery, surgery will cost me a small fortune, recovery will be a pain in the ass and I need to work on myself and my family before I jump onto another gurney -- be that one with or without stirrups.

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