Panniculectomy Tips & Tricks

I have recently had a panniculectomy to remove the large flabby flap of skin and fat left from being hugely pregnant thirty years ago. I'm collecting here all the tips & tricks I found out or learned later, in hopes that it'll help others. Don't try to read it all at once; it's too much. Pick a section and make plans from it, then come back for the rest later. 

Doing Research

• Figure out where you will have the surgery. 
• Look at many many pictures of top surgery results.
• I suggest a clipboard or folder where you start keeping your important top surgery notes together. Make lists of details you want to remember, questions you want to ask, a shopping list of things to get, concerns you have.
• Once you meet your surgery team, let them guide you. They'll walk you through the process. They've done this many times before and know what to do next. If they don't seem concerned about something, you shouldn't be either. 
• Keep a list of questions you have, so you're ready when you have a chance to ask them.

Insurance & Billing

• This is going to be the longest and most frustrating part of the whole thing. Set aside time to look at the money end of things when you have the spoons to do so.
• You can ask your insurance about the surgery before even talking to the surgery team. Send them a message (they probably have a client portal, and you'll want to go ahead and get familiar with it). They will probably have a form response they'll send back to you.
• Insurance pre-approval will happen on its own timeline, if it happens at all. Don't be in any rush, it may be several weeks.
• And the answer may be a non-answer. My insurance doesn't do pre-approvals or pre-authorizations for panniculectomies, so I've just got to hope it all goes through correctly.
• Get a prepayment estimate, but unless there's a discount for prepaying, try to wait until after the bills come in and you've collected them all.
• Sometimes you'll get a bill that is still pending insurance. Let them keep pushing for insurance to pay it. It's easier to pay later than to get a refund. But don't push it off so hard they start talking about Collections.
• There will be multiple bills & claims, and they won't match exactly. Wait for at least three months after surgery (if you can) to start matching up insurance claims & Explanations of Benefits with hospital bills. 
• If insurance won't pay something that it seems they should, ask your insurance provider if it would be paid with a different medical code. On some things, the hospital can change the medical code to something else and get it approved.

At Your Job

• Schedule as much time off for work as you can get away with. My team suggested three weeks off from work, but see what you can get covered. I'm planning to take three weeks totally off, then half-time for a month.
• Work with HR, and do all the paperwork. HR will need a letter from your surgery team, but you'll also want to look at whatever vacation/sick time structure you have available. And then you'll need to do paperwork for short-term-disability if you have it, and also do the FMLA paperwork (Family and Medical Leave Act). That protects your job when you come back. Probably won't be necessary, but cover your bases.

Prepare for Recovery

• Go through all this list and buy all the supplies you'll need. I took over a table at my house for nothing but surgery-recovery items.
• Plan to eat comfort foods that are easy to fix. You won't feel like fixing anything for the first few days, and you won't be able to stand around to fix things for a while, either.
• I already had a Rollator, and if you can get one for a week or two, I recommend having it in the car when you go for surgery. I think they took me out to the car in a wheelchair, but getting in from the car to the house, having that to lean on was a lifesaver. Getting around the house, I used it exclusively for the first five days. However, depending on it too much also irritated my back issues after a few days, so be aware of that. 
• Aside from that, rolling office chairs are useful too. I'm afraid to sit on my couch because I won't be able to get out of it, so I'm staying in my office chair most of the time. If you've been thinking about upgrading, before surgery is a good time for it.
• If you are able, get a power-lift recliner to sleep in for the first few weeks. I rented one for a month from Rent-A-Center for like $150. It was worth it to make sleeping on my back easy, and I didn't have to use abdominal muscles to stand up or lay back the first few days. A neck pillow may also be a good idea. And I also had a small pillow to tuck under a knee to help keep my legs bent.
• If you can't rent a recliner, you'll need to plan for how to keep yourself sleeping on your back, and how to get in and out of the bed. Others have suggested a wedge pillow or a pregnancy pillow with multiple regular pillows to make a nest.
• A bidet can be really helpful. Get it set up and get used to using it well before surgery. Wiping yourself may be difficult.
• A toilet riser was extremely helpful for me. It raised the height of the toilet several inches so there's not as much bending to get up and down for now.
• Schedule people to come visit and sit with you for at least two or three days - a week if you can. Just having someone to manage the remote, get a drink, and keep your spirits up is important. I made shifts for daytime, evening, and overnight, to make sure I wasn't alone at all for the first three days.
• Assuming you have daily meds you take, the surgery team will tell you which medications to stop when, and when to restart them. Write it down, and follow it.
• If you have one of those grabber tools, find it and have it within reach, too.

Surgery Day

• Take off the day before surgery, too. Use that day to take care of you, and to handle things that will be harder after. Get a massage, a haircut, fill up on groceries, refill prescriptions, make sure the car has gas. Go out to eat and do all the 'out and about' things you enjoy. 
• I shaved my head and face the day before so I wouldn't have to deal with that for several weeks. I was told not to shave any hair on my belly beforehand, and let the surgery team shave what they need to.
• Wear pajamas or something super-comfy in to the surgery center. Be as comfortable as you can. Your top will need to be a button-up, not a pull-over. Shoes you can slip on and off easily.
• There's a lot of killing time and waiting, so have a book or kindle or something. Pick light reading that you don't have to think about and don't need to remember later.
• You'll have a person with you to be a driver. If you're okay having them in the room with you, ask them to be in charge of all your things. Have a notebook for them to write down names of people, instructions you're given, and answers to questions you ask. You probably won't remember anything later (yay drugs).
• When you wake up, you'll have a sore throat from the breathing tube. This is your chance to demand a milkshake or something on the way home. I suggest having apple cider or juice that you can microwave to drink for the next few days.

Binders & Drains & Clothing

• Figure out what you can wear afterward. You'll have staples or stitches and drains and a binder to deal with, so if you can avoid anything with a waistline, do it. I have a zip-up fuzzy house-robe that I lived in for the first two weeks.
• You'll be sent home from surgery wearing a surgical recovery binder. You'll be wearing it like 23 hours a day every day, and it gets old really fast, but it helps.
• I used a small keychain carabiner to clip the drain bottles together and then onto attachment points. I had a lanyard for using in the shower, another lanyard for not in the shower, and a binder clip that I clipped at the top of my surgical binder, and attached them to those as needed. 
• Use some old clean cloth diapers to pad inside the binder against your incision if it helps to have a little pressure on it.
  
• Your old underwear may not fit, but with the drain bottles and everything, they may, after all, for now. I found that a previously-tight pair of boxer briefs would hold everything together and up. If you're having a lot removed, maybe buy a couple of pair of a few sizes down to have. Wait until you need them to open them so you can return any you don't use.
• Once you're cleared to go without the binder (for me, after my first post-op), some biker shorts provide light compression that helps. Get the high-waisted kind with pockets on both sides, and you can tuck your drain bottles in there. I'd get the smallest size that would fit you before surgery, and maybe the next size down, depending on how much is being removed. Get them from Amazon and return any you don't need afterwards.
• Socks are going to be hard to put on and get off for the first week or so. You may want to use a sock aid.
• Pajama pants that have both drawstrings and pockets are great - you can put the drain bottles in the pockets and give your neck a rest from the lanyard.
• But, because the skin on your belly will be stretched down, anything with a waistband gets old fast. Or even just seams on underwear. Instead, I practically lived in a zip-up house-robe I have for the first week or so, then began alternating the robe with pajama pants or biker shorts.

The First Two Weeks - Draining

• The first week or so is just survival mode. Eat, drink, sleep on whatever schedule your body wants. Take all the drugs they gave you. Watch a lot of TV.
• Drink lots of fluids to help flush out everything. Keep a cup next to you full of water. Get whatever flavor drops you like to give you some variety in taste. I like the Kool-Aid ones myself, and cycle between orange, cherry, and grape. Use a big cup with a bendy straw so you don't have to lift it, and have your people refill it for you. I was very thirsty - probably due to one or more of the drugs.
• The meds will give you some wicked dry-mouth. Keep that cup of water nearby, and some mints or hard candies, too.
• Have a chart or list or something to track what meds you took when and when your next dose is due. The meds will make you stupid; write it down. Set alarms if you need to.
• You may want to take Benadryl if the drain sites itch - don't try to scratch at them; it'll just make it worse.
• If you get constipated because of drugs, add a gentle laxative as needed. Have Gas-X ready, too, if you need it. And drink some more water.
• Since you scheduled people to come sit with you... let them help you. Don't try to get up and do things yourself; this is when get to be lazy and let everyone else do things. Healing is a full-time job right now; don't do any more than you have to.
• You'll have a lifting limit of ten pounds for a while. Stick within it.
• I had this list of things I was going to do during recovery while I was off work. I did not do the things. What I did do was watch a lot of TV. I picked some movies or a TV show with each of the people coming to sit with me, and we binged those together. What you need isn't a list of Things to Do; you need a list of Things to Watch.
• Since you can't shower yet, you'll want to wash off a couple times a day with shower/bathing wipes. Use them liberally, because you'll have extra body odor thanks to the drugs, too. Don't forget deodorant, either. Spray deodorant may be easier to apply right now.
• My team told me after 48 hours, I should take daily showers. I didn't feel like it until like Day 4, and then had someone with me to help for the first couple. You'll need to face away from the water so it's not pounding on the incisions, but by this time, you really appreciate the shower. 

The Next Month - Resting

• At my first post-op, the surgery team told me to wear the binder sometimes, like maybe at night, but it's not necessary all the time. The compression can be comforting, so wear it as much as it helps.
• Somewhere in here, you'll go back to work. For me, it worked out well to go back to work half-time, since I work from home. That meant I was still able to take a nap every afternoon. Napping is important at this stage. Even if it's just laying down for a while.
• I had a lot of trouble with my back the first several weeks, because of the leaning-forward hunched-over position I had to be in (standing straight up isn't advised, and isn't comfortable, for a while). Laying down for a while helped it stretch out.
• I also started hurting from the position I had to sleep in after a few hours, so my sleep schedule turned into 3 hours or so of sleep, getting up for an hour, then back to sleep for a few more hours.
• Don't drop off all the meds just because you're doing better. You'll be less exhausted if you hurt less. If you need more of something, ask your surgery team for it.
• Start getting active again, too. I tried to take an extra walk every afternoon, especially when I had someone with me. I didn't have people staying with me at night after the first week, but I did try to have company every afternoon to help me do things.
• They'll take the drains out one of your post-op appointments, maybe the first one, or maybe a few weeks out. It's based on how much is still draining. I kept one of my drains almost a month. 
• If you have staples rather than or in addition to sutures, they will also be removed at a post-op appointment. Most of the staples won't feel like much being pulled, but some will pinch, and a few will be awful. It has to be done.
• The way they'll remove the drains, though, is untape them, then tell you to breathe out while they gently pull them out in one long motion. It is a very weird feeling as they slither out. Not all that painful, just really uncomfortable, but alarming in its strangeness.

Two More Months of Recovery

• You'll still feel like you're 'recovering' until at least six weeks post-op. Try not to obligate yourself to anything at all before then, and be kind to yourself even after that if you need more rest or help from someone else.
• Weight restrictions will increase quickly now, but don't push it. Listen to your body about what you can and can't handle. 
• The first bath is a wonderful thing, as well as just being able to wash your own self and dry off without help.
• Spending more than a month not doing things will make you weaker. I'm lucky enough to be able to go to Physical Therapy regularly, so that's something we're working on now. If PT is available to you, go to one and ask them to help you recover. Insurance should pay for some amount of PT, and you usually don't need a referral.
• Some things may need later consultation with the surgery team, but after 12 weeks/three months, you're generally considered free and clear to manage yourself. You're 'done' as far as they are concerned.
• Get in the habit of stretching multiple times a day to get your flexibility back.

Additional Resources