Re: Plastic Surgery - info on Mt Sinai Meeting

[Guest guest]

In a message dated 12/20/01 3:59:58 PM, duodenalswitch writes:

<<

Congrats-That is great. I am still waiting to break that 200 but I know it

will happen. Did you get the Plastic Surgeons name and how was the meeting?

>>

Hi, Ellen(Pam: You WILL break that 200 plateau... I know how frustrating

that can be! Yikes! :) Warm vibes goin' out to you!

The surgeon who spoke was Zachary E. Garut. He teaches at Albert Einstein

Medical Center (and I think his 'offices' are located there but I wasn't sure

about this) and he's affiliated with two Long Island hospitals: Northshore

and Winthrop. He is board certified with the American Board of Plastic

Surgery.

He was very informative - no handouts but a powerpoint show. I think he has

quite a bit of experience dealing with WLS patients and this was a breath of

fresh air. I've been doing quite a bit of surfing on the issue and it

doesn't seem that many plastic surgeons really specialize in having us as

patients.... One of his most famous patients is our own Jill Sokol!

He does not accept insurance so if you have a Point of Service Plan you could

see him as 'out of network' and the insurance will cover whatever percent

after your deductable. Of course, that deductable would cover initial

consultation, office visits, etc. and the like in addition to the actual

surgery.

He does the surgery in his office -- having the person usually stay overnight

for observation. I liked that he said he filled the area with a local

anesthetic so one isn't in outrageous pain immediately in recovery. He also

injects the area with novacaine so less anesthesia is required for the

surgery. He said the time under can be extensive b/c there is a lot of

stitching and he does it all (he doesn't want an assistant and risk that the

stitching on one side may be different from the other).

He said that one should be at maximum weight loss when undergoing the

procedures. He mentioned that any combo was possible except those that were

prohibitive (a tummy tuck and arm job, for example because one would need one

set of these muscles to move after an operation and couldn't have them both

healing at the same time). He said the combo could be decided between

patient and doctor and the order in which one has the operations done is also

open.

With the breast reduction, he does a 'lollipop scar' and avoids nipple

grafting (nipple aureograft) at all costs. He said that the bigger/lower the

breasts, the more loss of feeling that may occur. I asked him about how a

reduction/lift can interfere with future mammograms: He said that fat

necrosis (which causes a kind of calcification in the breast) is pretty

common after the surgery. It isn't visible outside but will show up on a

mammogram as suspicious tissue (akin to cancer). So, if one does develop

this, it may cause more intensive observation, perhaps biopsies, etc. to rule

out cancer. A 'lift only' may reduce the calcification but it still may

present itself during a future mammogram. Something to think about.... I'd

like to find more research and opinions on this, too...

He suggests getting a mammo before the surgery then one year afterward. That

post-op mammogram will then become the 'new baseline' for future mammos.

And, the operation should not interfere with breastfeeding but he did suggest

that pregnancy might 'undo' the lift/reduction and a person should *ideally*

be done with childbearing to maximize the plastic surgery's effects...

As far as the tummy tuck is concerned, he confirmed that one would have less

back pain after one since the excess skin/fat would be removed. Also, he

holds the panni up and lets the blood drain back into the body to conserve

blood (this would also help those who may be anemic). He said he prefers NOT

to do transfusions, even self-stored blood because he thinks there still is a

slight risk (i.e. - who knows what has been done, who handled it, etc. when

it went into storage). he would rather put a patient on Procrit or another

red blood cell enhancer if needed post-op (or pre-operatively?) for anemia

rather than transfuse a patient during surgery.

He also clarified that the stomach muscles are pulled INWARD towards each

other rather than 'upward' with the tuck. He explained that if the muscles

are separated they are not going to magically come together even with

exercise/toning. The condition of the 'panni' may be reduced but will not be

eliminated with exercise, etc. He strongy suggested having pregnancies

BEFORE the tuck because it could become stretched with a future pregnancy.

One cool thing he mentioned about the lower body lift was that he takes a

piece of the fat lying in the lower back and imbeds it in the buttocks...

this prevents people from having totally flat or non-existant butts after

having their lower body lifts. He says it didn't present any circulation

problems or anything and provided that 'natural' extra padding. He wished he

could do the same for breast lifts!

The insurance lady mentioned that we all had medical necessity having lost

100 lbs or more. Insurance approval is usually given about 4 weeks after the

initial consult/exam. She mentioned a 99 pct approval rate.

Anyway, here's the info if anyone is interested in making an appointment or

using it for future reference:

Zachary E. Gerut, MD

960A Park Avenue

New York, NY 10028

1245 Colonia Road

Hewlett, NY 11557

All the best,

lap ds with gallbladder removal

January 25, 2001

Dr. Gagner/Mt. Sinai/NYC

10 months post-op and still feelin' fabu

preop: 307 lbs/bmi 45

now: 194 lbs (yahoo!)/bmi 28/size sweet 16 but squeezin' into a 14! LOL

[Guest guest]

Theresa -Thank you so much. Ireally appreciate the info. Ellen(Pam

[Guest guest]

In a message dated 12/22/01 8:32:43 PM, duodenalswitch writes:

<<

Theresa -Thank you so much. Ireally appreciate the info. Ellen(Pam

>>

Ellen(Pam: Oh, you are most welcome. I know quite a few people were

interested in the topic but couldn't make the meeting. I took notes and just

wanted to give a synopsis of what the surgeon said... I am now researching

the topic more thoroughly since I " m *considering* a breast lift/reduction and

PERHAPS a tummy tuck (if needed - I still have some more time to lose, right?

ROFL)

all the best,

[Guest guest]

Arms and Tummy are my main thrust. I have a decent size hernia so I rthink a

tummy tuck is in order. Don't you?Ellen(Pam