8th Liposuction for Lipedema and a Panniculectomy

In my last post from June (2018), I mentioned that I might need an 8th liposuction for lipedema.  My surgeon turned me down and referred me to a plastic surgeon that does difficult skin reconstruction cases at UMC Utrecht here in the Netherlands.

On Wednesday (22 August 2018) I had the appointment at UMC Utrecht and the good news from my consultation is the surgeon and his last year resident want to take me.  It will of course be entirely out of pocket since insurance won’t pay for it since my BMI is still too high.  I’m currently sitting at 122kg which puts my BMI at 43.  I wasn’t shocked, but I did request that they write a convincing letter so I can try to get insurance to pay.  Not counting on a dime from them (I’m sure I’m on my insurance’s blacklist by now) but who knows, maybe I can win another 10,000 euro from them on another administration error.  10k is 10k after all!

The Appointment at the Hospital

The main reason my surgeon referred me to the hospital is because of my weight and there is still a lot of fat left in the loose skin.  Overall it would be safer for me and I’d have someone very experienced in stomach reconstructions doing the work and taking care of me.  The big plus in this plan, due to all the risks of a lot of fat being left, my BMI, etc is UMC Utrecht is an university hospital.  The care will be extremely high even though it’s pretty likely I’ll be a fish in a glass bowl with all the students participating on my case.  I don’t mind, there’s a good chance I might be able to get either a video or pictures from the surgery itself! Also, I’ll be able to educate them further about lipedema so its win win.

For the appointment itself, I talked to a last year intern in the plastic surgery department before seeing the actual surgeon.  He was a really nice, good looking (hey, it’s important if I’m going to hit on him while coming out of general) guy and half American as well.  Additionally he already knew a little bit about lipedema.

He was upfront in saying that he’s not an expert, won’t pretend to be an expert, but knows the major bullet points.  He did have some questions about how hormones trigger it and if I really had tried everything possible to lose more weight before and after my liposuctions and I was happy to fill him in.  He then took a look at my stomach and said it’s going to be quite a big job and asked if I understood the risks.

He showed me where they’d cut and how they’d bring all the skin in together.  Then he went in to get the actual surgeon, who’s also the head of the plastic surgery department.

When the surgeon came in he took a look at my stomach and right off identified my upper stomach as being a problem (it was obviously not going to work out to make a nice waistline).  My husband and I of course had already discussed this with the resident but since this is a case he hadn’t dealt with before, he didn’t have the answers.

My main concern, of course, is if they could cut the fat out of my upper stomach or if they’d have to liposuction it out.  The surgeon agreed 100% that the fat in the upper stomach needs to be gone before he operates on me.  He said that sometimes they do liposuction along with the panniculectomy or tummy tucks but he didn’t like to do it with this much fat being left and at my BMI because (even though he agreed it’s a lot of loose skin and muscle left) it’s just one more thing to go wrong.

He also said he’s not a lipedema surgeon and wouldn’t know if he got it all out to my or my liposuction surgeon’s satisfaction.  In the end we agreed it would probably be best if I went back and had one last liposuction done by my own surgeon.  After the swelling goes down (about 3 months after the lipo) and I’ve healed a bit, he said I could have the panniculectomy.  So I wouldn’t have to wait a year for it all to heal and hope my stomach doesn’t start growing again.

My husband and I both agreed with this assessment and were totally on board.

Choosing to go with a Non-Lipedema Plastic Surgeon

One of the things that I see come by in the various support groups I belong to is the worry of using surgeons for liposuction or skin removal that aren’t lipedema experts.  Not going to lie, this was a big concern of mine as well.  I’ve actually gone out of my way to try to find some lippy liposuction surgeons that also did skin removal over in Germany to talk to.  However, the surgeons over in Germany were 1 to 3 years scheduled out and I really don’t have that luxury of time to deal with the remaining fat in my stomach.

After talking to this non-lipedema plastic surgeon I’m feeling pretty comfortable with him doing my panniculectomy.  Here’s why:

  1. He knew what lipedema was before I entered his office.  He admits he doesn’t know the finer points, but he knows broadly what it is and that there is no way to really lose the non lippy fat any other way than liposuction.
  2. He was perfectly happy to answer all of my questions and didn’t treat any of them as stupid.
  3. When I told him my concerns about the lymph nodes, he explained that in a panniculectomy they never cut near the big ones in the stomach and instead pull up the skin.  This is how all panniculectomies are supposed to be performed in order to reduce the chances of surgery induced lymphedema (why risk it, right?).
  4. He went over all of the possible complications including possibly losing my belly button (who cares, I’d have a smooth canvas for a tattoo LOL).
  5. He didn’t argue about my BMI being too high.  He simply stated there is an increased risk, which he’s willing to take on if I am.  He also stated there’s no way any dutch insurance will pay for it since it’s so high, it will come out of my own pocket.

At the end of the day, using a non lippy surgeon is always going to be a risk.

What the Panniculectomy Will Entail

So, here’s the nitty gritty.  This is a paniculectomy, not a tummy tuck.

Paniculectomy removes the “apron” of skin and tissue (both skin and fat) from below the belly button.  A Tummy Tuck tightens the underlying muscle.  Trust me, my abs are perfectly fine and don’t need to be touched.

Now that bit is out of the way, here is what my surgeon will actually be doing.

Under general anesthesia he’ll be making a horizontal incision between the pubic area and belly button.  Since I have a lot of loose skin on my upper stomach he’ll also make a vertical incision from the belly button up to under my breast.

They’ll cut out the tissue between my belly button and pubic area then pull the skin from the pubic area (raising my pubic line) up to my mid stomach and stitch that.  They’ll also pull the skin tight on the upper stomach and stitch up the vertical cut.  In the picture you can see how the pubic area is pulled up tight to meet the upper incision.

Oh, and here’s a nice video showing the panniculectomy.  They’re doing the upper abdomen liposuction (and other liposuction) but you can skip to 1:13 to see the beginning incision. At 2:04 you can see ow the pubic area has been pulled up to close up the incision. (WARNING: it is graphic)