Abdominoplasty (tummy tuck)

[Miss Clara]

Will transition ever end?  I fear not.  There's always something more to accomplish. 

Four days ago I underwent a tummy tuck operation.  I'm sure many of you can relate to the dissatisfaction of having a cylindrical torso shape, i.e., no definable waistline.  Unlike others, I didn't benefit from any fat redistribution to the butt, hips and thighs.  It pretty much stayed in the tummy area in a typical masculine contour.  Ugh!

So I went to my BA surgeon to discuss body contouring options.  He did a great job on my boobs, so I had every reason to put trust in his advice.  He discouraged me from hip implants without hesitation.  He told me that there's little in the way of tissue covering the hips so they often look unnatural, and without a pocket to hold the implant in place, they are likely to migrate.  Fat transfer to the buttock was not an option either because I don't have enough donor fat cells anywhere on my body (most of his natal women patients have the opposite problem).  Butt implants was another option, but because the implant is placed in a pocket incised within the gluteus muscle, that muscle needs to be fairly thick.  At my age, and having experienced muscle loss from HRT, having butt implants is risky.  He was concerned that the implant could break through the muscle in time and look unnatural.  I haven't decided to pursue the butt implant option as yet.

He did suggest that an aggressive tightening of the abdominal muscles was feasible to produce a feminine waistline of sorts.  He noted that I have significant separation of the abdominal (recti) muscles which cannot be corrected my exercise (crunches).  The operation involves exposing the abdominal muscles through a hip to hip incision (bikini cut), and pulling the muscles together using permanent sutures running vertically from the breast bone to the lower abdomen.  How aggressively he can tighten the muscles depends on the strength (thickness) of the muscle fascia which covers the muscle.  Mine turned out to be stronger than expected, so I'm expecting a good result.

I've had all the surgeries, except VFS, and I have to say, this recovery is the most painful yet.  GRS was a walk in the park compared to this one.  I have a struggle just walking to the bathroom.  I've caught myself thinking why did I ever choose to do this??  Thankfully, my SO is here and willing to do most everything for me that involves putting tension on my incision and internal stitches.  I'm told it'll be at least 6 weeks before I get back to normal activities.

I've still got a drain tube coming out of my tummy, and the liquid is gradually reducing in volume and redness.  I am wearing a compression band around my tummy to help reduce swelling, but clearly swelling is present.  My goal now is to heal to a flat tummy, visible waist, a thin white scar, and then to get on with my life. 

[jentay1367]

You're a pretty brave chick, Clara. I hope you get that hourglass figure you seek. I'd like to do what you've done but don't think I'm tough enough for that one! Congratulations,  though.  This is a tough row we choose to hoe...lol

[Karen_A]

Four days ago I underwent a tummy tuck operation.  I'm sure many of you can relate to the dissatisfaction of having a cylindrical torso shape, i.e., no definable waistline.  Unlike others, I didn't benefit from any fat redistribution to the butt, hips and thighs.  It pretty much stayed in the tummy area in a typical masculine contour.  Ugh!

i hope you heal well and the results are what you hope for!


I have been looking into body contouring procedures for both some of the same reasons as well a different one...

I have been on HRT 21 years and post-op (SRS with BA) close to 19 years and post FFS (Dr/ O - the works) almost 18 years...

I too never got the fat redistribution to the backside or hips and almost no natural breast development... and I am cursed with a very big male type frame  with a broad back, big ribcage, no hips or backside to speak of etc etc...

It really killed me when after all the time on HRT and the surgeries I would get read because of my body (seated at a table i pass well... standing, particularly when seen from behind is a different story)...

But there is another factor that has me thinking about the body contouring...

I always hated my body with it's big frame (i was always one of the biggest framed kids even in grammar school), so from a young age so I never paid any attention to it and well eating was a way to anesthetize myself ... I guess it was better than drinking or drugs, but it has it's own downside.... I put a LOT of weight on and was very heavy.

When I decided to transition I got the motivation to care about how I looked and lost 160 lbs (not a typo) before the surgeries.  A few years afterward when I was till getting read I got depressed and put the weight back on in fact I put back on 170lbs .... even though it did not go to the right places, paradoxically it does help with passing... but a at very steep price socially.

Some years later when it looked like my job might go away ( they were having money trouble) I got very afraid about not being able to get another job looking like that, so I lost most of that weight again... The company did eventually go under ... Once I got another job my weight started drifting up again but ONLY to a little less than 50lbs...

This year I turn 62 and it will be 20 years since my legal name change... and I'm considering one last push to see if maybe I could look like a normal reasonably attractive woman (even if a senior citizen now)... So I started losing weight again... so far almost 15lbs... To get to a healthy weight by BMI I need to lose another 60ish lbs...That would put me at about 200lbs weight loss from my highest weight!!

Maybe now you can guess the second reason I am  considering body contouring... Quite simply it having a Lot of extra skin all over... This is a common issue with massive weight loss, most commonly associated with those who have had bariatric weight loss surgery...

More skin grows when you put on weight, but past certain point it does not contract when you lose it and it gets worst with age. I already have a lot and will have a lot more if I do get down to a healthy weight... And of course with my frame and where fat naturally tends to stay, i will make my frame more obvious again...

So basically I need the body contouring to get rid of the lose skin essentially everywhere ... But also need fat grafted to the hips and backside too (which is iffy because of the potential for reabsorption) ...

It would be a LOT of surgery with potential complications (and often needs to be redone to get right), a Lot of money which would difficult in and of itself, and LOT of pain and long recovery times, and lots of scars... It would take a VERY skilled surgeon with a good eye aesthetics and the challenges of dealing with a male frame...

At my age it might be insane to even contemplate it... but being able to look like a more normal woman with all that goes with that is what I always wanted ... Don't know what I will do. The finances alone are daunting and there is a lot of risk... But for now I will keep trying to lose weight...

Some links on body contouring after massive weight loss for those interested... 

FYI: While all the pictures in the surgery link are clinical in nature, they do show naked bodies where gentiallia can be seen

https://www.intechopen.com/books/body-contouring-and-sculpting/body-contour-surgery-in-massive-weight-loss-patients


Here is a link on the psychological aspects:
"Changing Body Image and Well-Being: Following the Experience of Massive Weight Loss and Body Contouring Surgery"
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4934463/#

[Rachel]

Clare, I hope the pain subsides soon. I agree, you are tough.

Karen, I wish you luck on the contouring.

[Dani]

I had a tummy tuck about 6 months ago. My goal was to just tighten the loose skin, but my surgeon suggested sutures to tighten the abdominal muscles as well. I am glad I let her do her job.

Yes, it hurts. It hurts constantly for about 2 weeks. At one month, it feels better, but when I move it stills feels like I am about to tear something inside when I contract my abdominal muscles. Situps are out of the question. After 2 months, I can move about without too much trouble. No pain in normal movements, but situps are still not possible. After 4 months I can do abdominal crunches without any problems, but leg lifts are difficult to do. Now, I am at 6 months and situps and legs lifts are no trouble at all.

The results are amazing. Unless you are very young, no exercise program will do what a tummy tuck will do. I now have a significant curve in my waist in the proper direction. Yes I am still large, but I measure 43-34-42, which puts me in a size 16 women's dress. I am happy with that.

[barbie]

Yes. Beauty sometimes asks pain. Hopefully you will recover soon and be satisfied with the outcomes.

I have never tried any adventurous medical procedure at that level of pain. My only solution for tummy tuck is running and hiking, and I am 53 yr old. For example, yesterday I ran a full marathon course (42.2 km), despite heavy alcohol drinking the night before. Yes. It was painful, too. I suffered from thirst, although I drank water ceaselessly. One blister in each foot. And some minor leg muscle pain. I feel a slight decrease in my tummy size, but I need more exercise to wear bikini this summer.

barbie~~

[Karen_A]

I have never tried any adventurous medical procedure at that level of pain. My only solution for tummy tuck is running and hiking, and I am 53 yr old. For example, yesterday I ran a full marathon course (42.2 km), despite heavy alcohol drinking the night before. Yes. It was painful, too. I suffered from thirst, although I drank water ceaselessly. One blister in   each foot. And some minor leg muscle pain. I feel a slight decrease in my tummy size, but I need more exercise to wear bikini this summer.

I hope you realize the issue we are talking about solving here can NOT be solved by ANY amount of exercise... and for some of us it's not about beauty or vanity... it is about looking more normal.

- karen

[Karen_A]

Yes I am still large, but I measure 43-34-42, which puts me in a size 16 women's dress. I am happy with that.

I would take that in a New York minute! How were your HRT results... Did you get fat migration to the hips and behind? As i said I did not at all even after all tees years.

I assume the 43 is bust size.. my circumference under my breasts at my lowest weight was 42" and I doubt it will get much smaller no matter what... Clothes choice would be a lot easier (and potentially cheaper) if my band size could get down to 38 but that is not in the cards.

You mentioned you lost about 100lbs... How did you do it?

For myself I lost about 160lbs twice with just dieting.

I am not sure what weigh I should be shooting for... there is a lot of excess skin (which is weight I can't lose) and I also have scoliosis as well as a bit of a hunchback so BMI calculations might be off for me.

- karen

[Karen_A]

I am not sure what weigh I should be shooting for... there is a lot of excess skin (which is weight I can't lose) and I also have scoliosis as well as a bit of a hunchback so BMI calculations might be off for me.

Also when I was in my late 30's before I started HRT I was 5'11.75" essentially 6 ft with big guid... At my last doctor's visit I was measured at 5'7.25"... Some of that may be posture but again makes me wonder how well the BMI calculation applies to me! That is another reason I have no idea what weight I should target.

I need more than a tummy tuck... I need a thigh and arm lift as well with all the hang in skinI have now (and I still need to lose at least another 50 lbs - possibly more) . My backside , even though it never got proportionally big, probably needs a lift (as well as plumping too)...

I looked over Dani's old posts... looks like she got a LOT better HRT results than I did even though i started HRT when I was  20 years younger than she did... <sigh>

- Karen

[Miss Clara]

It's day 5 post-op and I'm feeling much less pain.  I'm almost pain free while quietly reclining or lying in bed.  It's getting to a standing position and moving about that is still a challenge.  Oh, and coughing is excruciatingly painful, so I try hard to avoid that.  The Hydrocordone-Aceteminophen pills take some of the edge off.  Overall, I think my recovery is going well.  I see my doctor tomorrow for evaluation and to have the drain removed.  He will also change the tape covering the abdominal incision.  It's very important to keep the incision tightly closed and under minimal tension to avoid forming a hypertrophic (raised) scar.  Silicone gel (e.g., Kelocote) applied to the incision has also been shown to help reduce keloid scarring.

Separation of the abdominal muscles (diastasis recti) is commonly seen in women who have had children, but is also associated with obesity, and natural aging.  I was never overweight, due to my genetics, mainly, and never pregnant, obviously, but I still developed about 2-1/2 inches of separation between my abdominal muscles.  Internal (viseral) fat buildup can cause separation as well.  You can test if ab separation has occurred by lying on your back and doing a crunch.  As the abs are flexed, a bulge will appear down the center of your stomach if there is separation.  As mentioned, no amount of exercise and strengthening of the ab muscle will close this gap.  It can only be closed surgically.

Prior to my operation, I was instructed to wear a corset 24/7 for two weeks.  Doing so helped push my internal organs down into my pelvis so that an aggressive tightening of the abs could be done.  The tough fascia tissue covering the ab muscle, stitched together, acts as an 'internal corset' which produces a narrower waist.  Even a small reduction in the waistline has a nice feminizing effect.  After several months, the internal sutures scar over producing a permanent result.

Because only a small amount of loose skin was removed from my tummy, the abdominal incision only needed to be 10-1/2" long to do the muscle tightening (ablation) all the way from the breast bone to the pubic bone.  Longer incisions are needed when large amounts of loose skin are also excised.  The incision scar was placed so that it's covered by my panties.

BTW, I had to go off estradiol for a week ahead of surgery, and was told stay off for 2 weeks post-op.  My doctor is super careful to avoid blood clots forming in the legs (DVT) that can happen after surgery of this type.  I have been experiencing varying amounts of depression, moodiness, and frontal headaches as a result.  I'll be so glad to get back to feeling normal again.  (sigh)

[jentay1367]

Jeeesh.....as I said before, you......are........one......tough.......cookie.

[Dani]

Prior to my operation, I was instructed to wear a corset 24/7 for two weeks.

I wore my corset for 2 months. It does help with the pulling feeling when you use your abdominal muscles as in getting up from a sitting position or coughing.

I looked over Dani's old posts... looks like she got a LOT better HRT results than I did even though i started HRT when I was  20 years younger than she did... <sigh>

Karen,

I neglected to mention one more secret ingredient.

Genetics.

My genetics are remarkably similar to Kim Kardashian. Women in my family are known for hourglass figures, if we keep our weight down. Unfortunately, some of us are grossly obese. Life is just not fair.

I assume the 43 is bust size.. my circumference under my breasts at my lowest weight was 42" and I doubt it will get much smaller no matter what... Clothes choice would be a lot easier (and potentially cheaper) if my band size could get down to 38 but that is not in the cards.

My chest measures 39 inches under the breasts. I comfortably wear a size 40 D support bra.

You mentioned you lost about 100lbs... How did you do it?

A diet heavy in vegetables. 50% fresh vegetables, 25% fresh fruit and the rest a little bit of lean meat, little bit of bread and a little bit of dairy.

For myself I lost about 160lbs twice with just dieting.

I am not sure what weigh I should be shooting for...

I shoot for about 20 % body fat, the same as many healthy women. Not too thin and not too thick.

Losing weigh through diet alone requires a permanent change to your eating habits. Watch your portion sizes. Calories still count and too many calories of the proper foods will still cause weight gain.

[Miss Clara]

Day 10 post-op.  I'm feel better and better each day, but progress is slow.  I had the drain removed on day 6.  OUCH!  I'm off pain meds now.  What pain I still feel is useful in keeping me from flexing my abdominal muscles which I don't want to do yet.  The worst thing possible would be to pop the stitches that are tying my abs together.  I still have a lot of swelling in my tummy and groin area, and there's a general numbness across my whole stomach and abdomen.  The incision is still covered with tape, so I can't tell how it's healing. 

I resumed taking E today.  It's bad enough to suffer through surgery recovery without having to endure the discomfort that comes with being off hormones.  Plus, I suffered prolonged low grade headaches over the past 3 weeks.  I normally never get headaches.

When I look at myself in the mirror without the compression bandage around my waist I can see the effect of the surgery.  My tummy is very flat now despite the presence of swelling.  There's no loose skin.  I can see a bit of a waistline now although it's not very pronounced.  Still, even a little bit comes across more feminine than masculine which was my hope.  Only time will tell if that improves or gets worse, and whether it was worth it.

[Miss Clara]

Day 23 post-op.  I feel pretty good.  I get around fine now except that I'm still wearing a compression bandage, and will continue to do so until this seroma is gone.  I have a seroma, a pocket of fluid beneath the skin of my upper abdomen.  It's not huge, but it has to be drained (aspirated with a syringe) every couple of days by my doctor.  He's pulling about 15cc of serous fluid out each time.  It's so frustrating, but he said seromas are a common complication of abdominoplasty surgery, and usually clear up in a few weeks. (sigh)

[Miss Clara]

Day 26 post-op.  I see my doctor tomorrow for what I hope will be the final aspiration of any remaining serous fluid.  The most recent extraction was 9 cc, and the one before that was 15 cc, so I'm nearing the end.  The generalized swelling is going down, too, and I'm getting a sense of what has been accomplished.  There's no question that the abdominoplasty has flattened my tummy even when I relax my abdominals.  That's cool.  There is also a modest narrowing of my waist.  The overall effect is not as much as I was hoping for, but there should be further improvement when the remaining swelling goes down.  I have to avoid strenuous physical activity for a few more weeks, though, to give my body a chance to heal thoroughly.  I don't want to risk popping the internal stitches before they are locked in.  That would be a disaster.

[Miss Clara]

6 weeks post-op, and still not out of the woods.  I feel fine, incision healed, and I'm able to go about life as usual, but I'm still having my doctor extract serous fluid from my abdomen twice a week.  It's so annoying, and a mystery as to why that aspect of recovery is taking so long.  I'm continuing to wear a foam pad and compression bandage to eliminate the pocket into which the fluid accumulates, preventing the reattachment of my skin to the underlying muscle tissue.  The seroma holds about 10 cc of fluid which isn't much, but if it's not removed, the fluid can encapsulate and become a possibly visible permanent 'deformity' of my tummy.  I've never experienced a post-op complication with all the surgeries I've had until now.  (sigh)

[jentay1367]

Prayers and all my positive energy are with you, Clara. I'm sure the issues will resolve themselves in short order. Keep your head in a good place and keep us in the loop.     All rhe best, Lisa

[Karen_A]

I had a tummy tuck about 6 months ago. My goal was to just tighten the loose skin, but my surgeon suggested sutures to tighten the abdominal muscles as well. I am glad I let her do her job.

I'm still considering doing it... fell off my diet (Still have 55lbs to go) so I'm not quite ready yet...but I was wondering how noticeable the scars are for you now..
Did you have the inverse T type incision?

From what I have seen on-line, the midline incision can be quite noticeable ... I was wondering how item scaring turned out for you long term ...

Thanks,
- karen

[Miss Clara]

Did you have the inverse T type incision?

From what I have seen on-line, the midline incision can be quite noticeable ... I was wondering how item scaring turned out for you long term ...

Thanks,
- karen

My incision was a transverse cut from hip to hip.  The scar is very noticeable except that it is easily covered with a bikini panty.  A section of bdominal skin was removed, pulled down sutured.  My navel was repositioned on the underlying muscular wall.  I still massage the scar to help soften it and reduce its thickness but it's been only modestly effective.  I would probably need laser treatment to eliminate it completely.  But I'm not planning to do that.  Still, the operation was effective.  My abdomen is flat and I have a bit of a waistline now rather a typical masculine belly.  The recovery was long only because I suffered an abdominal seroma that took many fluid extractions (by syringe) to promote healing.  The long recovery had little impact on my lifestyle, however.  I did have to wear a tight elastic compression bandage around my wait for 3 months because of the seroma.  Pain was non-existent, and after a month I was able to use my abdominal muscles freely.

[Megan.]

... Did you have the inverse T type incision?

From what I have seen on-line, the midline incision can be quite noticeable ... I was wondering how item scaring turned out for you long term ...

Thanks,
- karen

Karen,  FYI I had an inverse-T (extended) tummy tuck about 18 months ago. PM me if you have any questions on this. X

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