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Help me think through breast reduction at the same time as abdominal hysterectomy.


brett_ashley
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I need a hysterectomy--the largest of my five fibroids is 16cm and uterus is measuring 22wks. My hemoglobin is 8.8, and I'm constantly napping and fainting from postural hypotension. I've been on supplements and oral contraceptives for 18 months in an attempt to avoid surgery with no noticeable improvements.

 

I have always wanted a breast reduction in theory--but am wayyyyy too chicken to ever go under for elective surgery. My ob suggested doing a reduction at the same time as the hysterectomy and I love the idea of one recovery period. I'm scared of the extended time under general and of extra blood loss (since I'm already running low). Any thoughts?

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I think doctors are very good at assessing actual medical risks -- things like time under anesthetic and levels of blood loss. Therefore unless my doctor expressed reservations about those things, I wouldn't allow myself to imagine the into something scarier. Clearly these are fairly everyday surgical tasks. While, absolutely, every surgery is risky -- I'd certainly get stuff done if I wanted it done.

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I think doctors are very good at assessing actual medical risks -- things like time under anesthetic and levels of blood loss. Therefore unless my doctor expressed reservations about those things, I wouldn't allow myself to imagine the into something scarier.

 

Also, if for some reason the hysterectomy caused more blood loss than anticipated (or w/e), the doctor may very well just skip the elective surgery part - just because the plan is to do both, doesn't mean that they're going to do it no matter what happens.

 

When I was in college I had a Jehovah's Witness friend who said that JWs don't accept blood transfusions in general, but that they will sometimes donate blood to be used by themselves in an anticipated surgery. Not sure if you could do that.

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Also, if for some reason the hysterectomy caused more blood loss than anticipated (or w/e), the doctor may very well just skip the elective surgery part - just because the plan is to do both, doesn't mean that they're going to do it no matter what happens.

 

When I was in college I had a Jehovah's Witness friend who said that JWs don't accept blood transfusions in general, but that they will sometimes donate blood to be used by themselves in an anticipated surgery. Not sure if you could do that.

No. JWs do not do this.

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I need a hysterectomy--the largest of my five fibroids is 16cm and uterus is measuring 22wks. My hemoglobin is 8.8, and I'm constantly napping and fainting from postural hypotension. I've been on supplements and oral contraceptives for 18 months in an attempt to avoid surgery with no noticeable improvements.

 

I have always wanted a breast reduction in theory--but am wayyyyy too chicken to ever go under for elective surgery. My ob suggested doing a reduction at the same time as the hysterectomy and I love the idea of one recovery period. I'm scared of the extended time under general and of extra blood loss (since I'm already running low). Any thoughts?

 

Do you have a plastic surgeon in mind?  What does he/she say about it?   Does your plastic surgeon and ob work well together?   These would be the questions I'd ask once I'd processed the need for the hysterectomy and the possibility of the reduction.  

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Do you have a plastic surgeon in mind? What does he/she say about it? Does your plastic surgeon and ob work well together? These would be the questions I'd ask once I'd processed the need for the hysterectomy and the possibility of the reduction.

Yes on all three counts. This is a combo done regularly (though not extremely common because typically patients want the use of their upper body when their lower body is out of commission.)

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I would not do it. Once you have the hysterectomy, your body will change over the next year. You might want a little extra at the top to offset the little extra you will probably get at the bottom. Cosmetically, it is a risky combination.

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I would not recommend it. Recovering from a hysterectomy is a long process. Your hormones (or immediate lack there of) will probably throw you into a tailspin for a while. You will need your arm strength to pull yourself up from a chair or bed for quite awhile because your abdomen will be healing and trying to resettle the rest of your organs. With a breast reduction your arm movement will be impeded somewhat.

 

I also recommend going to Hystersisters.com You can read about the typical recovery for your specific type of surgery and read other's stories. There is a forum where you can ask all kinds of questions. My best advice is to be really prepared before the surgery for what your recovery will be like after. I felt like I wasn't prepared enough and just expected it to be a quick recovery.

 

Best wishes to you!

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I agree with aaplank.  And I have had a LOT of abdominal surgeries. But it might depend, too, on how large an incision is needed to do the surgery.  And how large an incision is needed for the upper body work.  It is tempting to have only ONE hospital bill and ONE anesthesiologist bill.  

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My initial post was "heck no," but since it is the only way you will consider having the breast reduction, I erased my post and started over. :) You will feel so wonderful post-reduction, that some discomfort will be worth it.

 

Having had both surgeries within three months of each other, my vote is to go ahead with it if it is the only way you would have the breast reduction done. Be aware that recovery will not be fun as both are major surgeries. My advice is to stay at a post-surgical rehabilitation center for a few days afterwards if possible so you could get the around the clock care you will need.

 

If you can take HRT, then I recommend it post surgery to minimize the hormonal changes. I am on bioidentical estrogen and provera and have lost ten pounds since the surgeries. Weight gain isn't always an issue post hysterectomy.

 

My biggest concern is the low hemoglobin and how it will slow recovery time. If they can give you an iron infusion prior to surgery, then that would help a lot as long as you don't just bleed out the iron before surgery. That's a miserable, helpless feeling, and you will feel so much better after surgery.

 

My doc told me that hysterectomy and breast reductions have the highest patient satisfaction rates, so if you can get through recovery you will feel like a new person.

 

If you do decide to have the surgeries separately, we can then talk about how safe modern anesthesia is.

Edited by trulycrabby
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I remember after the car crash and when I finally was in rehab and then home, I had to take an iron supplement daily. Heck, after having the twins (c-section) I was given iron via injection after being home a few days. Just remember to take Miralax (or similar) if on iron to avoid getting "plugged up". Heck, take it afterwards anyway as anesthesia can stop the innards from working smoothly for a while. You don't want constipation on top of recovery from abdominal surgery.

 

Oh, and have you asked if you are a candidate for laparoscopic hysterectomy? Fibroids can be removed that way, too. Recovery far easier.

Edited by JFSinIL
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How much help will you have at home after? As in totally handling everything and waiting on you help?

I will have two adults the first week (husband and mom or mil) and then one adult (mil or mom) for the next two weeks. I can piece together the fourth week with friends. I do have five kids age 4-11.

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My initial post was "heck no," but since it is the only way you will consider having the breast reduction, I erased my post and started over. :) You will feel so wonderful post-reduction, that some discomfort will be worth it.

 

Having had both surgeries within three months of each other, my vote is to go ahead with it if it is the only way you would have the breast reduction done. Be aware that recovery will not be fun as both are major surgeries. My advice is to stay at a post-surgical rehabilitation center for a few days afterwards if possible so you could get the around the clock care you will need.

 

If you can take HRT, then I recommend it post surgery to minimize the hormonal changes. I am on bioidentical estrogen and provera and have lost ten pounds since the surgeries. Weight gain isn't always an issue post hysterectomy.

 

My biggest concern is the low hemoglobin and how it will slow recovery time. If they can give you an iron infusion prior to surgery, then that would help a lot as long as you don't just bleed out the iron before surgery. That's a miserable, helpless feeling, and you will feel so much better after surgery.

 

My doc told me that hysterectomy and breast reductions have the highest patient satisfaction rates, so if you can get through recovery you will feel like a new person.

 

If you do decide to have the surgeries separately, we can then talk about how safe modern anesthesia is.

Great idea on the rehab center. Will I still need hrt if they remove uterus only? He was planning on leaving ovaries and cervix.

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I will have two adults the first week (husband and mom or mil) and then one adult (mil or mom) for the next two weeks. I can piece together the fourth week with friends. I do have five kids age 4-11.

You're not going to be able to lift over 10 pounds for at least 6 weeks. A gallon of milk is 8 pounds (and you will feel every ounce of it the first time you pick one up post-surgery). I suggest you get two more weeks of help lined up, on an on-call basis at the very least.

 

Healing is one thing. Regaining your energy levels is another, and can take several months after major surgery.

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If the surgeons think that the blood loss is not going to be an issue, and you won't do the reduction otherwise, go ahead and do both. Ask how long you can stay in the hospital, and if your doctors will push insurance to let you stay longer if need be. Having the adjustable hospital bed may really help as far as getting up and down to go to the bathroom, etc. Plus pain meds via IV can be glorious. 

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Just remember to take Miralax (or similar) if on iron to avoid getting "plugged up". Heck, take it afterwards anyway as anesthesia can stop the innards from working smoothly for a while.

 

Never heard of anesthesia causing that problem, but the opiates they'll likely prescribe for the pain afterwards definitely do.

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Great idea on the rehab center. Will I still need hrt if they remove uterus only? He was planning on leaving ovaries and cervix.

No, you won't need hrt, which is great!

 

If you can start taking Floridex liquid iron, it might help your hemoglobin a bit. Ironically, anemia makes the bleeding heavier. I didn't have fibroids but something different which caused the same cycle of bleeding and anemia.

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