ANA Discussion Forum
Treatment Options => Microsurgical Options => Topic started by: sarahinPA on July 08, 2011, 07:54:55 am
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I've read on here a few times that you will have an incision in the belly area after surgery. My doctor didn't mention this to me and u was just wondering why this would be and if it's there for everyone. Any info would be nice, as my surgery is in 21 days
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Hi Sara,
They call it a "fat harvest", not all the time but depending on your surgeon, they will make a small incision on your belly, usually on the left side and "harvest" some fat tissue to pack your surgery area with. It's not very big and they didn't even use stitches on me, they just applied a "tape" over the incision. I hope this helps. I may not be explaining it just right but I hope you get the general idea. Doctors usually take the fat from the left side because your appendix is on the right side and if you were to get into some sort of accident and couldn't speak, they don't want the medical team to think that your appendix has been removed. Maybe others will offer a better explanation. Hang in there. Ann
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Yes, I had just a tiny incision on the left lower abdomen. The joke is PLEASE take out as much fat as you can, but they don't :(
There was the strip across the incision, and it heals just fine. No pain there. Let us know if you have any other questions!
Maureen
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I've had three fat harvests (unfortunately, my waist is no slimmer!) It seems like you really want to know what to expect, so not knowing what approach your doctor will take I'll share my experiences.
My first fat graft was taken fairly high up ("muffin top" region) on the right. It was closed with stitches at first, replaced by steri-strips after a few days. The other two (different surgeon than the first) are lower on the left as others have said and had no stitches. The last one was used to plug a spinal fluid leak, so I guess they really tried to take a lot of fat (I actually do have a little depression under that incision now.) I had a drain in that incision for several days and my entire abdomen was VERY bruised and swollen like a grapefruit. More than four months post-op, it's still a little bit bruised looking. Actually, as bad as it looked, it didn't really hurt much. I think that extreme result with the last incision was because they were taking a lot of fat for the CSF leak, and it was less than a week after the translab so I had a still fresh incision just above it.
Mostly, this is a really minor thing in comparison to the rest of the surgery.
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Sarah ~
As noted in an earlier post (#2), not every doctor uses 'belly fat' to pack the surgery site. Mine didn't. The issue never came up in our pre-op consultations because, at the time, I was a lot more concerned with avoiding facial paralysis than how the surgery site would be packed. My neurosurgeon (30 years experience with AN surgery) used titanium mesh and nothing else. I had no problems. Apparently this is a matter of doctor preference. If you're concerned - or just curious - I would place a call to the doctor and simply ask him if he intends to use 'belly fat' or just the titanium mesh. If you're really curious, you could ask him why he uses whatever method he does. In any case, I'm sure it will not be an issue for you. This rarely is.
Jim
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Sarah .....
As I recall there was some uncertainty on your part as to which approach your doctor was using. If he guaranteed you being SSD after surgery and the incision is right behind the ear, it sounds like a translabyrinthine approach. I am not a doctor, but my understanding is that with a translab (literally "across the labyrinth") approach, the surgeon does a mastoidectomy (removal of the mastoid bone) and a labyrinthectomy (removal of the labyrinth portion of the inner ear) in order to have the maximum view of the tumor and facial nerve in the internal auditory ear canal. In order to prevent cerebral spinal fluid leakage, these areas need to be packed with fat (taken from the abdomen) before closure.
With a retrosigmoid approach (from the back, closer to the brain stem), this is usually not necessary and titanium mesh is most often used to cover the area.
I have had two retrosigmoid surgeries (one on each side by different doctors in different medical facilities) and no fat was harvested for either of those. Only titanium mesh and screws were used for closure. Most recently I had the translabyrinthine surgery and fat was harvested from the left side of my abdomen. A drain was inserted for the first couple of days post-op. Steri-strips were used to close the approximately 2 1/2 to 3 inch incision. If I did not see it, I would never have known it was there ..... never had any pain nor discomfort from it.
I hope this helps.
Many thoughts and prayers.
Clarice
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Thank you everyone for the information! this was not discussed in my appointment, but I will put it on my list of questions and be sure to ask the doctor just so I am aware. Thanks a lot!!!
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I actually had staples in my incision - sounds like I'm the unusual one (again ::)). I had a drain for a few days and had those staples removed the same time I had the ones in my head removed. I didn't have any pain and you can barely see the scar. My only complaint was that the doc didn't suck all the fat out of there while he was there. >:(
Lori
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Ah, yes, the ever popular abdomenal fat graft. As most who've had one with our AN surgery can attest to, they just don't take enough fat! :'( And probably 99.9% of us ask our docs to do that!
I had one and didn't have any issues with it. No healing problems, no pain, etc. My doc does the graft on the left side of the abdomen so that scar isn't confused with a scar from an appendectomy.
I also didn't have a CSF leak post op, which may be neither here nor there. However, I have heard a theory that those of us who have fat put into the hole left by the tumor removal typically don't get leaks. I've heard no scientific evidence to support this theory; I just find it interesting.
Jan
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I must be a rarity because I had a fat graft and a leak afterward. I had a second graft which seems to be holding up.
While my incision at the graft site healed well I became concerned when it seemed to protrude and became hard about 2-3 weeks after the procedure. I was informed that it was scar tissue. Keep that in mind if you notice a change and it concerns you.
Tim
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I had fat removal also- definately a plastic surgeon he was not. At the time I wore a size 24 and told him I was upset that he had left such a scar- now I wouldn't be able to wear a bikini! Now I'm an 8 and have thought about integrating it into a tattoo but that would be much more painful than the original :)
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They use the piece of fat (small) to prevent CSF leak. It has been very successful. If your Doc didn't mention it he probably doesn't do that. CSF leaks can be serious. Ask them.
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Ah, you aren't the only odd one out, Lori...I also had staples....my incision doesn't show at all, which totally amazed me. Jan, I too, asked for a lot more fat to be used and they just didn't listen,,,ugh.
Brenda
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My fat graft was done by the "fellow" aka intern that was working w/my neurotologist at the time.
He did a great job; scar is hardly visible at all.
Many thanks, Dr. Rivera, wherever you are ;D
Jan
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Thank you everyone! I spoke with my doctor yesterday at my pre op and he told me that he does not use belly fat.
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belly fat is a great way to prevent a CSF leak,
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so i've had 2 surgeries and now have 2 scars!
the first is very long and right under my belly button. i am thin and lost even more weight before the operation from being sick, so the dr's didn't anticipate not finding enough fat which is why there's such a big scar. i didn't wear a bathing suit for a year but now i don't care :)
the second operation they took it from my left thigh and that was a nice tiny incision.
just some thoughts for other undernourished people ;)
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I have very low body fat because I eat the right foods and exercise, but they did find some. It left a 2 1/2" scar just to the right of my belly button. They installed a drain in the wound for 2 days, and put one stitch in when the drain was removed. It is an ugly little scar. It does not bother me, but if I was a young female, it would be a bad place. I would ask the doc to find an area that would not show if you are going to wear swim suit.
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The dOctor used a thing called gel foam for me, he said it will eventually dissolve and tissues will grow around it over time. He believed that the swelling of this may be the cause of my throat swelling, he thinks this nerve may be being effected. Without going back in, he can't be certain for sure, but an MRI I got while at the hospital showed some nerve swelling that area. O had the csf drain for a few days and had a small stitch when they tool it out. Sitch was removed before leaving the hospital :)
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My doctor did the belly fat thing. I also had staples and a drain. My scar is highly visible, thick, long, and is at an angle. The edges of mine are jagged. Maybe they used a bread knife with seratted edges. Mine is in the middle of my stomach - not on the right or the left.
I always thought mine didn't look like very professional. I think I've now confirmed that by reading everyone's replies.
On the upside, and I'm sure most of you have heard these.. but I can attest to the fact that I am a fathead. And when people say something like "I need that like I need a hole in my head", I reply that I already have one, thank you. :-)
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I too had a translab and had belly fat used to fill the void. 3" scar, pretty obvious but no spinal fluid leaks which was far more important to me than another scar!
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I had the fat plug done as well (Middle fossa)...although I experienced no pain or issues with the incision, I did end up with a pretty healthy looking scar out of the deal...kinda weird ???
Jay