**This sharepost is part of a series about total body contouring plastic surgery that My Bariatric Life underwent following massive weight loss.
**** My Bariatric Life's Total Body Lift - Part 1: Why Did I Do This?**
I am no longer in occupational or physical therapy for my arm lift complication (see my last share post on this topic). Therapy was not covered by my insurance and I accumulated over $3,000 in treatment costs by the time the shoulder specialist discharged me. He said that he had gotten me as far as he could. I never did regain my full range of motion even after months of therapy. The physical therapist said I may never regain it.
At this point I can raise my right arm high enough up my back to reach the bottom of my bra strap; and I can nearly raise it 90 degrees above my shoulder over my head. In previous posts I showed an image of me reaching my arm up my back unable to get past my waistband and another of me
unable to keep my arm straight as I raised it above my head. Scar tissue has caused my right shoulder to roll forward slightly. Therapists can see it with their eyes but my untrained eyes cannot distinguish the slouch. However, I do notice that my shoulders do not lie flat on the ground when I am on my back. I also have chronic intermittent pain in my shoulder that intensifies at night, and sometimes shoots up my neck or down my back. While all of this is not a good thing, it is not as awful as it may appear.
Both the occupational therapist and the physical therapist referred me to the chief of plastic and reconstructive surgery at another hospital. He also came very highly recommended to me by a surgeon in New York City. This chief specialized in treating burn victims and is one of only three plastic surgeons in the U.S. using IPL laser for scar therapy.
The chief assessed my right arm and said the reason I got a contracted scar was because of the one long incision from my elbow to under my breast, connecting the arm lift incision with the breast lift incision. He said this technique can cause contracted scar and when he sees it in his arm lifts (brachioplasty) then he does the z-plasty right then and there in the OR at the time of the brachioplasty. You may recall from an earlier post that I had a z-plasty done in March at 5-mos post op to lengthen the scar, which it did, but I had a complication with that procedure, too. The chief added that when performing a brachioplasty, he either skips the incision in the armpit, or makes a "Z" incision through the armpit during the incision from elbow to under the breast, so as to reduce the risk of a contracted scar.
my bariatric life, dr. joseph f. cappella, cappella plastic surgery
This image shows My Bariatric Life's z-plasty that opened.
The chief said it was very rare to have frozen shoulder from an arm lift. You may recall in a previous sharepost that I explained an arm lift is a skin removal procedure, and frozen shoulder (or adhesive capsulitis) is a joint problem. That is in line with what my plastic surgeon had told me, as well. In fact, my plastic surgeon could not find it in any of the medical literature.
The chief's plan was to put me under general anesthesia and do a series of z-plasties and an Alloderm graft then apply a wound vac. Alloderm is a regenerative tissue matrix that supports revascularization and white cell migration and cell reproduction and acts as a host tissue for a strong and healthy repair, versus doing a graft with skin from another part of one's own body. During the same surgery, an orthopedic surgeon from the same hospital would do manipulation under anesthesia of my shoulder to release the capsule. Then the chief would do the IPL laser treatments to lighten the scars.
The chief assured me that he's treated many burn patients with scars far larger than mine, and that I would have a good outcome. He also thought that the surgery would be covered by my insurance. So I began to feel hopeful.
I awaited insurance approval and a surgery date. Then one day the chief's nurse practitioner called. She did not have a surgery date for me. Instead she told me that the surgeon decided not to do my surgery. I pleaded with her to have him reconsider. But I never received a callback.