by Lynda P. Haddon

In October of 1980, Arthur and I became the proud parents of a darling little girl. At conception I weighed 120 lbs. and put on 32 lbs. for this 40 week pregnancy. When I conceived our dizygotic (fraternal) girls, I had almost gone back to my pre-pregnancy weight, weighing in at 124 lbs. For my multiple pregnancy I put on 58 lbs. and two healthy girls were born 17 minutes apart at 40 weeks and one day gestation.

I should add that I am just shy of 5 foot 4 inches and weighed 182 lbs. at their birth. The gestational length of my twin pregnancy and the fact that I put on 58 lbs. was a wonderful beginning for our daughters, who weighed 6lbs. 10 ozs (one ounce more than our singleton) and the second who weighed in at 5lbs. 9 ozs. They both came home from the hospital with me.

As the time progressed and my abdominal muscles did not respond to various exercises, sit-ups, rollerblading on a regular basis, swimming and my very active lifestyle, I began to become more and more aware of the 'tire' that was around my waist. In my early 40's, I contacted a plastic surgeon for a consultation and asked his assessment of the situation. I left his office, "not a happy camper" as the saying goes. He examined me and then we met in his office for a talk. He threw a picture in front of me of a woman with a large 'apron' of weight around her belly and he said, "Now there's a woman with a problem. Go home and lose 10 lbs.!"

I was very discouraged because I knew, now at 153lbs., I was still within a 'normal' range for my height, but the "tire" around my waist interfered more and more with my lifestyle as time went by. Gardening (which I love) was a huge deal as it requires long periods crouched down. The "tire" would get compressed by my knees and be pushed up into my chest area. I found myself panting and mouth breathing in an attempt to gulp in adequate air. I could not stay crouched for longer than a few minutes at a time and would take several minutes to recover upon straightening up as my heart would slow down to accommodate the change of position.

I was resigned to wearing loose fitting and flowing outfits as nothing fit comfortably. I pretended that it didn't bother me that the slim fitting outfits were beyond my reach and that they remained so as the years passed.

At age 54 and with much discussion and support from my husband, I made an appointment with another plastic surgeon for another assessment. I was also asking for an opinion on a breast reduction (one breast was very large, with stretch marks due to breastfeeding). He agreed this breast could use some work but the operation itself was a lot to go through for just one breast. "On a scale of 1 to 10, I'd say you were a 2", he said. OK, I replied, "and the belly". "Oh yes, he said upon a visual observation, "your muscles are 'finished'. You could do sit-ups 24 hours a day and it won't make any difference." This was very affirming to hear because I was worried that I had not exercised properly or consistently enough. His next question, "Are you doing this for vanity reasons?" What a loaded question! I told him that it would be difficult not to answer yes in some part, however, I have been more and more uncomfortable with this extra 'tire' as the years progressed and was hoping for some improvement in my physical well-being rather than hoping that every man that passed me by might want to fall at my feet!

The surgery date was set for 4th April, 2000. I would go in early in the morning, he would repair the breasts and make them closer to the same size (anything but "perky" I said, "Perky is for 14 year olds!"). He would also repair my belly and expected that I would be in the operating room for about 4 hours. Because they would be doing both procedures at the same time, I would be kept in over night for observation.

In preparation for and at least 6 weeks prior to the operation, I was to cease all hormone supplements and stop taking Vitamin E and glucosamine (helps with arthritis but interferes with healing). I could continue with my Calcium supplements.

In the hospital hallway I met the Anesthesiologist . In the operating room, everything was once again explained to me and the equipment involved. The surgeon had me stand up while he drew on my breasts and belly, where he would make the incisions (how many times have we told the kids not to write on themselves?). The last thing I remember was being told that they were giving me oxygen in order to assist the anesthetic to quickly travel through my system.

I woke up to a lovely nurse advising me the surgery was over and that I was in the recovery room. She encouraged me to sip a little water. I was very drugged and was firmly bandaged from just below the neck to the top of my legs. The top bandage was a large padded square to soak up any blood and the lower Velcro belt I would wear for the next 4-5 weeks, and provided the healing muscles with support and encouraged them to heal in place. Over the next few hours, I was monitored for oxygen levels in my blood, temperature, blood pressure and blood was drawn. At one point I felt very ill and was sick. Using a bedpan was difficult but necessity helped. At the end of the day I was up and used a portable potty (what the heck - modesty had long gone out the window). Doctors came and went as did my husband and I could hear lots of mumblings. I was told they were keeping me an extra night. Fine, I thought, just let me sleep and I did.

On the second day post-op, I was moved to a ward. Blood tests and monitoring for blood oxygen levels continued at regularly set intervals. I was given a nasal prong in order to breath pure oxygen. Still the doctors came and went, some new faces that I did not recognize - but I am not sure I would have recognized anyone anyway. The evening of the third day I had 3 doctors appear at the bedside. They grilled me with all kinds of questions about my state and only in retrospect did I realize that I made a fool of myself. They wanted answers and I was too sick to make any sense at all. The first doctor said, "This is potentially lethal and I want you to know that we will do everything we can to save you". "Thanks." I responded sleepily and they left. I drifted back to sleep. My husband spent the day after the operation with me, reading magazines and giving me water when I woke up and then encouraging me to sleep. The pain killers were making me hallucinate and Beanie Babies fell from the ceiling vent all over my bed (I was going to be rich), the faucets and taps of the sink in the room took flight and I asked the nurse to turn off the running water as it was being wasted just pouring down the sink. The faucet was not on. When the hallucinations began to turn nasty (threatening voices were threatening me), I stopped taking the pain killers.

In the middle of the third night I was asked if I could sit in my ward chair and portable X-ray equipment was used to take chest X-rays. Next I was asked if I felt strong enough to get on a gurney and proceed to the X-ray department where they would take some further X-rays of my lungs and ultrasound of my legs. I was given a portable oxygen tank and whisked down the halls. The porter should have been given a driving test as he overlapped a hallway door by at least 25% and the resulting crash was very hard on my incisions.

In the X-ray department, I was given a radiation/oxygen combination to breath, pictures were taken and then I was injected with radiation and the same pictures repeated. The injection was handled with heavy gloves and not brought into the room until it was actually to be injected. Charming, I thought, maybe I'll end up as "glow in the dark".

In the "Vein Department" I had a routine ultrasound done on the back of my legs and was told by the technician that the veins were "Clear but you have this beautiful vein and I know that Dr. So and So (who remembers names at this point) would love to have a photo of it for his conference talk next week. Would it be OK if I get him?" Sure - why not? So, for anyone looking at vein scans, one of them is probably mine! My 15 minutes of fame had at last arrived!

My husband was awakened later that night by a phone call (I learned later) and he was told that I had had a pulmonary embolism and 30% of one lung was blocked.

Meanwhile I continued doing a lot of sleeping and didn't even notice the week pass by. A friend came to visit me and to this day, I don't remember her visit. On the sixth day I was allowed to go home. With the diagnosis of the embolism, I began a series of Coumadin injections, which required an injection directly into muscle. Consequently in very short order, you are covered in large bruises. To give the muscles a break, different muscles are used for each shot. Arthur was taught how to give me the injections, which would continue at home. Thank heavens we were (are) still in Love! Injections are given initially so that your blood can be quickly thinned - they work quicker than pills. When the desired blood density is reached (i.e. thin and watery), the patient can then switch to pills and boy are the muscles pleased! I now had thin blood and still heavy thighs. Where's the justice?

Coumadin is a blood thinner (rat poison, to be exact) and its purpose is to thin the blood enough so that blood clots do not form and the blood can flow freely through the veins. Although blood clots usually come from the back of the legs, mine resulted directly from the abdominal surgery. A clot(s) tends to come to rest in one of three major organs: the brain, the heart or the lungs. I was lucky and mine chose to lodge in my lung. 30% of one lung was affected. The score from a blood test taken every few days determines the amount of Coumadin you must take. The scores are personal and each person would have their own evaluation (mine needed to register between 2 and 3 out of 10) then I would have to take one, one and a half or two pills each day until the next blood test.

For the next several weeks, I was closely followed by the Thrombosis Unit of our local hospital. I couldn't have had better treatment. They took another set of X-rays and radiation pictures and confirmed there had been a clot. It was explained to me that I will now spend the rest of my life at risk of further clots and need to advise my doctors of the risk, if I have any further operations during my lifetime.

After 3 months on Coumadin and a clean bill of health, I was allowed back on my Vitamin E and glucosamine. I have been rollerblading and gardening with none of the previous difficulties. I can stay crouched down for long periods of time and physically feel very well.

Today I am feeling more like myself prior to the birth of the twins. It has been a long haul and I feel that both my husband and I went into the venture rather naively. Either one of these operations (breast reduction or abdominal repair) would have been a major ordeal on its own and here I had two done at the same time. I wasn't prepared for the amount of muscle-spasming as the abdomen healed. When a spasm occurs, it catches your attention very quickly. Further, I was encouraged to keep the incisions moist with vaseline and although it was messy, the vaseline did stop the itching.

How the Repair Works:

For the breasts, they are cut underneath side to side and up underneath to the nipple and areola. The nipple and areola is removed, the breast 'gathered' and excess fat, flesh, skin removed. The nipple and areola are sewn back into place. None of the scars are visible to the front view. It takes some time for the redness and swelling to go down and the incision areas are extremely itchy as they heal.

For the belly, a cut is made hip to hip much like a caesarian section but not through the muscle tissue like the cesarean. The overstretched muscles are pulled down toward the incision and tacked in place on each side and the middle. These three "tacking points" are the last three places to heal. The spots remained tender and oozed blood and the middle one became infected and necessitated treatment with an ointment for about 9 weeks after the surgery. Apparently this is normal. No muscles are removed or cut. The muscles are, in a sense, pleated and gathered, much like curtains and then tacked at the bottom. As you can appreciate, your navel is drawn down because there is also excess skin (which is cut away). The one I have now is a fake. It is sewn into the appropriate place and resembles the one I had before.

If you can follow this description, there needs to be liposuction done from just below the breasts to the top of the navel. This is necessary because if only the lower muscles are tightened, you would be left with a ledge between the upper abdomen and the lower. Liposuction allows the belly to run smoothly from under the breasts to the pubic area. What they did not tell me ahead of time was that liposuctioned areas are numb due to the fact when fat is siphoned off, surface nerves are interrupted and must resettle and adjust themselves and this takes time. I was shocked to find there was no feeling at all to this area. However very slowly the feelings have come back. As there is pooling of water and blood in the abdomen after this surgery, two small incisions were made on each of my sides and drains with tubes were inserted. Twice daily the drains were pumped and the excess fluid drawn off. These were left in until about 4 days after surgery.

I do have some hints for anyone considering having this type of repair done:

• You will need to wear a bra post op. Gravity is a problem on the repairing muscles and a bra alleviates some discomfort. As it will be impossible to tell what size you will be because you are so swollen, take a couple of your old bras and remove any wires out.
• Cut your toenails BEFORE you have surgery as it is impossible to reach your feet until some time after the swelling goes down.
• Purchase 3 or 4 pairs of men's boxer shorts to wear as underwear. These are loose fitting and do not put any pressure on the incision areas.
• Purchase some large pairs of jogging pants. These pull very nicely over the abdomen and, once again, do not put any pressure on the incisions.
• Make sure that you have someone in the house to assist you for at least one week following the surgery. My husband took one day off work because we thought this would be sufficient but we grossly underestimated my recovery time. My dear friend came from Toronto and moved into the house for 4 days and I don't know what we would have done without her support. It took pressure off of our shoulders.
• It is quite expensive and a belly repair from having multiples is not covered by health insurance in Ontario. It is currently viewed as elective surgery. It can cost up to $9,000 - $5,000 for the belly and $4,000 for the breasts. Some surgeons offer a discount for having both done at the same time. The procedure is expensive and full payment was due in advance of surgery. You may wish to get a couple of opinions and a couple of quotes.

Lynda P. Haddon had her abdominal muscles repaired 17 years after the birth of her twin daughters. We would like to hear from you regarding this topic. If you have information to share please contact the business office at office@multiplebirthscanada.org