Age 45, healthy, very healthy, how many procedures can I get at same time? (Photos)

Thank you for your question regarding having multiple procedures combined and for including photos!

In my practice, it is very common to have multiple procedures combined when a patient is wanting a mommy makeover.

I would recommend that you see at two or more experienced board certified plastic surgeons in your area for a in person consultation and a complete evaluation. Your surgeon will be able to inform you if having all the procedures you are wanting is safe to be done all at once.

I hope this helps!

In general,you would be an excellent candidate for a mommy makeover type procedure in which you pursue breast and abdominal rejuvenation at the same time. You would be an excellent candidate for a full abdominoplasty (tummy tuck) with muscle repair.
For your breasts, most women after four children will need at least a lift. Whether or not you pursue an implant will depend on how much upper pole fullness, or cleavage, you would like. The majority of women will desire an implant to fill their loose skin following weight loss and childbearing, but some women are just as happy to have their breasts lifted back into their previous position.
Regarding buttocks deflation, that is a difficult question. Both breast and buttock deflation can be treated with fat injections, and this often is a good compliment to a mommy makeover type procedure because breast lifts and abdominoplasty procedures often have liposuction associated with them. However, based on your pictures your problem appears to be mostly a skin problem so you may not be left with much fat to inject. This may make you a better candidate for a posterior buttock lift type of procedure, but difficult to tell without better pictures.
Whichever method you choose, make sure to be treated by a Board Certified Plastic Surgeon in an accredited operating room in order to make sure you are receiving the highest level of care.