Combined procedure: can laparoscopic hysterectomy and tummy tuck be done at the same time?

Question

Combined procedure: can laparoscopic hysterectomy and tummy tuck be done at the same time. If possible what is the sequence of procedure like.

Richard H. Tholen, MD, FACS · Answer

Yes, they can, but NO, they shouldn't.Furthermore, although combining elective and insurance cases may seem that you can get "part" of the elective procedure "covered" by insurance, this does not work any more, and the total costs will be hugely higher than if you separate the cases. This is because you pay hospital prices for what could be substantially less costly at an accredited outpatient surgical center or in-office accredited facility. Sure, that means two operations and recoveries, but the financial downside can be unbelievable (PLEASE check this out before you decide to go this route, as it is "too late" once the hospital bills start rolling in--the deed is already done and you have no ability to say"Wait, they didn't tell me about this!"). And that is not the only concern.Others have commented on the favorable aspect of "combined" surgery, but hysterectomy is not a completely sterile case, as it involves the genital tract, which has bacterial contamination. If the laparoscopic access ports become contaminated, and that contamination infects the widely-undermined abdominoplasty flap, you could end up losing the entire flap, which would be a disaster of truly epic proportions for you. No matter how good your plastic surgeon is, s/he cannot overcome a slightly sloppy (bacteriologically) GYN procedure, regardless of antibiotic use. This could lead to a devastating complication, all to save a few bucks (probably NOT), and to combine two recoveries into one. Still possible, but separate your surgeries by at least a couple of weeks to ensure there are no complications from your hysterectomy.It's an unusual scenario that I'm suggesting as a possibility, for sure, but so is it unlikely that you will be in an automobile accident on the way to surgery--should you go without your seatbelt? Even though an accident is "unlikely?" Please consider this--elective surgery should be as safe as possible, and combining these two procedures does have a higher risk of complication (and that complication can be loss of your entire abdominal skin flap). Be safe and best wishes! Dr. Tholen

Christopher V. Pelletiere, MD · Answer

This is a very common procedure to undergo, and makes sense to utilize one anesthesia setting if possible.  Usually, the gynecologist will go first with their part, then the abdominoplasty is completed.  This creates one recovery period, and since the limitations after surgery are very similar between each procedure, works very well.  I hope this helps.

Peter D. Geldner, MD · Answer

The short answer to your question is yes. There are some technical questions that need to be addressed. If this is a laparoscopic hysterectomy, the abdomen is distended with gas to allow visualization of all the tissues. This can prove to be a problem especially if you need plication of the abdominal wall. Though the gas is released at the end of the hysterectomy, the overall discomfort can be substantial. Typically, if a combined procedure is chosen, the plastic surgeon begins by raising the abdominal flap, and the gynecologist performs an open procedure to remove the uterus and the plastic surgeon finishes the procedure. I've done this many times with good results but I prefer to separate the procedures. In doing the surgeries separately, please do the hysterectomy first. Your abdominal contents will be reduced after the hysterectomy so the subsequent abdominoplasty can be more effective. Doing the abdominoplasty first is a bad idea since the hysterectomy can mar the result of the abdominoplasty. Best of luck with your procedures.

Mark A. Deuber, MD · Answer

It is fairly common for patients who desire elective body contouring procedures and require gynecologic procedures like hysterectomies to undergo these procedures in one combined surgery; this would most commonly be a combined abdominoplasty and hysterectomy.  The hysterectomy can be done laparoscopically.  In general, this can be safely performed provided that both procedures are uncomplicated, the operative times will not be too long, the patient is in excellent health, has no contra-indications to either procedure and is a good candidate for the contemplated procedures.

Nelson Castillo, MD · Answer

Thank you for your question. A hysterectomy and a tummy tuck can be safely performed in the same operation, with papers demonstrating no increased risk to the patient. Be sure to discuss your desires with your ob/gyn, they may be able to recommend a plastic surgeon with whom they perform joint cases.  Best wishes.

John Y.S. Kim, MD, FACS · Answer

Yes this can be done simultaneously with minimal added risk.  It is routinely done at many larger hospital systems.  It is also a way to save cost and have one healing time as opposed to two.  The gynecologic surgeon and your plastic surgeon can normally coordinate this so that the plastic surgeon can start raising the abdominal flap then the gynecological surgeon comes in and does this through the open fascia then the Plastic surgeon comes back and tightens any diastasis and removes excess skin and fat and closes.  Typically you would stay overnight in the hospital so both surgical teams can monitor you.  Hope this helps!

Florence Mussat, MD · Answer

Hi There,I understand your thinking: since you are going for general anesthesia, why not getting the tummy tuck at the same time ? unfortunately, it has been shown statistically there is an increased risk of infection, and mostly more pain !why not going thru the hysterectomy first, which is covered by your insurance and necessary, then get back on your feet ? back to work, and exercise etc... then 6 months or 1 year later, you get organized, and go thru a tummy tuck ? remember for a smooth process, your BMI should be less than 30.a tummy tuck is an elective cosmetic procedure to make you look nicer with a smoother silhouette. put all the chances on your sides.you should consult with a board-certified plastic surgeon.best of luck,F. Mussat

Mark T. Boschert, MD · Answer

Yes those two procedures are combined.  There is a small increase risk of infection, however your surgeon will take that into consideration and be more cautious. I would find a board certified plastic surgeon and ask who they have worked with.  Or ask your GYN which PS they have worked with for recommendations.  Good Luck!

Angeline Lim, MD · Answer

Having a laparoscopic hysterectomy and tummy tuck under the same anesthesia is possible, and many women who are considering both procedures like the idea of having only a single recovery.In a combined surgical case, typically the gynecologist would perform the hysterectomy first, and the plastic surgeon would follow with the tummy tuck.  If the hysterectomy is being done for large fibroids, the muscle tightening part of the tummy tuck becomes much easier and more efficient afterwards.That said, I strongly caution my own patients against having the procedures at the same time.  Although the gynecological part is not significantly affected by the plastic surgery that follows, there is a higher risk of complications (particularly infection) with an elective, cosmetic tummy tuck after gyn procedures.Have a good discussion with your gynecologist as well as an experienced plastic surgeon who is board certified by the American Board of Plastic Surgeons.  The idea of having to take time off only once for two big procedures is very appealing, but you want to make sure that the risks are worth it.Hope this is helpful, and take care.Dr. Lim

Robert A. Hardesty, MD, FACS - Account Suspended · Answer

Dear Ms. Doubletroublett,Thank you for your questions.Unfortunately with out photos, a review of your past/current medical history and a exam of your tissues I can can only comment based your story, however I hope you find my comments helpful.MULTIPLE PROCEDURESOnly after a complete review of your medical history and a complete exam can the final decision be made on how many procedures can be performed in one setting.Assuming no major health issues multiple procedures are often done in one surgical setting.RECOVERYHopefully, you will be meeting with your Plastic Surgeon prior to your surgery to go over all the pre and post operative instructions and to answer all your questions.I reccommend you make a list of your questions and schedule several consultative appointments with Plastic Surgeons who are Certified by the American Board of Plastic Surgery and ideally members of the American Society for Aesthetic Plastic Surgery (denoting by membership as having met additional criteria and a focus on Cosmetic Plastic Surgery).I wish you my best and success,R. A. Hardesty, MD, FACSDiplomate and Certified by the Am. Bd. of Plastic Surgerywwwimagineplasticsurgery.com4646 Brockton AveRiverside, Ca 92506(951) 686-7600

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