No problem combining procedures
I have many patients who undergo combined procedures that aren't actually related to each other. The determining factors include the general health of the patient, the type of procedures being considered, the length of time to do all the procedures, patient safety should always be the primary concern more than saving a patient recovery time or cost.
It sounds like your physician is doing things correctly, keeping overnight for observation as well as ordering preoperative tests and monitoring any problems in your leg. Circulation problems in your leg may be due to blood flow in or blood flow out. Patients that I operate on have compression devices put on the calves during the procedure to push blood out of the legs and decrease the chance of developing blood clots .
As some of the other responding physicians have stated, there is a higher risk for complications when certain procedures such as liposuction and abdominoplasty are combined, versus when they are done individually. It's important to choose a board certified plastic surgeon if you're undergoing extensive multiple procedures and that you're confident in his reasoning.
2 things to reduce risk from multiple procedures
1. Risk of general anesthesia overall, and blood clot to the lungs in particular.
a) There is risk related to the use of general anesthesia. Risk of general anesthesia increases rapidly after 4 hours of surgery. Therefore, multiple procedures are considered riskier. This risk virtually disappears when using IV sedation in combination with tumescent anesthesia. This has been documented in thousands of cases by Dr. Ersek and Dr Mustoe.
b) The risk of pulmonary embolus is likewise virtually eliminated with IV sedation, as has been documented by Drs Ersek and Mustoe.
2. Certain procedures preserve blood supply better.
a) For breast reduction, the vertical scar technique does not have the long horizontal scar that the top of the abdomen that would concern me if I was doing a Tummy Tuck with an "Inverted T" incision.
b) The "Lockwood" technique for Tummy Tuck preserves many more blood vessels, making it much safer to combine lipo with it.
Risks of multiple procedures
On TV, these combinations of procedures are very common following massive weight loss or in "mommy makeover" combinations.
This combination of procedures typcially will take the average plastic surgeon a minimum of 4-6 hours. Surgical time can be reduced by the use of multiple surgeons or assistants or using techniques that cut down on the "sewing" time.
The risks of prolonged surgery are well described. As plastic surgeons, one of our most common concerns in clotting which develops in the calves or pelvic veins which can break free and travel to the lungs or heart with potentially fatal consequences. The rates have been estimated at 1 out of 3,000 to 40,000. Other risks do occur and may be related to generated to your general health and associated medical problems.
Any surgery lasting over 2 hours can have an increased risk of clot formation with certain identified procedures having a higher risk. There is some controversy about whether abdominoplasty and liposuction together have an especially higher rate.
Certain interventions can decrease the rate of clot formation but not completely prevent them.
Can be safe all things considered
You are appropriate in your concern for a longer operation. There are a number of factors to consider; using a board-certified plastic surgeon, having your procedure(s) performed in a fully accredited facility, recovering in a proper health care setting with all precautions taken, and your health to begin with. This is a lot of surgery to undergo at one setting but can be accomplished safely with all proper precautions taken. This is a discussion that you should have with your plastic surgeon.
The procedures that you name can all be done at the same time in an appropriate patient - young, healthy and not overweight. The goal should be to have the surgery completed within 6 hours. However, if you have any issues, the operative time may extend beyond this. You also have to factor in the recovery time and emotional and physical impact on your body. Good luck with your surgery.
In a healthy patient who understands what is involved this is a good approach
While combining breast reduction, liposuction and tummy tuck surgery is a lot of surgery, It is a safe combination if safety criteria are followed. I frequently do breast reduction or breast lifts with or with out implants, liposuction of the abdomen, hips, lateral thighs, medial thighs and knees and tummy tucks with correction of the muscle separation. I feel that it is best to do these big multiple procedures in a major hospital and keep the patient over night at least. It is critical to maintain the patients body temperature, hydration, and oxygenation during and after the operation. It is important to minimize blood loss and limit the operating time to under six hours. If these parameters can not be met then it would be best to separate the procedures. Since each operation requires 2 weeks, 6 weeks and 6 months of recovery, doing them together limits the recovery time to one series of weeks. It is also financially better to do these in combination when safe and feasible.
It is very important to individualize.
Hi! If you are young, and healthy, and not overweight -- and if you are talking about liposuction of the love handles only -- then in NYC we would probably do breast reduction and tummy tuck and liposuction together.
But if you are not in good shape, or if you want liposuction of several areas, then I would do it in two stages.
Safety depends on what is done to whom, not the names of procedures
The procedures you mentioned do not describe the complete nature of the surgery. A breast reduction can remove 250cc or 1000cc. per breast. It might involve just a lollipop type tincision or an inverted-T incision. The same with the tummy tuck. Liposuction is even more variable as to volume and surface area. Certainly surgeons have perfomed all of these procedures at once. One of my patients on Extreme Makeover was such a patient. But the surgeon has to carefully weight the specifics of each procedure. For example, does he need to undermine the abdomen so close to the inframammary fold of the breast that the fold can shift inferiorly and thus distort the landmarks of the breast for his reduction and might it interfer with the blood supply of the abdominal flap? For the liposuction, it is perhaps not so much the total volume he needs to remove but the total surface area of the suctioned tissue that contribute to physiological fluid loss and demands on wound healing capacity. Your surgeon and you should also discuss the bailout points of the operation so that he can decide to curtail the operation in case things are not going according to plan. You are right to put safety first.
Certainly, you must be healthy to do this and you must have an excellent Board Certified Plastic Surgeon caring for you. Personally, I do this all the time but I never do any liposuction below the waist in this combination of surgeries. I restrict the liposuction to the flank areas only when I combine breast and abdominal surgeries. The reason I do this is to minimize the risk of blood clots in the veins which can dislodge and travel to the lungs and be fatal. I feel that you need to be mobile to minimize this risk and pain from head to toe will limit this mobility. My patients always go home without an overnight stay.
Multiple proceedures during one O.R session
Your age,health status, and risk factors are important considerations. Depending on the unit and the timing of the proceedures an overnight stay is often advisable. The surgeon's experience and comfort with multiple proceedures also plays a role. finally, an auto transfusion can often make for a smoother recovery.