I have had 2 hernia repairs and now have another repair needed. I've considered during the hernia repair (mesh will need to go from side to side since the hernia is on both sides of the midline and is over 15 cm) having the panniculectomy and breast reduction at the same time. Can these surgeries be done at the same time?
Extensive Hernia Repair, Panniculectomy and Breast Reduction at One Time?
Doctor Answers 2
You certainly may have these operations done concurrently if you are in good health and have no substantial extenuating circumstances. Many studies have looked at the safety of multiple procedures. As long as certain standards are met, these combination operations are just as safe as staggering them over a period of time.
I would recommend that you spend the night at the surgical facility under the observation of a professional.
Extensive hernia repair, panniculectomy and breast reduction at one time?
Regarding "I've considered during the hernia repair (mesh will need to go from side to side since the hernia is on both sides of the midline and is over 15 cm) having the panniculectomy and breast reduction at the same time"
In theory - yes, it IS possible to do them all at the same time. But - are you aware of the risk involved?
First, why do you think you failed 2 previous attempts to repair your ventral hernia (? large diastasis). The likely explanations are that your abdominal pressure is still high (you have not lost as much weight as you could have), you cough frequently (?past or present smoker) or strain frequently (lifting etc), stressing the repair, are malnourished (not allowing the surgery to heal properly) among others.
Placing a foreign body (mesh) in patients with a large panniculus has a higher rate of complications (which may require a 4th trip to the OR to remove an infected mesh). The reason it is hard to sterilize the fold under the apron before surgery starts. Any bacteria/fungi living there would have an easy time attaching to the mesh.
For this reason, it MAY be easier to do a panniculectomy and breast reduction (keeping a close watch on the OR time - see blow). This will remove the weight pulling on the hernia and a potential source of contamination. THEN - return a few months later and do the mesh repair in a safer environment. Alternatively, the mesh repair could then be done as part of an abdominoplasty which would remove a lot more of the loose lower abdominal skin/fat.
As regards OR time - the longer you are on the OR table the higher the rate of complications. The most dangerous of which are blood clot formation which may travel to the lungs. It is best to do multiple shorter procedures than one or 2 really long procedures.
I hope this was helpful.
Peter A Aldea, MD