Fat Removal Volume for Breast Reduction and Liposuction?

Question

I'm getting a Breast Reduction of 1 kg done at the same time of Liposuction to upper and lower abs, flanks, and outer thighs. I'm supposed to be under general for 5 hours. Based on the max volume for Liposuction, should my doctor remove less fat from my areas if she is already removing 1 kg from my breasts? Should I split the surgeries to be in a safer side and get more fat removed with the surgery for Liposuction alone?  Thanks.

Brent Moelleken, MD · Answer

Breast reduction and liposuction together have higher complication rates than if both surgeries are performed separately.  However, there are recent studies suggesting that the complication rate may be acceptably low.
It is certainly a judgment call and an issue for the patient to weigh carefully, the slightly increased risk vs. getting the surgery done at once.  The age, general health of the patient and experience of the surgeon will all also weigh heavily in the equation.
Obviously, a premium surgical facility, measures to prevent blood clots and probably postoperative monitoring of some sort should be considered.

Trevor M. Born, MD · Answer

Dear Ms. Danicomia
The length and extent of your surgery needs to be dicsussed with your surgeon. You have to make the decision based on the information that is given and move forward with conficence.  As you can see from the replies there is not one correct answer.  Sometimes you have to go with your gut.  Most practitioners have your best interests in mind and will offer the safe course.
In my practice the combination of procedures you are describing is a reasonable option.  If you do not feel comfortable with the combined surgeries then split them up.
With Warm Regards,
Trevor M Born MD

Lane Smith, MD · Answer

The safety of any surgery depends on many factors, including but not limited to, your general level of health, your weight, the procedures performed and the skill of the surgeons and anesthesiologists etc. Generally, a well-trained meticulous surgeon can safely perform the liposuction and breast reduction provided you do not smoke, have no additional risk factors or family history of blood clots, you are not morbidly obeses and are generally healthy. If you are a smoker or extremely heavy, then I would consider dividing your surgery into two surgeries. Otherwise you should be fine having the surgery.

Tom J. Pousti, MD · Answer

Thank you for the question.

	You are wise to be concerned about the extent of surgery that can be done safely in one session. It is more so the blood loss as opposed to the adipose tissue removal that is of major concern.

	It would be best to break the procedures into 2 stages if you feel that the aesthetic results of the liposuction procedure will be compromised because of safety concerns.

	Best wishes.

Pat Pazmino, MD, FACS · Answer

It is typically safe to perform a breast reduction surgery at the same setting as a liposuction procedure. The breast reduction will directly excise that and breast tissue. The liposuction surgery will remove fat from a wider area in your body. Discuss with your plastic surgeon how much volume they anticipate removing with the liposuction surgery. If they recommend extracting a very significant amount, such as more than 5 L of fat, it may be in your best interest to perform this surgery as an inpatient procedure.

Steven Wallach, MD · Answer

It is perfectly reasonable to perform a breast reduction and liposuction at the same time provided that you are healthy and the surgery will not be too long.

Robert M. Freund, MD · Answer

I try to limit surgical time to four hours or less. I use this number for several reasons. 
1. Any human being starts to get tired and in my own hands, I start to rush after that time.
2. As the length of the case goes up, so does your risk for blood clots in your legs. The risks go up even higher after four hours.
3. Although the two procedures together may have some added risks, as described above, It sound like you are looking for significant results for the liposuction, which may not be possible with a combined procedure. These are reasonable concerns.
Finally, When everything is taken into account, separating the two procedures is the safest way and perhaps yield the best results. However, this will likely cost you more money and the added time of two recoveries instead of one.

James C. Grotting, MD, FACS · Answer

I agree with your surgeon's goal of trying to limit the duration of surgery to 5 hours. The amoun of fat removed refers only to the volume of lipoaspirate. 5 liters is the at the upper end of what is generally considered safe for a single anesthetic.

	Although with proper overall patient management, especially fluid management, lipoaspirates of greater than 5 liters can safely be remove at one setting. The amount of tumescent fluid infiltrated should not exceed the maximum safe dose of the lidocaine component (generally accepted to be around 35 mg/kg).

	There have been some laws enacted which impose stricter regulations on patient management after liposuction. For example, the state of Florida requires all patients who undergo liposuction of greater than 3 liters to be admitted to an ambulatory surgery center or hospital and observed overnight.

	Your sugical risk is affected by your current body weight and overall state of health. Assuming these are normal and good to begin with, it sounds like combining the procedures you mentioned should be perfectly safe. MH

Thomas T. Nguyen, MD · Answer

Most often, we combine procedures for the convenience of the patient.  Part of the cost of the procedure is the time off from work and all of your normal activities.  So we often do as much as we feel is safe to give you the most benefit from your time off and let you recover one time instead of having two separate recoveries.
If you don't mind waiting for the liposuction, by all means do so.  One thing about the breast reduction is that it is exhausing for the body.  Although it is not normally very painful, it takes a toll on you physically.  Liposuction is also similarly draining.  If you are concerned, express this to your doctor.  Maybe you will feel so good after your breast reduction that you will be able to be a little more active and get rid of some of the extra 20 lbs first before undergoing liposuction, if you even need it at all.
Good luck!

Christopher L. Hess, MD · Answer

Studies have shown that liposuction is safe with aspirates up to 5 liters. This is based on infusion volumes and the medications that are put into the tumescent solution. So it's safe as long as the amount of local anesthetic is in the safe range for the case. It is possible that your surgeon will get close to that safe range. But as long as she does the math you'll be just fine.

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