Tummy tuck combined with hysterectomy?

Question

Looking for a plastic surgeon in the Kansas City area that will do a combined surgery(tummy tuck with hysterectomy.)

Richard H. Tholen, MD, FACS · Answer

Not recommended. (For a number of reasons.)
First, though it sounds appealing to combine two operations into one, one is elective, and the other covered by insurance. Gone are the days when you could get insurance to "cover" the operating room, anesthesia, and many share-able costs, and you would only have to pay the surgeon's fee for the tummy tuck. Good deal since this would "save" money, and you only have one recovery. However . . .
 . . .insurance has now figured this out, and will divide the operating room and anesthesia fees into the "covered" ones and the self-pay (cosmetic) ones, and charge YOU for every non-hysterectomy-related part of these costs. You can bet they are not at the insurance-discounted rate either--these costs will be at the full-price hospital rate, making the elective tummy tuck portion of your hospital bill extremely high in cost and very surprising! Once the surgery is done, it's too late to appeal these costs, since they have already been incurred, and you "chose" to have elective surgery at the hospital, so you really get it stuck to you cost-wise! 
Thus, you not only still have to pay the entire plastic surgeon's fee, but the tummy tuck-related portion of the OR, anesthesia, as well as any costs they can determine are related to the "cosmetic" part of the procedure, at the full hospital price. Trust me, many patients have been bitterly disappointed at this fact, and even get angry with their surgeon, as if we had something to do with the patient's misconception that they could add-on a "bonus" tummy tuck and get insurance to "cover" part of it.
Secondly, if there is a complication, insurance COULD decide that the complication is related to the cosmetic surgery rather than the hysterectomy, and charge those costs to you as well, even though the cosmetic surgery may not be the cause, or it may be impossible to determine. Still, hospitals and insurance companies have the power to fight you, and make your life miserable, and cost you time and lawyer's fees when you're trying to recover from surgery.
Thirdly, tummy tucks involve skin flaps and lots of potential space in which seroma, blood, and possible infection can come from a less-sterile hysterectomy procedure, especially if it is not a vaginal hysterectomy. It may seem a good idea to have the abdominal hysterectomy incision "removed" by the tummy tuck, but this also means the non-sterile genital tract bacteria can contaminate the otherwise-sterile tummy tuck spaces, increasing usually low risk of infection. (And even if the infection came from hysterectomy contamination of the tummy tuck, the infection will be in the tummy tuck space, and guess what the insurance company says about who pays those infection-related costs? Yep, you're right! The tummy tuck "got infected" and the elective part of the operation and related complications are paid for by you.) Or maybe you like to fight with insurance companies! They are huge for a reason, and the individual patient has little recourse but to fight, lose, and pay through the nose again!
I know this all sound theoretical and very cynical, but there is a reason I bring up these facts, and it's not because I "heard" about this happening once. I've had more than one patient describe these exact occurrences, and this is why I refuse to "combine" these procedures, even with excellent Ob/Gyn surgeons. (my daughter AND son-in-law are both Ob/Gyn specialists.) They agree with and understand my concerns. Incidentally, these types of time-and energy-stealing battles are also why I no longer perform reconstructive surgery and refuse to accept insurance. They may not ALL be crooks and liars, but I don't want to deal with ANY of them! I miss the surgical procedures, but not the insurance paperwork and continual hassles.
So, sure, tummy tuck and hysterectomy is possible as a combined case. But is it wise? And will it REALLY save you any cash? No. Not recommended. Get over your hysterectomy, and when cleared by your Gyn surgeon, proceed with your elective tummy tuck at the outpatient surgery center or doctor's accredited office surgical facility. I operate in my own nationally-accredited (AAAASF) surgical facility in my office, and I can tell you we have NEVER had ruptured appendices, dead bowel, sick patients, nasty bacteria, or farm injuries in our operating rooms. Guess what the hospital has to say about those things! They have had all of these and more I do NOT want to hear about with MY tummy tuck patients! Just saying. Dr. Singer is right. Best wishes! Dr. Tholen

Nelson Castillo, MD · Answer

Thank you for sharing your question.  It is possible to combine these two procedures and I would advocate speaking to your ob/gyn about plastic surgeons that they work with to have this done. You can then interview each to find one that you are most comfortable with.  Hope this helps.

Steven Wallach, MD · Answer

Many surgeons will do both at the same time for non-cancer procedures.  Best to coordinate it with your plastic surgeon and your gyn.

Paul J. Leahy, MD · Answer

Thanks for your question. Combining tummy tuck with a GYN procedure such as a hysterectomy is not uncommon. It can be convenient to just have one recovery. It just takes a little coordination between the two surgery teams. The best thing is probably to find out where your OB/GYN surgeon wishes to do your procedure, and then from there you can find a plastic surgeon who can also go to that hospital. Best wishes.

Jack Peterson, MD · Answer

A hysterectomy is a common procedure to combine with an abdominoplasty. It does increase the surgical time, potential blood loss and postoperative infection risk. It usually done in a "tag team" approach with your gynecologist and your plastic surgeon. I would recommend that you discuss this with your gynecologist and your plastic surgeon well before you are planning to have your procedure, because sometime it is difficult to get two busy surgeons schedules to coincide.

Robert Singer, MD · Answer

While these combined surgical procedures have been
performed together, most experienced plastic surgeons feel that this is a bad
combination of surgical procedures to undergo at the same time. There is an
increased risk of bleeding, infection, deep venous thrombosis (DVT)
and subsequent pulmonary embolism with this specific combination.

Robert Singer, MD  FACS
La Jolla, California

Jon E. Rast, MD · Answer

Thank you for your question. It is possible to combine both of these surgeries. Both surgeons would have to have operative privileges at the same hospital.

Daniel Bortnick, MD · Answer

Hi and thanks for your question. I have done many tummy tuck and hysterectomy combo surgeries  over the years. Having performed many thousand of abdominoplasties, here are a few special things to know. Having combined procedures does not decrease the cost of hospital or anesthesia. It does however, make sense in terms of one recovery and one time for anesthesia. Combined procedures of this type carry a slightly higher rate of wound infection and a slightly higher rate of deep vein thrombosis. Depending on your pre existing health that might be a concern. Combined procedures like this require at least overnight hospitalization, as opposed to outpatient for a tummy tuck. This is usually covered by your insurance at least. Hysterectomies performed with the Davinci robot decrease time in hospital and recovery and risk from the two together and is a nice option if your GYN does these and your hospital has the equipment.  Overall it should not be a problem if your medical health is good and you are a good candidate for tummy tuck. I would suggest you contact your plastic surgeon and get their input after an examination. Make sure your GYN and plastic surgeon have worked together before and feel comfortable. Good luck!

Joseph Rucker, MD, FACS (retired) · Answer

A combination of the two procedures is routinely done. There is a slightly higher risk of post-operative infection but the upside is: 1. the hospital will partially cover the cost of your anesthetic and operating room charge. 2. you have one recovery and one time off work.  Good Luck

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