Thigh Lift + Tummy Tuck + Breast Augmentation - Would it be unsafe or unwise to do all 3 procedures at once with no lipo?

Question

I'm a healthy 30 year old woman interested in having a tummy tuck, thigh lift and breast augmentation after losing 100lbs. I am now floating around 140-150lbs at 5'6". I've gotten conflicting answers from the surgeons I've had consults with on the amount of surgeries I would need to have and my "need"for liposuction. Hopefully I can get a consensus here. Would it be unsafe or unwise to do all 3 procedures at once with no lipo? And do I need liposuction?

Ryan Rebowe, MD · Answer

Following significant weight loss there are many options for correction. Typically, you will need an in person physical exam by a board certified plastic surgeon for the best management options. The reason for this is the need to examine the quality of your skin. Most of the time, following weight loss, the skin has lost its elasticity and therefore liposuction alone is not a great management option because it can create skin that is even more loose. Therefore, skin excision is often necessary. In terms of your case, I think it would be safe to pursue the abdominoplasty and augmentation at the same time. I would not pursue any type of thigh procedure in conjunction with that as your mobility would be too limited following surgery predisposing you to blood clots. Furthermore, the amount of excess skin following weight loss creates a relatively frequent rate of asymmetries. These can be effectively addressed when staging surgeries as additional operative time is already planned.

J. Timothy Katzen, MD, FACS · Answer

Thank you for your question regarding Thigh Lift + Tummy Tuck + Breast Augmentation and whether it would be unsafe or unwise to do all three procedures simultaneously with no lipo. Thank you for your pictures and your history. In regards to your specific case, congratulations on losing 100 pounds. In your pictures, I do not see any areas needing liposuction. Do you? Are there any localized areas of fat that bother you? If so, these would need liposuction; otherwise, in my opinion, I do not think you need liposuction. You could undergo a tummy tuck or thigh lift in the same procedure.
I would suggest silicone breast implants placed through an inframammary incision for your breast augmentation. If you want more cleavage, I would suggest on top of the muscle. If you want more natural, I would suggest under the muscle. In regards to your abdominoplasty, I would suggest horizontal abdominoplasty. Alternatively, you may want to consider a high-tension tummy tuck to achieve more of a waistline. The tummy tuck should include muscle plication, necessary after weight loss, and your distended abdomen on profile view. Your tummy tuck will also include a pubic lift and reduction. In regards to your thigh lift there are five different types of thigh lifts. Regarding your thigh lifts, I suggest an incision from the groin, partially down the inner thigh or to the knee. If the knee area bothers you, I suggest the thigh lift incision be taken to the knee. Nonetheless, I believe all these procedures can be done at one time. I hope I've answered your question about whether you can simultaneously undergo a thigh lift, tummy tuck and breast augmentation. Good luck.
Sincerely,
Dr. Katzen

Chet Mays, MD · Answer

Thank you for your inquiry! I recommend consulting with a board certified plastic surgeon like myself to create a surgical plan targeted towards your specific goals. A consult would allow us to hear your goals and make sure you're a great candidate for these surgical procedures. Each plastic surgeon varies in the amount of time allowed in the OR for one surgery. It's important to prioritize safety for any elective surgery. Liposuction can be included with some procedures as that also varies with each surgeon as well.

Ricardo Vega, MD · Answer

Thank you for your inquiry and photos, congratulations on your weight loss! You are young and healthy there is no problem having all procedures done at once, of course it is important to have a preop general blood check up and EKG by Internist dr before surgery. No lipo seems to be needed in your case, you would have a good outcome result with only the tummy tuck with muscle repair. Breast augmentation no lift needed and inner thigh lift. Best of luck!

Thomas Trevisani, MD · Answer

Congrats on your weight loss! In person exam is essential. In our Practice we often perform extensive  combination body contouring procedures in a Hospital setting, with overnight stay . I suggest that you seek an experienced Board Certified PS and discuss your options once the exam is conducted

Alireza Najafian, MD · Answer

Hi! I am not surprised you got different answers to this question because it is a tricky question. I will give you my answer and reasoning and I hope it will help you with your decision. I recommend staging these 3 into 2 surgeries: 1-tummy tuck + augmentation 2-thighsReason is that the combination of operations has significantly longer anesthesia time and longer and more difficult recovery and both of these come with higher risks. Having done surgery in both legs and abdomen at the same time significantly limits your physical abilities. I always would like my patients to be able to mobilize early (starting with few steps every hour or so) to prevent blood clots and having all these would make your recovery way more challenging. Also, your body uses protein and energy resources for healing and having too much healing demand will result in slower recovery. 
I would also recommend liposuction, not as the main treatment, but as an adjunct. I do VASER lipoabdominoplasty and use lipo to facilitate other procedures like thigh lift and arm lift. It helps with the efficiency of the operation, facilitates closure and give smoother results. So it is more of a technique and that is why it may differ from surgeon to surgeon. Hope these answers help!

Darryl J. Blinski, MD · Answer

Great posted photos. I see much more surgical needs! And best to separate in 2 sessions. Start with full TT w muscle repair, silicone implants High Profile, mini inner thigh lift. Then after few months lipo with hip dip BBL. Best to virtual consult with...

Camille Cash, MD · Answer

Congratulations on your impressive weight loss!  Combining procedures is common and considered safe, but there is a limit.  Generally it is best to limit surgical time to six hours.  For the procedures you are considering you may exceed this time frame.  I've included a video discussing plastic surgery after major weight loss that I hope you find helpful.

Diego Ampudia, MD - Account Suspended · Answer

Many plastic surgeons do not recommend combining those three surgeries since combining an inner thigh lift with a tummy tuck causes more edema and increases volume in the legs. This produces stress in the wounds and, as a result, their opening.If you contact a plastic surgeon with experience in these operations, you could have this combo done safely and with excellent results.In my expert opinion, liposuction is worth it to enhance body contouring and better manipulate the skin for the inner thigh lift.

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