I'm considering doing a breast implant (a to b), smart liposuction, and upper eyelids. Is this too much for one surgery?

One highly respected doctor said that overall it should take approximately 3 hours and doing the three st once would be fine. Another highly respected doctor said he would only do 2 procedures at once. It seems the 2nd doctor sees the procedure lasting for almost 6 hours. I'm fit, 120lbs, 5'4" some stubborn fat around my middle. I also have Factor V Leiden. Would love some other opinions. Thank you.

Doctor Answers 8

Combination Procedures

Surgical procedures are often done in combinations for aesthetic, financial, or convenience reasons. These procedures can include any combination of body contouring and facial procedures. 

Upper lids, breast augmentation, and a conservative amount of lipo in an otherwise health individual is typically safe and able to be reasonably done within 3 hours. 

For healthy patients, the most significant factor limiting the number of procedures is the total operative time. Patients have more complications as the operative time goes above 5-6 hours.  In your case, your Factor V Leiden also increases your risk of complications - most significantly a blood clot. This risk would have to be weighed against the benefits of the surgery.

A detailed examination will help delineate the best surgical option. Consultation with a surgeon certified by the American Board of Plastic Surgery would be the next best step. See our link below for more information. 

I'm considering doing a breast implant (a to b), smart liposuction, and upper eyelids. Is this too much for one surgery?

Generally speaking complications increase as the number of different procedures increases and most importantly the time of surgery increases.

As you can tell different surgeons operate at different speeds based on their experience an technical skill.  The other issue is your discomfort  postoperatively which most likely will be more difficult after 3 procedures.  I routinely combined blepharoplasty with breast augmentation but would be less swelling to add a third liposuction procedure.

It depends on your level of comfort with each surgeon.  I would ask the first surgeon if he/she is confident with the three-hour estimate..  The other estimate of 6 hours seems to me unusually long and I would recommend that you  limit yourself to surgery that will take less than 4 hours.

Multiple surgeries

Factor V requires medical and hematology clearance before considering any elective surgery. This should also discuss which, if any, procedures can be planned.

An exam and consultation with a plastic surgeon is recommended to discuss your options and expectations.

Factor V and Multiple procedures

The key to your situation is your medical history of Factor V Leiden deficiency, which does impact your risk for multiple procedures or prolonged anesthesia even if you are fit and otherwise healthy. An in person consultation is the best way to determine what is appropriate, but since you have done that and now have 2 somewhat different opinions, the best advice may be to go with the more conservative approach. These are elective procedures and above all else we want them to be safe. It is not unreasonable to think that the procedures you desire could be done at the same time in the 3 hours estimated by the first surgeon (depending on how much liposuction is planned, as I see that as the greatest variable in this plan). However, any one part of the surgery could require unexpected additional time and attention which could then prolong your anesthesia time and as a result increase your risk for complication. One approach would be to have only the breast augmentation and liposuction done under general anesthesia and then have the eyelid surgery under local anesthesia, which is very well tolerated. Depending on the amount of liposuction planned, it would also be reasonable to combine the Smart Lipo with the eyelid surgery under local anesthesia and only have the augmentation done under general anesthesia, which can often be completed in an hour or less. Although less convenient to split up the procedures, it would allow for more control over the amount of general anesthesia time required, which is the factor most directly related to your operative risk. All of this of course assumes you have been cleared by your primary care physician for elective surgery. Ultimately both opinions you have obtained may be valid and reasonable, but it is never wrong to treat a higher risk medical history with the respect it deserves in order to provide you with the safest care possible. Best of luck!

Evaluation

Hello and thank you for your question.  The best advice you can receive is from an in-person consultation.  In my practice, all of these procedures can be safely combined in a healthy patient, who is able to obtain medical clearance.  Make sure you specifically look at before and after pictures of real patients who have had this surgery performed by your surgeon and evaluate their results.  

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Richard G. Reish, MD
New York Plastic Surgeon
5.0 out of 5 stars 80 reviews

Factor V

Thanks for posting this question. Factor V deficiency is a serious problem that will place you at higher risks of blood clotting problems after surgery. It makes me think that 3 operations might be too much risks with this condition in your genetic background. I think you should weight the pros and consequences after consulting with a blood specialist (hematologist) on your risk factors. Then return to speak with the plastic surgeons. Best, Dr. Aldo

Aldo Guerra, MD
Scottsdale Plastic Surgeon
4.9 out of 5 stars 191 reviews

Combined surgeries

The most important part of your question to me is the mention of Leiden factor V.  Can you be medically cleared for surgery? What are the risks?  Have you been cleared by your hematologist? Based on this, surgical time could be affected even if your condition is controlled.  I would proceed with more caution than in a patient without a clotting disorder and limit the procedure as a consequence.

Surgery limitations

The problem is it is difficult to say without being able to examine you in person.  I can't say why one surgeon thinks it can be done in two hours, and the other 3 hours.  Is one surgeon rushing or the other taking too long?  Again, difficult to say without knowing the surgeons, and why they're proposing what they are.  In the end, I think it is safer to go with someone who is being some more conservative and recommending less at once, especially for someone at risk for clotting.
Best of luck!

Dr. Subbio
Board-Certified Plastic Surgeon
Newtown Square/Philadelphia, PA

Christian Subbio, MD
Philadelphia Plastic Surgeon
5.0 out of 5 stars 52 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.