Removing a Fibroid Along with a Tummy Tuck After Complicated Previous Surgeries?

Question

I'm a 47 y/o with a 26 BMI. In 1990, I was in a car accident, suffered internal damage (+lots of other damage) and have an "emergency" scar from pubic to sternum; in 1992, I had my third child, who was breech so C-section. Now I have fibroids - 11 cm/penduncullated (sp?) and causing a lot of issues: chronic anemia, heavy bleeding, weight gain, etc. Depressed. Will any doc give me a tummy tuck AND remove the fibroids (w/o hyster) considering my history? And does removing them cause weight loss?

Gary M. Horndeski, MD · Answer

You should not undergo a tummy tuck at the same time of the fibroid surgery.  If you had a previous laparotomy then you may have adhesions that will make it a difficult and long surgery.  Thus, increases the incidents of pelvic vein thrombosis and possible pulmonary embolism.  One of the most frequent complaints after fibroid removal is weight gain, not weight loss.  You may benefit from abdominoplasty with mesh reinforcement to help reduce the weight and maintain the reduced weight.  There are recently published articles in Plastic and Reconstructive Journal that support this concept.

	Best Wishes,

	Gary Horndeski, M.D.

Jourdan Gottlieb, MD · Answer

It is not uncommon for a patient to have a tummy tuck ant the time of various gyn procedures. 

	Safety is the main issue. Given the fact that you have had a major previous abdominal operation, it seems wiser to be to do the operations separately. Your tummy tuck would be better done after your anemia is resolved rather than at the time of the fibroid operation. 

	Check with your gynecologist about the relationship of fibroids to weight gain--I don't know of a connection. 

	Thank you for the question, best wishes.

Robert L. Kraft, MD, FACS · Answer

Fibroid surgery can produce a lot of bleeding and should not be combined with a cosmetic procedure.  Discuss the weight issue with your gynecologist.  I would also expect a patient with your history to have adhesions which would complicate things.  It is true that combining he procedures may actually cost more because the hospital may not give you the discounted cosmetic rate at the same time that it charges an insurance company full fee.  My choice would be to have you address the fibroids first, make sure that your hematocrit is up to snuff and that you are medically clearable, and then consider tummy tuck at a later date.  Best of luck!

Erez Sternberg, MD · Answer

You have a complicated history and therefore are correct to approach surgical procedures with caution.  The short answer to your question is Yes.  It is possible to have both of these procedure performed together and may be the best option for you. The reason is that even though you would have to pay more for the tummy tuck (hospitals charge much more than outpatient centers were cosmetic surgery is usually performed) you would be able to stay and recover in the hospital which would be covered under your insurance from the hysterectomy part.

	   I would recommend having an evaluation by the GYN surgeon, plastic surgeon, and a general surgeon as well should anything unforeseen arise from your abdominal surgery the general surgeon could be ready to repair or fix any complications or unexpected hernias. You will have a longer recovery period by having all of this performed together, but in the end it may be the safest and best route for you. Good luck.

Paul Gill, MD · Answer

I am sorry to hear of your previous accident and subsequent surgeries.   It is not uncommon to perform a tummy tuck in combination with your fibroid removal.    It would be important to obtain clearance from your gynecologist on the safety of adding a tummy tuck to removal of your large fibroids.   

	If they have any concerns on the safety of the procedure, I would recommend that you delay your tummy tuck until you recover safely.     After fibroid removal, you may lose the excess weight and get a better longterm result from your tummy tuck too.

	In regards to weight loss from the fibroids, you would have to ask your gynecologist, but i don't imagine the weight loss being of much significance.

	 

	I hope this helps.

	
	Dr. Gill

Sugene Kim, MD, FACS · Answer

Sorry to hear that you were involved in car accident. Although removing a fibroid and tummy tuck can be done at the same time technically, you need to meet certain criteria. For me to proceed with any elective surgery, patients need to be 1) medically optimized and healthy, and 2) at a stable weight for at least 3 months. You want to be evaluated by your primary physician to be cleared for surgery. Find out your level of anemia. In addition, your plastic surgeon and Ob/Gyn need to communicate prior to surgery. (Plastic surgeons will not removed fibroid). Lastly, removing the fibroid alone will not cause weight loss.

Vincent D. Lepore, MD (retired) · Answer

It is possible to have uterine fibroids removed while having a tummy tuck. The fibroids would have to be removed by a gynecologist and then a plastic surgeon would perform the tummy tuck. Given your accident and complicated history, be certain to have your surgeons review the records from your previous surgeries and have the discuss with each other how they plan to do their procedures. You should also discuss this procedure with your primary physician to make sure they feel you are in reasonably good health to undergo the surgery. Best Wishes.

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