Multitasking Surgery: Combining Cosmetic Surgery with Other Surgery

Bad News: you need gynecologic abdominal surgery; Good News: you can get a “tummy tuck” at the same time

Filed in the category, “two birds with one stone,” it sounds like a great (and efficient) idea to have plastic surgery on your abdomen at the same time another surgery becomes necessary in your abdomen. Is this the silver lining in an otherwise dark cloud?

Gynecologic abdominal surgery and plastic surgery involving the abdomen, however, are two different birds altogether. As an example, one of the more common “combo” surgeries done in the USA, hysterectomy and abdominoplasty (tummy tuck), are very different, indeed:

  • In a hysterectomy, the uterus (womb) is removed from the abdomen and
  • In a tummy tuck, the fourth most common cosmetic procedure,1 the abdomen is not even entered.

It doesn’t matter if the abdominal surgery is another gynecologic procedure—fibroids, tubal ligation, ovarian cyst removal, the same rationale applies.

Like an onion.

The abdominal wall is made up of layers, the combined affect creating a thick shell for the abdominal cavity—what you consider your “insides.” Tummy tucks involve only this body wall, never going through this protective wall completely—never entering your internal abdominal/pelvic cavity.

Different surgeries—different risks: how do they add up?

Because these are two different types of surgeries, does doing them at the same time double the risks? The simple answer is – usually not. It turns out that the combined risks are less than if you had each one separately. (That’s two small steps for medicine, one giant step for womankind!) The reason multiple simultaneous surgeries don’t just add up the risks arithmetically is because the risks of each overlap. Doing the procedures together consolidates the risks to one event, compared to doing them separately (which means undergoing the risks twice).

According to one study, however, the risk of venous thromboembolism seems to be additive when abdominoplasty was combined with hernia repair or combined with liposuction. It is also important not to stack too many procedures together – to keep the overall total surgical time down to a reasonable number of hours. The patient’s underlying medical conditions should also be factored into the equation.

The most important (and forgotten) risk of all: anesthesia.

In deciding to combine an elective surgery with a needed one, the cornerstone of the good sense of your decision is anesthesia. Anesthesia is a big blotch on that Venn diagram of overlapping risk, and its risk is primarily with the necessary surgery (abdominal), not the elective one (tummy tuck). This is because you need deep general anesthesia for gynecologic abdominal surgery. The combined procedure has less anesthesia risk overall than having these surgeries at different times. Twice the anesthesia on different days is sometimes riskier than undergoing anesthesia only once on the same day.

Bonus! Combining an insurance surgery with a cosmetic procedure may lower your cosmetic surgery fees (but probably just a little).

Insurance companies think that improving your self-image is vanity and not medically necessary and hence do not cover any cosmetic procedures. It is well established, however, that body image impacts quality of life, which frequently favorably impacts mental health.2 When you combine an insurance procedure with a cosmetic procedure, in many cases (but not all), the surgical facility and anesthesiologist will pass on a small cost reduction of their usual cosmetic service fee onto the patient.

Double bonus! Strong pain relief immediately after your tummy tuck.

Tummy tucks are not without discomfort, so having a few days of postop care in the hospital (covered by insurance) with adequate pain relief enough for a gynecologic abdominal surgery will usually cover the discomfort of a tummy tuck. Normally, you would have to “go it alone” at home with just oral pain pills if you were undergoing just a tummy tuck by itself. Nice!  Another hidden bonus – if your two procedures are done together, then you have only one recovery period (about three weeks long) – rather than two separate independent recovery periods (two separate three week long recovery periods).

The verdict.

If you are otherwise medically healthy, combining the two surgeries (multitasking surgery) may be a good idea. Some studies have shown that combining cosmetic surgery with another surgery is generally safer than doing them separately.3,4,5,6 In many cases, the immediate post-operative period is also more comfortable since you are already being admitted overnight to the hospital (and getting strong intravenous pain medication) for the gynecologic procedure. It is important, however, not to over do it.  The total number of hours of surgery (total operative time) should be kept at a reasonable number. Some studies have shown that as time spent in the operating room lengthens, the rates of certain complications also increase – such as surgical site infections and blood clots. Of course, most conscientious board certified plastic surgeons take appropriate precautions such as administering intravenous antibiotics and using blood clot prevention devices (sequential leg compression devices known as SCD’s) to keep complication rates at a minimum.

Your pre-existing medical conditions are more predictive of whether complications will occur during (or after) elective surgery. You would be considered “high risk” for surgical complications with any elective surgical procedure if you have severe (unstable) heart disease, severe COPD (chronic obstructive pulmonary disease), pulmonary hypertension, history of stroke, insulin-dependent diabetes mellitus, kidney insufficiency or severe liver disease. If you have any of these serious pre-existing medical conditions, then you are at “high risk” for experiencing surgical complications.

Resources:

  1. ASAPS Press Center – Cosmetic Surgery National Data Bank Statistics 2017. American Society for Aesthetic Plastic Surgery. Available at: www.surgery.org
  2. Carlo M. Oranges, Kristin M. Schaefer, Martin Haug, Dirk J. Schaefer; The Impact of Aesthetic Surgery on Body Image and its Implications for Mental and Physical Health, Aesthetic Surgery Journal, Volume 36, Issue 8, 1 September 2016, Pages NP256–NP258
  3. Sinno, S., Shah, S., Kenton, K., Brubaker, L., Angelats, J., Vandevender, D., & Cimino, V. (2011). Assessing the safety and efficacy of combined abdominoplasty and gynecologic surgery. Annals of plastic surgery67(3), 272-274.
  4. Kryger, Z. B., Dumanian, G. A., & Howard, M. A. (2007). Safety issues in combined gynecologic and plastic surgical procedures. International Journal of Gynecology & Obstetrics99(3), 257-263.
  5. Massenburg, B. B., Sanati-Mehrizy, P., Ingargiola, M. J., Rosa, J. H., & Taub, P. J. (2015). Outcomes and safety of the combined abdominoplasty-hysterectomy: a preliminary study. Aesthetic plastic surgery39(5), 667-673.
  6. Cosin, J. A., Powell, J. L., Donovan, J. T., & Stueber, K. (1994). The safety and efficacy of extensive abdominal panniculectomy at the time of pelvic surgery. Gynecologic oncology55(1), 36-40.
  7. Saad, AN. Risk of adverse outcomes when plastic surgery procedures are combined. Plast Reconstr Surg. 2014 Dec;134(6):  1415-22.