Combination procedures in plastic surgery
William Bruno, M.D.

Often times, patients will request more than one procedure to be performed during the same surgery. Whether this includes a facial procedure with a breast augmentation, or a tummy tuck and several areas of liposuction, the combination of procedures is not as important as the patient's overall health and safety.

Firstly, patients should be in good overall health as determined by their primary care physician or internist. This involves a complete history and physical examination with an EKG and additional blood work. Occasionally a patient may even need clearance from a cardiologist. The patient's age is not as important as their level of health. If there are any health concerns, the patient can be referred to a specialist for further investigation prior to surgery. Remember, cosmetic surgery is elective, so there is no rush to undergo these procedures until you have the proper medical clearance.

Secondly, once your good health has been established, the total length of the surgery must be closely considered. For example, a breast augmentation, which takes about one hour, can safely be combined with a tummy tuck, which takes about two hours. That makes for a total of about three hours, which is reasonable for outpatient plastic surgery. In fact, the American Society of Plastic Surgeons (ASPS) has determined six hours to be a guideline or limit of surgery duration for outpatient plastic surgery. If the combined procedures last longer than six hours, it is recommended the patient stay overnight at a hospital or after-care facility to be observed. If a combination surgery is scheduled to be longer than six hours, the surgeon needs to consider staging the procedures and performing them at separate times to ensure patient safety. The longer a surgery is, the higher the risk of deep vein thrombosis (DVT) or blood clots developing in the lower extremities becomes.

Each patient has their own unique anatomy and their own individual needs. I will be happy to discuss the most realistic and safest approach to your surgery if you are considering a combination of procedures.

Best wishes,

Dr. Bruno