Combining tummy tuck and breast reduction is one of the most popular mommy makeover surgeries. While this has been a routine procedure, theoretically it results in increased bleeding and higher surgical trauma, and ultimately higher risk of complications.
To minimize risk of complications from multiple surgeries, the consensus is to complete combo surgeries in less than 6-7 hours. For this reason, some patients may need a team of surgeons operating simultaneously to limit the operative time.
Furthermore, combining tummy tuck and breast reduction entails a strict patient selection process. The idea is to rule out any medical condition that can increase the risk of complications, particularly relating to wound healing and infection.
Hypertension, blood disorder, heart problem, obesity, and diabetes are just some of the roster of medical conditions that make any elective plastic surgery, particularly when it involves multiple procedures, imprudent.
If tummy tuck and breast reduction surgery is expected to take “too long,” or the patient has a medical condition that makes “combo surgery” inadvisable, the consensus is to have them separately. Nonetheless, procedures done in series also have their downsides such as multiple recovery periods and higher cost (i.e., the patient will pay for anesthesia and OR fees each time).
Increased bleeding is one of the caveats with combining tummy tuck and breast reduction or any other type of combo surgeries. Nevertheless, new techniques can minimize such risk. For instance, leading Beverly Hills plastic surgeon Dr. Tarick Smiley may elect the use of epinephrine injection before creating incisions.
Epinephrine is a drug that constricts the blood vessels thereby reducing the amount of bleeding. This is particularly helpful in tummy tuck, breast reduction, body lift for massive weight loss, and liposuction.
Furthermore, epinephrine can prolong or rather “spread” the numbing effects of local anesthesia, hence the patient could rely less on oral narcotic pain meds, which are linked to constipation, nausea, and lethargy.
The amount of postop pain is another issue with combining tummy tuck and breast reduction. But with proper pain management system, e.g., pain pumps or Exparel injection, most patients will find the initial healing stage (5-7 days) not too unpleasant.
Exparel injection is particularly ideal in combo surgeries. This is injected into the fascia and muscle right before the incision is closed with sutures.
Dr. Smiley says the numbing effects of Exparel can last up to four days without “disrupting” the normal functions of the body as their effects are limited to the surgical site. This is not the case with oral narcotic pain meds, which are known to cause nausea and vomiting.