Combining operations in one session: when yes, and where the limit is

"While I am asleep, they may as well do everything." It is one of the most repeated sentences in the consultation, and the logic is perfectly understandable: one set of pre-operative tests, one anaesthetic, one period off work, one fright for the family.

Sometimes it is the right decision. Other times it is what turns two safe operations into one dangerous one, and the difference deserves explaining.

When combining makes sense

The clearest example is what has come to be called a mommy makeover, which is not a technique but the combination, in one session, of abdominal and breast surgery after pregnancy and breastfeeding.

It makes sense because the two changes have the same cause. In the abdomen, the skin stretched beyond its capacity to retract and the rectus muscles separated. In the breast, volume rose during pregnancy and fell when breastfeeding ended, and the skin did not fully return. Solving it in one go avoids going through the same thing twice.

In general, combining is reasonable when the areas do not compete with each other, when the positions on the table are compatible, and when the total time stays within a prudent margin.

Where the limit lies

What has to be understood before deciding is this: combining operations does not make them smaller. It adds theatre time and it adds operated surface, and both raise the risk.

There is a reasonable limit, it is different for each person, and defining it is the important part of the consultation.

What moves it one way or the other:

• Total operating time. More hours of anaesthesia means more thrombotic risk and more time immobile.
• Cumulative blood loss from several procedures at once.
• Operated surface. Each area adds its own risk of infection and of healing problems.
• Your health: age, weight, smoking, diabetes, history of thrombosis, medication.
• The resulting recovery. An abdominoplasty requires a flexed posture and breast surgery limits the arms; together they can leave someone unable to get out of bed alone.
• Who looks after you at home. This sounds minor and is not, especially with small children.

The signs that it is being pushed

If the plan you are offered adds up to five or six procedures, if nobody mentions the estimated total time, if there is no talk of thrombosis prophylaxis or of where you will spend the first night, or if the main argument is the saving, it is worth stopping.

A plan defended by what it costs rather than by what you can tolerate is not a surgical plan.

Two stages is not a failure

Splitting into two operations separated by a few months is, in many cases, the decision of someone looking after the result rather than the calendar. You recover twice, yes, but each recovery is more manageable and the margin of safety is greater.

What is not promised

A mommy makeover is not weight-loss surgery and it does not replace a diet, and it does not give back the exact body you had before pregnancy: it gives back a version with the abdominal wall repaired, the breast in place and permanent scars that are the real trade-off.

And there is a condition worth respecting: stable weight and a complete family. A further pregnancy or a significant weight gain can undo much of what was achieved.