?Extreme? cosmetic surgery: a retrospective study of morbidity in patients undergoing combined procedures*1

Stevens, W. Grant; Vath, Steven D.; Stoker, David A.

doi:10.1016/j.asj.2004.04.005

Cited by 41 publications

(16 citation statements)

References 9 publications

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“…It has proven feasible to combine breast surgery with abdominoplasty provided that operating room time is minimized and appropriate logistical precautions are taken. This conclusion is consistent with the vast majority of literature on the topic of combining abdominoplasty with additional procedures (Table 1), 2,[6][7][8][12][13][14][19][20][21][22][23]65,72 including recent American Association for Accreditation of Ambulatory Surgery Facilities data 34 demonstrating that abdominoplasty plus one additional procedure is performed slightly more frequently than abdominoplasty alone (187,847 versus 176,092 cases, respectively), but abdominoplasty plus one, two, or three procedures is performed over 1.5 times more frequently than abdominoplasty alone (286,742 versus 176,092 cases, respectively). Critical elements in avoiding pitfalls include careful patient selection, meticulous but efficient operative planning and technique, a well-thought-out operative sequence accounting for necessary changes in patient position, close attention to fluid management, and a well-thought-out postoperative care plan that includes early ambulation.…”

Section: Impressions and Recommendations From Our Experiencesupporting

confidence: 91%

“…2,[19][20][21][22] Stevens et al report no increase in complications when comparing isolated abdominoplasty to abdominoplasty combined with breast surgery or facial rejuvenation. 2,20 They report a revision rate of 13 percent for these combined procedures, and note that although a 13 percent revision rate is not insignificant, 100 percent of these patients would have required a second operation should their procedures have been staged from the outset. 21 Although the breasts and the abdomen are anatomically distinct with regard to operative intervention, they are physiologically linked.…”

Section: Combining Abdominoplasty With Anatomically Distant Procedurementioning

confidence: 96%

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Combined Breast Surgery and Abdominoplasty

Matarasso

Smith

2015

Plastic and Reconstructive Surgery

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Abdominoplasty and breast surgery are frequently appealing to patients as combined procedures. The practice of combining abdominoplasty with other procedures originates from abdominoplasty performed in conjunction with intraabdominal or gynecologic surgery. Initially, the focus of combined surgery was on ensuring safety and minimizing local (e.g., wound healing) complications. As surgeons began combining abdominoplasty with distant procedures such as breast surgery, because the individual procedures have little adverse impact on one another and are not altered because of the combination, concerns with systemic morbidity surpassed the initial focus on avoiding local complications. Prevention of venous thromboembolism became a paramount concern. The authors perform abdominoplasty in conjunction with other procedures more frequently than in isolation, reflecting broader societal demand. Indeed, because of the effects of pregnancy and aging, abdominoplasty is being performed in conjunction with breast surgery with frequency sufficient to have driven the term "mommy makeover" into mainstream parlance. Consideration regarding length of surgery and the other recommendations in this report allows for the safe and successful execution of this common combination.

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Section: Impressions and Recommendations From Our Experiencesupporting

confidence: 91%

Section: Combining Abdominoplasty With Anatomically Distant Procedurementioning

confidence: 96%

Combined Breast Surgery and Abdominoplasty

Matarasso

Smith

2015

Plastic and Reconstructive Surgery

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“…Nevertheless, many combined plastic surgery procedures are routinely and safely performed in ambulatory surgery settings. Although studies that support the feasibility and safety of performing multiple simultaneous surgical procedures in the ambulatory setting are scarce and limited to the office-based setting, 77,78 these findings are corroborated by additional studies carried out in nonambulatory or unknown surgical settings that identified no statistically significant differences in complication rates between single and multiple procedures (i.e., abdominoplasty with or without other procedures). 79 -81 Despite the general safety of performing multiple surgical procedures in concert, certain patient factors have been correlated with an increased complication rate during multiple procedures, most notably, elevated body mass index.…”

Section: Multiple Proceduresmentioning

confidence: 78%

Evidence-Based Patient Safety Advisory: Patient Selection and Procedures in Ambulatory Surgery

Haeck

Swanson

Iverson

et al. 2009

Plastic and Reconstructive Surgery

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Despite the many benefits of ambulatory surgery, there remain inherent risks associated with any surgical care environment that have the potential to jeopardize patient safety. This practice advisory provides an overview of the preoperative steps that should be completed to ensure appropriate patient selection for ambulatory surgery settings. In conjunction, this advisory identifies several physiologic stresses commonly associated with surgical procedures, in addition to potential postoperative recovery problems, and provides recommendations for how best to minimize these complications.

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“…Given the financial incentive to the patient as well as having to endure only one postoperative recovery, it is not surprising that combined procedures are offered more frequently by plastic surgeons. 43,44 Safety of these procedures remains a main concern, particularly in the elective aesthetic surgery population. Our analysis identified 1180 hematomas, of which 473 (40.1%) occurred in patients who underwent combined procedures.…”

Section: Risk Factorsmentioning

confidence: 99%

Incidence and Risk Factors for Major Hematomas in Aesthetic Surgery: Analysis of 129,007 Patients

Kaoutzanis

Winocour

Gupta

et al. 2017

Aesthetic Surgery Journal

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Background: Postoperative hematomas are one of the most frequent complications following aesthetic surgery. Identifying risk factors for hematoma has been limited by underpowered studies from single institution experiences. Objectives: To examine the incidence and identify independent risk factors for postoperative hematomas following cosmetic surgery utilizing a prospective, multicenter database. Methods: A prospectively enrolled cohort of patients who underwent aesthetic surgery between 2008 and 2013 was identified from the CosmetAssure database. Primary outcome was occurrence of major hematomas requiring emergency room visit, hospital admission, or reoperation within 30 days of the index operation. Univariate and multivariate analysis was used to identify potential risk factors for hematomas including age, gender, body mass index (BMI), smoking, diabetes, type of surgical facility, procedure by body region, and combined procedures. Results: Of 129,007 patients, 1180 (0.91%) had a major hematoma. Mean age (42.0 ± 13.0 years vs 40.9 ± 13.9 years, P < 0.01) and BMI (24.5 ± 5.0 kg/m 2 vs 24.3 ± 4.6 kg/m 2 , P < 0.01) were higher in patients with hematomas. Males suffered more hematomas than females (1.4% vs 0.9%, P < 0.01). Hematoma rates were higher in patients undergoing combined procedures compared to single procedures (1.1% vs 0.8%, P < 0.01), and breast procedures compared to body/extremity or face procedures (1.0% vs 0.8% vs 0.7%, P < 0.01). On multivariate analysis, independent predictors of hematoma included age (Relative Risk [RR] 1.01), male gender (RR 1.98), the procedure being performed in a hospital setting rather than an office-based setting (RR 1.68), combined procedures (RR 1.35), and breast procedures rather than the body/extremity and face procedures (RR 1.81). Conclusions: Major hematoma is the most common complication following aesthetic surgery. Male patients and those undergoing breast or combined procedures have a significantly higher risk of developing hematomas.

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?Extreme? cosmetic surgery: a retrospective study of morbidity in patients undergoing combined procedures*1

Abstract: The results of this retrospective review do not indicate that the combination of cosmetic surgical procedures increases morbidity. The potential benefits of combined procedures may be considered with the expectation of comparably low complication rates.

Cited by 41 publications

References 9 publications

Combined Breast Surgery and Abdominoplasty

Combined Breast Surgery and Abdominoplasty

Evidence-Based Patient Safety Advisory: Patient Selection and Procedures in Ambulatory Surgery

Incidence and Risk Factors for Major Hematomas in Aesthetic Surgery: Analysis of 129,007 Patients

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