The combination of a tummy tuck with a hysterectomy is a common request. There are many reasons for putting the two together including avoiding two surgeries, having but one recovery, convenient surgical access, and potential economic savings. There is also the simultaneous attainment of a medical and a cosmetic benefit as well. The ‘hysterectomy tuck’ has been done for a long time and is generally regarded as a safe procedure. The biggest problem in executing this combination is getting the schedule of the gynecologist and the plastic surgeon together.
Despite this perception of safety, I know of no clinical series that has ever been reported looking at the outcome or number of complications from this combined extra- and intra-abdominal surgeries. This has been done and confirmed recently by a presentation at the annual meeting of the American College of Obstreticians and Gynecologists in May 2012. From a study out of Florida International University, 65 patients who had the combination from 1995 to 2011 were evaluated. Total average operative time was 3 ½ hours with an average hospital stay ofjust under 4 days. The complication rate was over 30% with the most common problems being fever, pulmonary atelectasis and wound healing issues. No major complications were encountered.
Both a tummy tuck and a hysterectomy are major body surgeries. A hysterectomy would have a higher risk than a tummy tuck for postoperative complications because it is more invasive being an intra-abdominal procedure. It would account for such potential complications as they need for a transfusion and time in the hospital which a tummy tuck would not. Conversely, a tummy tuck would more likely cause problems such as lung atelectasis, due to muscle tightening, andwound healing problems due to the long horizontal abdominal incision. Put together the risks of both procedures are multiplied, creating a not insignificant 30% complication rate. But no complication was lethal and all patients appear to have gone on to a full recovery.
Many hysterectomies today are being done either laparascopically or using a robotic approach. (e.g., DaVinci) Both approaches, although taking longer than the traditional open hysterectomy, tout a lower incidence of complications and a quicker recovery. While they could still be combined with a tummy tuck, there is less incentive to do so as it does not make the hysterectomy any easier or better for the patient. Given the much higher costs of operating inside a hospital where laparoscopic and robotic systems exist, a tummy tuck done under these circumstances is going to cost more than it done separately in an outpatient facility.
While a combined hysterectomy and tummy tuck can be done safely with numerous potential benefits, less of them will be done in the future due to improved hysterectomy treatment methods. The economics of combining them, a major incentive in the past, is not as significant today.
Dr. Barry Eppley
Indianapolis, Indiana