any specific limitations for patients who want multiple surgeries performed at once

This is a really good question, so I am going to share my response to this question with the rest of the office.

Are there any specific limitations for patients who want multiple surgeries performed at once including Breast Augmentation? I know one is if the patient has ever had gastric bypass, due to the fact that the minimal amount of nutrients consumed adds a certain caveat to healing.


The main limitations to having multiple surgeries at once are:


  1. Patient’s health – can they withstand the stress of having multiple surgeries at once?
  2. Length/Duration of surgery when multiple surgeries are combined – I generally try not to do surgeries under general anesthesia that last more than 6 hours – having said that, I have done some surgeries that are about 7 hours or  more, but it is not my preference to do such long surgeries because the longer the surgery duration, the more potential perioperative complications such as infection, wound healing issues, etc. can happen.
  3. Surgeries requiring different types of anesthesia– I usually do not combine surgeries that usually are done with different types of anesthesia, ie, general vs. local or local with IV sedation. There are some physiologic differences for these different types of anesthesia; and some surgeries are better done under one vs. another.
  4. Gastric bypass status – you mentioned this issue. And indeed this is one of the factors that I take into consideration. Reason: Gastric bypass patients are immunocompromised and they have a surgically altered gut system that purposefully creates malnutrition for them. Therefore, they generally do not heal as well. The malnutrition is not because they eat very little; whatever they eat, the nutrients generally don’t get absorbed, because they get a big portion of their gut cut out and the portion of the gut that gets cut out is the main area for nutrient absorption. And that’s how they lose weight; it’s not because of the amount they eat; its’ the decrease in absorption surface area. Because of that, most of them are not as healthy as someone who’s never had such a surgery. And gastric bypass truly should be reserved for treating medical conditions that are resistant and nonresponsive to non-operative treatments.


I hope that answers your question. If anyone has any questions about above, please let me know. J