Abstract

Sir: Dr. Chaput and colleagues use our article, “Combined Breast Surgery and Abdominoplasty: Strategies for Success,”1 as a springboard to present findings from their forthcoming study. In their meta-analysis, their first point was that in four articles on combined surgery and complications, there were two articles demonstrating a significant increase in complication rates with combined surgery and two that did not demonstrate such a finding. The articles are not available to us. Although acknowledging the absence of high-level evidence, and the fact that only half the articles demonstrated a significant increase in complications with combined surgery, they refer to a “trend.” As we referenced in our article, Coon et al.2 have succinctly noted that the total number of complications in a given combined procedure is similar to the sum of the complication rates for each component procedure when performed in isolation. We strongly advise attention to patient screening guidelines, an assessment of surgeon experience and comfort, the presence of a coordinated operating room team, availability of vigilant perioperative and postoperative care and meticulous anesthesia, and consideration of total operative time in deciding whether a given combined procedure is appropriate for a specific patient. We readily acknowledge that any benefit achieved from combined surgery is not worthwhile if it is likely to significantly increase the complication profile of the case. Indeed, since the 1990s when we first advocated combining liposuction with abdominoplasty, we advised that patients should not have comorbidities or thrombophilic risk factors, and obviously should be considered “safe” for each procedure if performed in isolation. Consequently, each case must be evaluated individually for the combination. Our article offers broad guidelines for this analysis. Naturally, in certain circumstances the combination should be reconsidered or avoided altogether. “When in doubt, don’t operate.” Dr. Chaput and colleagues next comment about abdominoplasty affecting breast surgery. There were no cases in our series of tuberous breasts. In our cohort, the majority of the breast reductions and mastopexies were performed with a T closure, without any adverse outcome greater than what would have been expected had the breast been operated on alone. Finally, our sample had too small a portion of massive weight loss patients to draw any conclusions. In general, though, most authors agree that this group experiences a greater number of complications than the “typical” normal-weight postpartum woman, the group that we most commonly encounter. We acknowledge that quality-of-life studies are meaningful and we would tend to agree with their statements about them. We thank Dr. Chaput et al. for their comments. DISCLOSURE The authors have no financial interest to declare in relation to the content of this communication. Alan Matarasso, M.D. Darren M. Smith, M.D. Department of Plastic Surgery Manhattan Ear, Eye, and Throat Hospital New York, N.Y.

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