Combining Abdominoplasty and Breast Procedures Under Tumescent Local and Spinal Anesthesia: A Retrospective Study.

Abstract

Background: The "Mommy Makeover" is a combined plastic surgery procedure designed to address aesthetic concerns commonly experienced by women after pregnancy and breastfeeding. This procedure typically includes abdominoplasty and breast surgery. Traditionally, these surgeries are performed under general anesthesia, but the use of tumescent local anesthesia (TLA) combined with spinal anesthesia presents several advantages, including enhanced safety, effective pain management, and reduced postoperative complications.

Methods: This study analyzes the outcomes of 62 patients who underwent Mommy Makeover surgery with TLA and spinal anesthesia from 2011 to 2023. The TLA solution was composed of 25 mL of 2% lidocaine, 8 mEq of sodium bicarbonate, and 1 mL of epinephrine (1 mg/mL) diluted in 1000 mL of 0.9% saline solution. Spinal anesthesia was administered at the L1-L2 intervertebral level using 15-18 mg of ropivacaine in a 4 mL solution.

Results: The patient ages ranged from 25 to 74 years (mean age 47 years, standard deviation 10.236), and BMI ranged from 24 to 35 (mean BMI 29.5, standard deviation 2.379). A total of 62 abdominoplasties were performed, 61 were horizontal (5 of these included hernia repair), and 1 was vertical. Breast procedures included 10 augmentation mammaplasties, 5 mastopexies without implants, and 30 mastopexies with implants, and 17 reduction mammaplasties. Additionally, 22 liposuction procedures of the flanks were performed. Major complications occurred in 14.5% of patients, including 1 case of hemorrhage requiring reintervention, 5 hematomas, and 3 seromas. Minor complications included 6 cases of abdominal wound dehiscence and 4 cases of breast wound dehiscence.

Conclusions: Tumescent local anesthesia combined with spinal anesthesia is a highly effective and safe method for performing combined abdominal and breast surgery in the context of a "Mommy Makeover." This technique provides significant benefits, including precise pain management, minimal postoperative side effects, and enhanced patient and surgeon satisfaction.

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