A typical mommy makeover at one Houston-area practice runs about seven hours under general anesthesia. Depending on the procedures combined, the operation can take as little as four hours or as long as ten. Those hours are the reason a patient planning a combined surgery should look hard at the facility where she will have surgery and the doctor who will manage her anesthesia.
At Leo Lapuerta, MD, Plastic Surgery, those two questions have specific answers. Dr. Leo Lapuerta, a triple board-certified plastic surgeon and Chairman of Plastic Surgery at St. Joseph Hospital in Houston, owns and operates an accredited surgical facility and works only with physician anesthesiologists. The practice publishes its policies on both.
Does a longer combined operation change the planning?
A mommy makeover pairs breast surgery with abdominal work, most often a tummy tuck and liposuction, in one session. Combining procedures means one anesthetic and one recovery period instead of several, and the practice notes that this shortens total recovery time compared with scheduling each operation on its own.
The trade-off is a longer stretch under anesthesia. Surgery of any kind carries risks, and the practice screens for them before scheduling. It looks for patients in good health at a stable weight, and asks smokers to stop for at least six weeks before surgery to minimize complications.
The practice also sorts patients by setting. Most mommy makeovers are same-day outpatient surgery. Patients with complex medical problems, or those having a significant amount of liposuction, are advised to have surgery in a hospital and stay overnight for observation. Dr. Lapuerta holds privileges in the Memorial Hermann network, at HCA hospitals including The Woman’s Hospital of Texas, and at St. Luke’s Houston Medical Center.
Is an office surgical facility a safe place for a long operation?
The answer depends on accreditation. The practice’s facility, the Plastic Surgery Institute of Southeast Texas (PSI), opened in 2003 and carries AAAASF accreditation, often called QuadA. According to the practice, AAAASF and AAAHC are the only two office-based accreditations recognized by the American Board of Plastic Surgery, and it urges patients considering any office facility to confirm one of them.
The practice says AAAASF accreditation requires that personnel, equipment and drugs meet strict standards for patient safety, for routine cases and for emergencies, as in a hospital. PSI is dedicated to cosmetic and plastic surgery. The practice argues that because office facilities see smaller numbers of patients, most of them healthy, the risk of infection can be lower there than in settings that handle high volumes.
Is the anesthesia provider a doctor?
At PSI, yes. Dr. Lapuerta uses physician anesthesiologists, medical doctors who specialize in anesthesia, and does not use nurse anesthetists or anesthesia assistants. The practice frames the reasoning in terms of attention: a dedicated anesthesia doctor oversees the patient’s safety and comfort through pre-op, surgery and recovery, which leaves the surgeon free to focus on the operation.
The practice says Dr. Lapuerta has worked for more than 15 years with a select group of five anesthesia doctors experienced in outpatient anesthesia and anesthesia for plastic surgery. Patients meet their anesthesia doctor before surgery to discuss options.
Are there choices in anesthesia and monitoring?
The facility is accredited to offer local anesthesia, sedation, total intravenous anesthesia (TIVA), general anesthesia and regional anesthesia, which allows a plan built around the patient’s medical history and procedures. For mommy makeovers, the practice says, general anesthesia is the standard.
For awareness during anesthesia, a rare complication, the facility uses a BIS monitor. The device reads the patient’s brain activity throughout surgery and helps the anesthesia doctor adjust dosing. The practice notes that such monitors are uncommon in outpatient settings because of cost.
Does pain control continue after discharge?
Dr. Lapuerta uses local anesthesia in his surgeries to block pain signals at the surgical site, which the practice says can reduce the need for narcotics and the odds of nausea and vomiting afterward. For mommy makeovers, he injects a time-released local anesthetic into the abdominal surgery site that provides numbing for three days after surgery.
The practice says the technique lets patients control pain with oral medication and recover at home. According to the practice, by the time the numbing wears off the body has begun to heal and severe pain has eased, and patients can move to over-the-counter medication for the rest of recovery.
This article is for general information only and is not medical advice. Results vary from patient to patient. Consult a board-certified plastic surgeon or your physician about your own situation. Written in partnership with Joseph Lambert, a publicist working with Leo Lapuerta, MD Plastic Surgery.
