Abstract
Modern plastic surgery continues to advance alongside the growing demands and expectations of patients, many of whom now seek maximum results from a single procedure. Individuals often wish to simultaneously improve multiple aspects of their body, such as correcting breast shape and size, removing excess subcutaneous fat, addressing abdominal protrusion, and enhancing the volume and contour of the buttocks. This has led to the rising popularity of procedures like the “Mommy Makeover.” However, such extensive and prolonged surgeries carry significant risks that must not be overlooked. Critical factors to consider include the patient’s somatic condition, anesthesia, extent and duration of surgery, blood loss, hypovolemia, hypothermia, and the risk of thrombosis or thromboembolism. Proper patient selection is essential, with candidates typically falling within ASA group I and, less commonly, ASA II according to the American Society of Anesthesiologists classification.
Local anesthesia protocols may involve a solution composed of 1000 ml of 0.9% NaCl, 2 ml of 10% lidocaine (0.2 g), and 1 ml of epinephrine (1:1000), with careful attention to dosage limits such as short-dose lidocaine with epinephrine not exceeding 1000 mg. Surgical volume should be controlled, with liposuction limited to no more than 6–8% of body weight and total surgical volume not exceeding 45%. Duration is another key factor, as procedures exceeding two hours can significantly influence risk levels, making it essential to optimize surgical time. To reduce duration and improve safety, procedures should be performed by a team of at least three doctors, ideally four to five. Blood loss must be closely monitored, typically ranging from 20–40 ml per liter of aspirate. If blood loss remains below 15% of circulating blood volume, crystalloids are generally sufficient, while higher losses may require colloids or blood products. Patients with hemoglobin levels below 80 g/L and symptoms should receive transfusions.
Managing hypovolemia is also crucial, with calculations based on lipoaspirate volume guiding fluid replacement. Preventing hypothermia requires attention to heat exchange mechanisms such as conduction, radiation, convection, and evaporation, along with measures like warming mattresses, heated solutions, and insulated surgical environments. The risk of thrombosis and thromboembolism must be assessed using tools like the Caprini scale, where a score above 5 indicates high risk. In such cases, prophylactic measures including low molecular weight heparin (e.g., fraxiparine or clexane), initiated 12 hours before surgery and continued postoperatively for 5–7 days, are recommended, along with intermittent pneumatic compression.
In conclusion, while simultaneous surgical procedures can yield highly satisfying results for both surgeons and patients, they require thorough preparation and careful risk management at every stage. It is essential to extend vigilance into the postoperative period and adhere to the fundamental medical principle articulated by Hippocrates: “Primum non nocere”—first, do no harm
