Combined Breast and Abdominal Surgery

To see Dr Avery, you will need a referral from your GP or another specialist who knows you well. Some people seek a consultation after speaking with family or friends, or following their own research into plastic surgery.

The initial consultation is an opportunity to discuss your personal reasons for considering surgery, your expectations, and any questions or concerns you may have. Dr Avery will take time to understand your health history and circumstances so that the information you receive is specific to you.

When you arrive at Avery, you will be welcomed by our Care Team and asked to complete a medical history form if this has not already been done. You are welcome to bring a supportive family member or friend with you to your consultation, should you wish, to help you collect and retain al of the information you need to make an informed decision about surgery.

As part of the consultation, Dr Avery will carry out an examination of the area of concern and provide information about whether surgery may be suitable for you. This discussion will include what the procedure involves, the possible risks and complications, and any limitations that may apply in your situation. The aim is to provide you with clear information about what surgery may or may not achieve, and whether it is an appropriate option for you.

Your consultation will also include discussion of the estimated costs associated with surgery.

After your appointment, our Care Team is available to answer any further questions, including those relating to fees and practical next steps.

At Avery, our focus is to provide you with accurate and personalised information to support your decision-making process before, during, and after surgery.

Abdominoplasty

Abdominoplasty involves removing redundant abdominal skin, addressing fat deposits where required, and repairing muscle separation (rectus diastasis) if present. The specific approach depends on the degree and location of excess tissue.

Types of abdominoplasty include:

• Mini-abdominoplasty:
  Involves a shorter incision along the lower abdomen. Only skin and tissue below the umbilicus are addressed. The umbilicus is not repositioned. Muscle tightening may be performed but is more limited than in a full abdominoplasty.
• Full abdominoplasty:
  A horizontal incision is made low on the abdomen, typically from hip to hip, just above the pubic area. Skin and fatty tissue are lifted towards the ribcage, allowing repair of rectus muscle separation if required. Excess skin is removed, and the umbilicus is repositioned through a new opening in the re-draped skin.
• Fleur-de-lis abdominoplasty:
  Performed when there is both vertical and horizontal skin excess, usually after significant weight loss. In addition to the horizontal lower abdominal incision, a vertical incision runs along the midline of the abdomen, enabling removal of tissue in both directions. This creates an inverted “T” or fleur-de-lis scar pattern.
• Extended abdominoplasty / Circumferential abdominoplasty:
  This extends the incision beyond the hips, addressing excess skin of the flanks and sometimes the lower back. When continued around the entire trunk, it is referred to as a circumferential abdominoplasty or belt lipectomy, which also improves the outer thighs and buttock area.

Surgical steps (for all types):
Once the chosen incision is made, the skin and subcutaneous tissue are elevated, muscle tightening is performed if required, excess tissue is excised, and the skin is re-draped. Drains may be placed to remove fluid, and sutures are typically layered for wound closure.

Reduction Mammaplasty (Breast Reduction)

This procedure involves incisions around the areola, vertically down the breast, and often along the inframammary fold (anchor or inverted-T pattern). Excess glandular tissue, fat, and skin are removed. The breast is reshaped, and the nipple–areolar complex is repositioned higher on the chest. Remaining tissue is sutured to form a smaller, lifted breast.

Augmentation Mammaplasty (Breast Augmentation)

Breast augmentation is performed using implants or, less commonly, fat grafting. Incisions may be placed in the inframammary fold (most common), around the areola, or in the axilla. A pocket is created either under the breast tissue (subglandular), under the chest muscle (submuscular), or in a dual-plane position. The implant is placed, adjusted for symmetry, and the incisions are closed.

Mastopexy (Breast Lift)

A mastopexy lifts and reshapes breasts by removing excess skin and tightening the surrounding tissue. Techniques vary according to the degree of sagging (ptosis):

• Periareolar mastopexy: incision limited around the areola.
• Vertical (lollipop) mastopexy: incision around the areola and vertically to the breast fold.
• Anchor mastopexy: incision around the areola, vertical to the breast fold, and along the inframammary crease.

The nipple–areolar complex is repositioned, and the skin envelope tightened.

Mastopexy with Implants (Breast Lift and Augmentation)

This procedure combines mastopexy with augmentation. After lifting and reshaping the breast tissue, an implant is inserted into a subglandular, submuscular, or dual-plane pocket to restore or add volume. Surgical planning must carefully balance implant size with skin tightening to reduce tension on wound healing.

As with all surgical procedures, combined breast and abdominal operations (such as abdominoplasty with breast reduction, augmentation, or lift) involve risks. While it is not possible to list every potential complication, it is important to be aware of both the more common risks and the less common but potentially serious complications. During your consultation, risks relevant to your individual health, goals, and surgical plan will be discussed in detail.

Certain factors increase the chance of complications, including smoking, nicotine use, obesity, diabetes, and other medical conditions. All prescribed medications, over-the-counter products, supplements, and recreational substances must be disclosed before surgery, as these may interact with anaesthesia or affect wound healing.

General risks of surgery include:

• Bleeding: Significant bleeding may occur from an operated site, sometimes requiring transfusion or additional surgery.
• Infection: Infections may require antibiotics or further surgical treatment.
• Allergic reactions: Possible in response to sutures, dressings, antiseptic solutions, or medications.
• Haematoma: A collection of blood beneath the skin may require drainage.
• Blood clots: Deep vein thrombosis (DVT) or pulmonary embolism (PE) are rare but potentially life-threatening.
• Cardiovascular or anaesthetic complications: Events such as heart attack, stroke, or complications from general anaesthesia, although uncommon, can occur.
• Pain, swelling, and bruising: These are expected in the early recovery period.
• Delayed wound healing or wound breakdown: More likely in patients with risk factors such as smoking or diabetes.
• Scarring: All surgery results in permanent scars. Their visibility, colour, and texture depend on individual healing responses.
• Nausea and fatigue: These may occur after general anaesthetic.

Additional considerations when procedures are combined:

• Longer operative time: Combining breast and abdominal surgery prolongs time under anaesthesia, which can increase risks such as clot formation, fluid shifts, or healing problems.
• Fluid collections (seroma): More likely when multiple areas are operated on.
• Increased wound tension: Large areas of skin removal or tightening across both the abdomen and breasts may increase the risk of wound breakdown.
• Recovery demands: Recovery may be more complex, as restrictions involve both the abdominal wall and breasts. Patients may have limited ability to lift, stretch, or move comfortably for several weeks.
• Revision surgery: The need for additional surgery, either for complications or refinement, is not uncommon after combined procedures.

Procedure-specific risks

Specific risks also depend on the operations performed. These are outlined under the individual procedures:

• Abdominoplasty (including rectus plication, skin and fat removal)
• Reduction mammaplasty (breast reduction)
• Augmentation mammaplasty (breast augmentation with implants)
• Mastopexy (breast lift)
• Mastopexy with implants (breast lift combined with augmentation)

The duration of surgery, length of hospital stay, and recovery period vary depending on the type and extent of the procedures performed. When breast and abdominal procedures are combined, recovery can be longer and more complex than with a single operation.

Hospital stay and early recovery

• Most patients remain in hospital for several nights after combined surgery. This allows for monitoring of pain control, wound healing, drains (if inserted), and early mobility.
• A catheter may be placed for the first 24 hours, particularly when mobility is limited after abdominoplasty or belt lipectomy.
• Surgical drains are often used to reduce fluid collection and are generally removed before discharge, although occasionally they remain in place for longer.

Time off work and activity

• Depending on the complexity of surgery, 2–4 weeks off work is usually required. People undergoing abdominoplasty with muscle repair, or more extensive procedures such as a circumferential abdominoplasty, may need closer to 4–6 weeks before returning to normal activities.
• Walking is encouraged soon after surgery to reduce the risk of blood clots, but heavy lifting, stretching of the upper body, or strenuous abdominal activity should be avoided until cleared at follow-up (usually 6 weeks or longer).
• When breast procedures are combined, restrictions apply to arm movement and lifting as well as core activity, which may extend recovery time.

Bruising, swelling, and garments

• Bruising and swelling are expected and usually peak in the first 1–2 weeks. Most swelling gradually resolves over 2–6 weeks, but some firmness or localised swelling may persist for several months.
• A compression garment or bandages will need to be worn for approximately 6 weeks. These provide support, reduce swelling, and assist with wound healing. The type of garment depends on whether the surgery involves the abdomen, breasts, or both.

Pain management

• A pain management plan will be prepared before discharge, typically including oral medication.
• Pain levels vary depending on the procedures performed. Abdominoplasty with muscle tightening often produces a sensation of abdominal tightness, while breast surgery may cause chest wall or arm discomfort. When procedures are combined, pain may feel more widespread.
• Pain should gradually improve. If pain worsens, this may indicate a complication and review is recommended.

Scarring

• All surgical incisions result in permanent scars. The location, length, and appearance of scars depend on the procedures performed:
  • Abdominoplasty: usually across the lower abdomen, sometimes extending hip to hip, with an additional scar around the navel.
  • Breast reduction or lift: scars may be around the areola, vertically down the breast, and along the breast crease.
  • Augmentation: scars are typically placed in the breast crease, around the areola, or in the axilla.
• Scars generally fade and soften over 12–18 months but will not disappear. Individual healing patterns, skin type, and history of abnormal scarring (such as keloids) all affect scar appearance.

Follow-up and monitoring

• Regular follow-up appointments are essential to check wound healing, remove sutures or drains if needed, and monitor progress.
• Adjustments to pain management, garments, or activity restrictions may be made based on recovery.

The financial aspects of your surgery are as important as the medical elements when planning for surgery. At Avery, the surgeries we offer fall into three different financial categories: Self-funded – aesthetic surgery; self-funded – plastic and reconstructive surgery; and health insured – plastic and reconstructive surgery.

To make sense of these three financial categories, we have created a detailed price guide to help you understand what may or may not be covered by your health insurer/Medicare and your out of pocket expenses.

To download this guide, please click here.

For more information or to book a consultation, please contact our team on 02 4002 4150.

The timing of surgery depends on your overall health, recovery from prior events such as pregnancy or weight loss, and the stability of your weight.

• After pregnancy and breastfeeding: It is generally advisable to wait until pregnancy and breastfeeding are completed, and the breasts and abdominal tissues have returned to a stable baseline. This allows changes from hormones, milk production, and abdominal stretching to settle.
• After significant weight loss: Surgery is usually considered once weight has been stable for several months. If weight loss has been achieved through bariatric surgery, most guidelines (including ASPS/ASAPS) recommend waiting at least 12 months before undertaking body contouring procedures.
• Future pregnancies: If further pregnancies are planned, delaying combined breast and abdominal surgery may be appropriate. Pregnancy can stretch the abdominal wall, alter breast tissue, and change the skin envelope, potentially reversing the surgical corrections.
• General health factors: Non-smoking status, good nutrition, stable body mass index, and management of any underlying medical conditions are important considerations before surgery.

Combined surgery is only considered appropriate after thorough consultation, assessment of your medical history, and confirmation that your body has recovered from recent changes and is in a stable state.

Recovery after combined breast and body surgery varies depending on the number and type of procedures performed, as well as individual health and healing.

• Hospital stay: A short admission (several nights) is usually required after surgery, particularly when procedures such as abdominoplasty are included.
• Return to work: Time off work is commonly 2–4 weeks, depending on the extent of surgery and the physical demands of your job. People who have physically strenuous roles may need longer before returning.
• Exercise and activity: Light walking is encouraged early in recovery. More vigorous activity, lifting, and exercise are usually delayed until at least 6 weeks, and in some cases 8–12 weeks, depending on healing and the procedures performed.
• Overall healing: Bruising and swelling usually settle over 2–6 weeks, but tissue healing and scar maturation continue for several months.

Your recovery plan, including time off work, exercise restrictions, and follow-up, will be tailored during your consultation based on the specific combination of surgeries and your personal circumstances.

Recovery and return to exercise depend on the type and number of procedures performed and how your body heals. A gradual, staged approach is important:

• 0–2 weeks: Walking is encouraged early to reduce the risk of blood clots and support circulation. Movements should be slow and within comfort, avoiding lifting, stretching, or sudden changes in posture.
• 2–6 weeks: Light daily activities can gradually increase as tolerated. Abdominal procedures (such as abdominoplasty) require avoidance of core strain, while breast surgery limits overhead arm movements and lifting. Compression garments should continue to be worn during this period.
• 6 weeks onwards: In many cases, unrestricted activity can begin after six weeks, provided wounds are healed and there is no ongoing discomfort or swelling. Gentle strengthening, stretching, and low-impact exercise may be reintroduced.
• 12 weeks and beyond: More vigorous activity, heavy lifting, or high-impact exercise is often delayed until 12 weeks. At this stage, many people feel they are approaching or returning to their pre-surgery fitness level, though healing and scar maturation continue for months.

Dr Avery will provide tailored advice, as the timing may be extended if you have undergone multiple combined procedures, if wound healing is delayed, or if complications arise.

The level of pain and movement restriction after combined breast and abdominal surgery varies depending on the specific procedures performed, the length of the operation, and individual healing responses.

• Pain management: During surgery, local anaesthetic is often used at the surgical site to reduce immediate discomfort. After surgery, pain relief is managed with tablets or injections while in hospital, and with prescribed oral medication at home. Physical measures such as supportive dressings, compression garments, and in some cases cold packs, can also assist in reducing discomfort and swelling.
• Expected pain patterns:
  • After abdominoplasty, discomfort is often felt as tightness or pulling across the lower abdomen, particularly if muscle repair has been performed.
  • After breast surgery, pain is usually felt in the chest wall, under the breasts, or along incision lines, and may be associated with restricted arm movement.
  • When both areas are operated on, pain may feel more widespread, and movement restrictions may overlap.
• Duration: Pain is usually most noticeable in the first few days, then gradually improves over the following weeks. Most people find it becomes manageable with oral medication and supportive garments after the early recovery period.

Movement restriction
Dressings and compression garments support the healing areas, but movement will need to be limited in the first 2 weeks:

• After abdominal surgery, bending, lifting, and core activation should be avoided. Many people walk slightly bent forward in the first week.
• After breast surgery, lifting the arms above shoulder level, pushing, or carrying weight should be avoided early on.
• Combined surgery means restrictions apply to both upper and lower body activity, which may make early recovery more demanding.

Gradual return to activity
A general guideline is that if gentle movement or activity does not increase pain or swelling, it can usually be continued and built upon gradually. Follow-up appointments are important to assess progress and confirm when restrictions can be eased.

Please allow two hours for your time with Avery. This will include meeting with Dr Avery and the Avery care team.

Combined breast and abdominal surgery is performed under a general anaesthetic, which means you will be asleep for the entire procedure. The anaesthetic is administered and monitored by a specialist anaesthetist in an accredited private hospital setting.

Local anaesthetic alone is not sufficient for this type of surgery due to the extent of the procedures and the length of operating time. However, local anaesthetic may also be used during the operation in targeted areas to help reduce pain immediately after surgery.

As with all anaesthesia, there are potential risks and considerations, which vary depending on your overall health and medical history. These will be discussed in detail at your consultation with the anaesthetist and surgical team.

Combined breast and body surgery is performed under a general anaesthetic given by a specialist anaesthetist in an accredited private hospital.

Dr Avery operates at Lingard Private Hospital, an accredited private facility. Accredited hospitals must meet established standards for surgical care, anaesthesia, infection control, and patient monitoring. This means your procedure is undertaken in a regulated environment designed to support patient safety and quality of care.