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

We respond to the comments by Dr. Dedeepya and colleagues regarding our retrospective study on combined abdominoplasty and breast procedures performed under tumescent local anesthesia (TLA) and spinal anesthesia (SA). We clarify methodological aspects related to procedural heterogeneity, anesthetic dosing, and complication reporting, emphasizing that the primary aim of the original study was to assess the overall feasibility and safety of this anesthetic approach rather than to compare individual surgical combinations. We further address concerns regarding cumulative local anesthetic exposure, detailing our conservative lidocaine dosing strategy and the rationale for extended perioperative monitoring. No cases of local anesthetic systemic toxicity or thromboembolic events were observed in our cohort. We also discuss patient selection criteria, operative workflow, and acknowledged limitations inherent to the retrospective design. This correspondence reinforces the role of TLA combined with SA as a safe and effective alternative to general anesthesia for carefully selected patients undergoing combined aesthetic procedures, while highlighting areas for future prospective research.Level of Evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .