It’s not as hard as it seems because of the way commercial buildings are built, the real ceiling is much higher than it looks and the visible ceiling can easily be removed then it’s just a matter of piercing some concrete, in the end your drains are mostly in your downstairs neighbor’s ceiling instead of being inside the limits of your unit. It’s super easy to run electricity and ventilation, framing is metal instead of wood (no moisture issue with concrete, no risk of splitting when using a ramset on the parts fixed to the floor), sheetrock for the ceiling is screwed to metal joists that hang from the metal frames the current ceiling tracks are hanging from…

I used to live in a building like that and the only time it was “problematic” when renovating the whole thing was when I had to change the bath drain as during the original construction they had repoured concrete around it to seal the floor after installing the bath.