Lee's Summit Doctors

Do You Reccomend Lovenox Injections for DVT/PE Prevention After TT and if So, for How Long?

Also wondering if you reccomend an overnight hospital stay.

Dear Galena,

The complication of a Deep Venous Thrombosis or a Pulmonary Embolism is one of the most dreaded in Tummy Tuck surgery.  It can strike out of seemingly nowhere and can be fatal.  Once it has occurred, it will require at minimum months of treatment and medication which is not without its own set of risks and complications.  This is why ASPS has been working to define a set of guidelines for its member plastic surgeons to use to minimize these risks by using anticoagulation during surgery to decrease the risks of developing blood clots. 

As of September 2011, the new guidelines by the ASPS VTE Task Force strongly recommended anticoagulation  in patients undergoing major surgery lasting over a certain period of time and with certain risk factors.  These risk factors are based on a scale that accounts for the patient's age, their past medical history, their medications, their family history, and the type of procedure being performed.  The surgeon adds the point total after performing the evaluation and then determines whether to use anticoagulation or not based on the resulting numbers.  Many patients who are going to have a tummy tuck will have enough risk factors to make a strong case for anticoagulation treatment.  There are lots of options for what type of anticoagulation to use including Lovenox, Arixtra, and others.

Please discuss this very important question with your plastic surgeon who can explain your risks and their recommendations based on those risks.  While there are some risks associated with anticoagulation, none of them are commonly fatal like a PE.

Hope this helps.

Herluf G. Lund, Jr, MD

Saint Louis Plastic Surgeon

Nerve Damage Years After Tummy Tuck and Breast Lift, Is There Anything I Can Do?

I had a tummy tuck, breast lift and implants about 6 years ago. I still have no feeling on my stomach in a large area below my belly button. As well, I've lost some sensation in my nipples. Can anything be done to restore feeling in any of these areas once the damage has been done?

Dear Curious6529,

Sadly, after six years, it is not likely that you will regain more sensation in the areas you described.  While it is uncommon to have the amount of numbness you noted, it certainly can occur.  There are no established treatments that can stimulate new nerve growth into these areas at this time.  I wish I had better news for you but..

Herluf G. Lund, Jr, MD

Saint Louis Plastic Surgeon

Does Anyone Know Anything About Nucynta for Pain Following TT and Lipo?

Does Anyone Know Anything About Nucynta for Pain Following TT and Lipo?

Dear Mimirocks,

I have been prescribing Nucynta  for post-operative pain management in my practice for over two years.  It has worked well for my tummy tuck patients.  

Nucynta is one of the newer generation pain medications that works on a different pathway than the older meds.  I started using Nucynta when studies showed it to be very effective for pain relief with less side effects than other meds such as Vicodin or Percocet.  The studies demonstrated significantly less nausea and vomiting, less sleepiness or the opposite, the being "wired" effect when compared to matched patient populations.  There is also a very large safety window with this medication.  Like all pain medications, it is not effective for every patient.  But as I stated earlier, it has worked well for my patients.

And to answer the question that everyone is probably wanting to ask, "No, I am not a paid consultant, speaker, or other for the company that makes the product."

Hopes this helps.

Herluf G. Lund, Jr, MD

Saint Louis Plastic Surgeon