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Should I Discontinue Birth Control Before TT?

Should I stop taking my birth control that I use as a hrt before getting my tummy tuck? I'm 51 yr's old

Doctor Answers (9)

Should I Discontinue Birth Control Before TT?

+1

This topic is somewhat controversial;  there is no “standard” or official recommendations that  can be made here. Although it is thought that the use of estrogens (or the natural higher concentration of estrogen seen during later pregnancy)  may lead to a greater incidence of thromboembolic events (clot formation and lower extremities and/or lungs),  there is no  "standard of practice”.   Some of the studies I have looked at demonstrate a 9 time greater risk of admission to a hospital for treatment of  thromboembolic  events (1:2000) for women who use oral contraceptives, compared to women who  do not use oral contraceptives (1:20,000).  These studies do not involve surgical patients.   Some studies Involving surgical patients report that for those women taking an  estrogen containing oral contraceptive and undergoing elective  major surgery there is a doubling of the risk  of deep venous thrombosis, relative to the general population.

The risk seems to be somewhat dependent on the type of oral contraceptive, and the quantity of estrogen involved. Other risk factors include obesity,  inherited blood clotting disorders,  a previous history of deep venous thrombosis,  cancer patients,  certain auto immune diseases,  inflammatory bowel disease, hypothyroidism, renal disease,  long-distance air travel…

The stopping of oral contraceptives prior to surgery may be of concern to patients/physicians at the risk of pregnancy is high,  due to improper technique or low success rate.  There are papers published recommending the continued use of oral contraceptives for this reason.  These authors recommend careful attention to the use of  venus thromboembolic prophylaxis during the time around surgery.  The alternative strategy  is to switch women to progestin only pills,  as this does not have a high association with thromboembolic events.

On the other hand, there are many authors, based on their studies, who recommend stopping the use of oral contraceptives prior to surgery.  The  recommendations for the length of time, prior to surgery, that these medications should be stopped vary; the optimal time for cessation is not known.  The most common recommendations I have seen is to stop the use of estrogen related containing oral contraceptives 4 weeks prior to surgery.

Ultimately, you will need to check with your own plastic surgeon ( and possibly OB/GYN physician) for their recommendations. As I mentioned above, these recommendations will vary from one practice to another.  In my practice,  given that we know the risk of venous thromboembolic events are cumulative ( and we want to do everything we can to decrease risk),  I recommend stopping oral contraceptive pills four weeks  prior to  major elective surgery  and the use of an alternative method of birth control.  Of course, the use of other measures such as early ambulation and the use of  pneumatic compression stockings are routine.

I hope this helps.


San Diego Plastic Surgeon
5.0 out of 5 stars 793 reviews

Ask your surgeon

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You should stop taking birth control pills and estrogen replacement therapy about four to six weeks before surgery because of the risk of blood clots. However, please ask your surgeon for their advice.


Jerome Edelstein, MD
Toronto Plastic Surgeon
5.0 out of 5 stars 74 reviews

Stop BCP 2 weeks prior to elective abdominoplasty

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Blood clots, DVT and PE are the feared complication of an abdominoplasty.  The reported risk is quite low when compared with the general surgical, orthopedic and neurosurgical patient population.  Since an abdominoplasty is a totally elective procedure we want our patients to be in the best physical shape to minimize the risk of all complications.  It is well known the HRT increased the risk of blood clots, DVT and PE.  You should stop taking these medications for 2 weeks prior to surgery to reduce your risks.

Jeffrey Zwiren, MD
Atlanta Plastic Surgeon
5.0 out of 5 stars 10 reviews

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Tummy Tucks and Estrogen are not a good combination

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I have my patients stop any estrogen-containing meds 2 weeks before tummy tucks and they can resume 2 weeks later.  The combination of a longer surgery, estrogen, and less mobility is a recipe for a blood clot in your veins that can travel to dangerous places.  It is very important to use the compression stockings and ambulate after surgery frequently.  Your surgeon may even want to give you a blood thinner after surgery.

Best wishes!

Holly Casey Wall, MD, FACS
Shreveport Plastic Surgeon
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Should I Discontinue Birth Control Before TT

+1

If you can you will decrease your risk of blood clots which can cause deep venous thrombosis or pulmonary embolus (blood clots breaking off and travelling to the lungs).

Discuss with your surgeon and your prescribing doctor regarding the proper balance of risks and benefits. If you stay on them, your plastic surgeon may want to ramp up the anti clotting measures which can be taken.

Thanks and best wishes.

Jourdan Gottlieb, MD
Seattle Plastic Surgeon
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No need to stop the HRT.

+1

There is no need to stop the HRT or many other medications prior to an abdominoplasty.  At the very least I would consult with your plastic surgeon an your primary care physician or whomever prescribes the medicine so that both can be made well aware of concerns

Robert Kratschmer, MD
Houston Plastic Surgeon
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Birth control pills and tummy tuck

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There is no simple answer, as pregnancy right after surgery or generally has risk, though so too do oral contraceptives, especially in smokers. Oral contraceptives are a risk factor for DVT and pulmonary embolism. The risk is small, though we have reviewed a case with a very bad outcome after tummy tuck. This question should be discussed with your OB or primary, and the possibilty of a clot understood to help you make the decision to stop or not before your tummy tuck.

Peter E. Johnson, MD
Chicago Plastic Surgeon
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Oral contraception and plastic surgery

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Oral contraception based on oestrogen tablets (the most common type, as opposed to the "mini-pill" which is progesterone) can increase the risk of blood clots somewhat. Therefore, if you are able to use other forms of contraception for the month before and the month after surgery, you will further minimise the risk of this complication. 

 

Marc Pacifico, MD, FRCS(Plast)
London Plastic Surgeon
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Birth control and Tummy Tuck

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 I see no reason to discontinue birth control prior to your surgery.  Prior to your surgery, you will have lab test, and discuss your medical history with the Anesthesia Dept. of your hospital or outpatient center, and your surgeon.  Consult with your Board Certified Plastic Surgeon, certified by the American Society of Plastic Surgeons (ASPS) to discuss all your concerns and expectations.  Follow your  Surgeon's post operative instructions and you should go great!

Robert E. Zaworski, MD
Atlanta Plastic Surgeon
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These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.