I've already had a consult for a tummy tuck with hernia repair. My doctor said it would take between 2-2 1/2 hours but now I am considering having a breast aug as well. (Not sure if I need a lift with it) Anyway, my question is, how long would this surgery typically take and how much more of a risk am I for DVT or PE by combining procedures with longer operative time. I am 26, 117lbs, 5 ft, and healthy. Thanks in advance.
Mommy Makeover DVT Risk
Doctor Answers 20
RISK OF DVT
It appears from your history you are young and healthy without any prior history of DVT. In this type of scenario you only require perioperative preventative measures including compressive stockings and sequential compressive devices during your surgery. Early ambulation is very important in maintaining your circulation. Factors that increase your risk of DVT include a prior history, a family history, blood disorders where you have increased coagulation, BCP, Cancer, Obesity, surgery within 6 weeks post pregnancy, smoking, age greater than 60 years of age. This mentions the main factors but there are others of less importance. I would not be overly concerned about having both surgeries. Good luck.
Tummy Tuck and Breast Surgery
Thank you for your question.
The tummy tuck and breast surgery is a commonly performed combination of procedures - average operating time in my practice is 4-4 1/2 hrs. Of course, the longer the surgery, the higher the risk. Generally speaking, you should do well working with a board certified plastic surgeon and a board certified Anesthesiologist in a fully accredited surgery center.
I hope this helps.
DVT risk factors
There's actually pretty good science on risk factors for DVT (look up the Caprini scale scoring chart for DVT risk in attached link). Since you are young, and not overweight, you would be in the low-moderate risk category, depending on factors like whether you take birth control pills, or not, and your family history.
While adding a breast augmentation wouldn't increase your risk significantly, there is also data that suggests the risk of anesthesia complications is directly related to the length of surgery, especially as procedures get longer than 6 hours.
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Minimize procedure time, minimize risks.
The combination of abdominoplasty, hernia repair, breast lift and breast augmentation can be performed in a single setting.When these operations are performed together, safety has to be the first priority.
For this reason, we believe that the length of the procedure should never exceed 4 to 6 hours.Complications such as deep venous thrombosis and pulmonary emboli increase significantly when these numbers are exceeded.An experienced surgeon and surgical team that focuses on efficiency can minimize the length of the surgical procedure.We often use another surgeon as a first assistant to help with this process.
In addition, every patient is evaluated for their DVT risk.The majority of patients are asked to use anti-embolic compression stockings, maintain hydration and ambulate frequently.In patients who have multiple risk factors, anticoagulants such as Lovenox may be necessary.If you have plans to travel in the immediate post-operative period, make sure you discuss this issue with your plastic surgeon.It’s important to remember that every patient’s situation is unique. For this reason, treatment needs to be individualized for every patient.In the absence of other risk factors, the length of your procedure shouldn’t increase your risk for DVTs.
Type of anesthesia and avoidance of prone positioning are important to avoid a DVT
Very good question. By hernia repair, do you mean abdominal hernia? As in a hernia from previous abdominal surgery? This type of hernia is usually effectively repaired when the muscles are brought together at the time of a tummy tuck. There is some evidence that internal abdominal surgery such as a hysterectomy poses a greater risk of DVT when done at the same time as a tummy tuck, but not this type of hernia repair.
It is common to add on breast surgery at the time of a tummy tuck. True, it makes the operation longer, but there are advantages to having the surgery done in one operation rather than two.
More important is the type of anesthesia. The ideal is a total IV anesthetic without paralysis (which slackens the leg veins unnecessarily), and avoidance of any prone positioning (sometimes used by surgeons doing liposuction). Also we all tend to use sequential compression devices on the ankles and calves. You need to get up walking right after surgery. And you need an experienced surgeon who can do this in a reasonable time frame, under 4 hours. It is an advantage that you are small and at ideal body weight.
If you put all the factors in your favor, the risk of a DVT or PE is reduced, close to the baseline risk. If you like, you can read more on my website. I've attached a link.
Mommy Makeover and DVT Risk
There have been several studies on this exact topic of DVT risk in plastic surgery procedures. In fact, the American Society of Plastic Surgeons has a Venous Thromboembolism Task Force that has systematically reviewed this matter in detail. Multiple studies have shown the risk of a blood clot from a tummy tuck or related procedure is well below 1%. To help plastic surgeons select patients who may or may not need Lovenox (or some form of blood thinners to help prevent blood clots, there are published guidelines to aide in patient selection (known as the Caprini/Davison risk assessment model (RAM). Ultimately, your plastic surgeon will determine the need for Lovenox based on 1) your health status and past medical history and risk factors and 2) length of your procedure(s). Most PS utilize SCDs (massage boots) and early ambulation as the mainstay for their blood clot prophalaxis. Others also opt to add on Lovenox as well.
Overall, combined procedures are VERY safe in healthy patients. A breast augmentation will likely just add 1 hour to your procedure. Early ambulation after your procedure is very important too. Please talk to your board certified plastic surgeon about your concerns.
Best of luck!
Mommy Makeover DVT Risk
Although your posting indicates you are young and healthy, your plastic surgeon can assess your risk factors for DVT based upon your medical/surgical/medication history and family history. The length of the surgery is also considered in the decision making process to use medications to prevent DVT.
This is an important judgement call since ANY patient who I feel is at much higher risk for deep vein thrombosis is given the protection offered by blood thinners.
When a cosmetic surgery patient is properly administered low dose anticoagulants, there is only a very small risk on increased bleeding encountered.
Hope this response is clearly explained and helpful.
Mommy makeover is very, very safe in a great candidate like you.
We would routinely treat your breasts and abdomen together and the risk of clotting is very low since you are young and thin. When the risk is higher, we still do it, but then we use blood thinners.
Mommy makeover, tummy tuck
Slightly more risk by adding breast surgery to a tummy tuck
Any surgery, especially longer procedures, may be associated with the formation or increase the chance of blood cloths in the venous system (DVT). It is important to discuss with your surgeon any past history of blood cloths, swollen legs, varicose veins or use of estrogen or birth control pills that may contribute to this condition. Air travel, inactivity or other conditions may increase the incidence of blood cloths traveling to the longs causing a major blood cloth that may result in the death. If you have any traveling plans shortly after the surgery, please discuss it with your surgeon, so you can plan accordingly. As for the length of surgery any additional time will increase risk of DVT but usually times up to 5 hrs for cosmetic surgery have quite acceptable risk
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.