Is preop testing not necessary before lipedema surgery?

Question

I'm having a high volume lipedema surgery in about 2 weeks. I'm 40 years old, i don't take any medication or have another know condition besides the lipedema. I went to my preop appointment and when I asked my surgeon what test i would have done he said i don't need any. I He is a board certified plastic surgeon. Im 200 pounds should i have test done? EKG blood count, uranalysis?

David Amron, MD · Answer

While each surgeon is different in terms of their approach to surgery and pre-operative preparation, Lipedema surgery itself is even more particular. I can only comment about what I do in my practice with lipedema patients. It is my protocol to have every patient have medical clearance. Especially any patient over the age of 55 or with ongoing medical problems. In your case, you are younger at 40 years of age and it is not unreasonable that your surgeon may not want a medical clearance. I do have every patient undergo preoperative blood tests including CBC as well as what is called a PT/PTT to evaluate any propensity for bleeding. Urinalysis is not generally needed unless a patient has a particular medical problem. This gets into a longer and different discussion but personally I prefer to avoid general anesthesia in my approach to lipedema patients for a number of reasons, safety being one, faster recovery and primarily optimizing results from both disease treatment and cosmetic improvement.

Aria Vazirnia, MD · Answer

Pre-operative testing includes a pre-operative physical examination, EKG, urinalysis and/or blood work to help clear a patient for surgery. The thought behind these tests is to detect possible health issues that can complicate a surgery if not addressed before the surgery. Typically, these tests are recommended after a thorough medical history, however they are not always necessary. It is important to discuss with your surgeon if pre-operative testing is recommended before your surgery.

Thomas Wright, MD · Answer

Women with lipedema can have a large area affected by the disease and so Lipidema Reduction Surgery often by necessity involves a large volume modified liposuction.  There is a not small risk of post operative anemia resulting from the this large volume surgery. We check HgB preoperatively and we have found postoperative anemia is not rare.  I have authored a paper on lipedema reduction surgery this is reporting around 10-20 % of the large volume modified liposuction surgeries can cause at least some mild postoperative anemia.  If we find anemia prior to surgery we will prescribe iron supplementation. In older women, women who are in their sixties or with other health concerns we will check an EKG or may have them get clearance from the primary or specialist physicians.  However, for healthy women with no significant past medical history, we often get only a few tests and sometime no tests.  Wishing you the best of health.

Daniel Barrett, MD · Answer

Dear Bright970254,
every plastic surgeon has his own preoperative protocol which he recommends to his patients. I would suggest you to discuss this with your plastic surgeon.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Douglas Taranow, DO, FACOS · Answer

Every surgeon has their requirements for pre-operative laboratory testing.  My office requires only a CBC (blood count to detect anemia and to confirm platelet count for clotting).  In NYC, we are also required to have a Covid test within 3-4 days of surgery.  Patients over 40yo or with medical conditions get an EKG.
Some physicians perform their cases under local anesthesia and perform no lab testing.
Dr. Taranow

Mats Hagstrom, MD (license on probation) · Answer

Most surgeons in the United States have backed off quite a bit when it comes to ordering tests before routine elective surgical procedures on younger healthier individuals.

There been good studies that show they simply aren’t necessary.

For patients with particular history of abnormal test or underlying medical conditions testing may be indicated as is the case when patients are older and the chance of having an undiscovered condition like kidney disease or significant anemia it’s worth looking for it.

What’s your plastic surgeon is doing sounds very routine. Some plastic surgeons still order tests but overall the trend has been to not order tests because they are not necessary.

Best,

Mats Hagstrom MD

Is preop testing not necessary before lipedema surgery?

Answers (6)

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