Must Take Heparin After Breast Augmentation, Should I Be Worried About That Causing a Hematoma?

This does not make sense to me. You are at increased risk of forming blood clots so the most dangerous time for you is on the operating room table when you could form clots while under anesthesia. That means when you need it the most you will not be medicated. I have operated on a number of patients cosmetic and reconstructive who took Lovenox before and after surgery and found it to be very safe.

Starting a blood thinner 3 days after surgery can be a disaster. I know of a patient 7 days out from a rhinoplasty who went jogging and had a sudden expanding bleed in the nose. Another a few days out from a facelift bent down to pick up a bar of soap in the shower and one side of the face suddenly swelled up with a bleed and subsequent clot. Now imagine those case scenarios with a blood thinner on board. Even if you say that before the thinner you are hypercoagulable that does not mean you are right on the normal line after taking the thinner because you cannot precisely control the level.

Risking your life because you don't want to pay for Lovenox is not logical because if something bad happens because you did not take it you will be paying a lot more.

My response to your question/post does not represent formal medical advice or constitute a doctor patient relationship. You need to consult with i.e. personally see a board certified plastic surgeon in order to receive a formal evaluation and develop a doctor patient relationship.

Yes, if you have thrombophilia, you are at significantly higher risks to form a clot in your leg or lung.  Preventative treatment with a blood thinner, like heparin or lovenox will minimize this risk, but does increase your risk for bleeding complications.

Think of this from the downside:  if you get a pulmonary embolism, it could be fatal.  If you get a hematoma around the implant, you'll need a trip back to the operating room.  Clearly, in the greater scheme of things, that's a much lesser problem.

Ask your hematologist if wearing SCD's at home (you can rent the machine) with a couple of days of lovenox treatment would be adequate protective treatment.

Yes heparin after surgery will lead to a possible hematoma.  I understand that you have been "cleared" for surgeon but as the surgeon I feel I have the right to decide that this surgery is not in your best interest due to the necessary medical treatment that you require.  Best wishes.

Dr. ES

Maybe you should not have elective cosmetic surgery.  I have had a patient who took aspirin at three days after breast implants. She bled and required blood transfusions.  I am very cautious about using anything that can effect normal clotting following surgery.  So our patients cannot take Motrin, Aspirin, Vitamin E etc etc for three weeks after surgery.  Why not use sequential pumps on your legs to help prevent blood stasis during surgery?  After three days when you are up and about the risks for clots should be over. Get another opinion.  Other factors to consider are do you smoke or take oral contraceptives.

 



 

You are wise to involve your hematologist in the decision making when considering an elective cosmetic surgical procedure.  More than likely you will be fine starting heparin 3 days after surgery.  During the informed consent process you should  be made aware of the increased risk of bleeding and how this complication is handled.  Prevention of clotting abnormalities is of prime concern. It is unlikely that your hematologist would have recommended an elective surgery if there was an extremely high risk of a complication.  It is just not worth the risk.  

A blood thinner such as heparin will increase your bleeding risk after breast augmentation, though the risk is lessened by the third day after when you are to start. The lovenox might be worth the investment with a single dosing each day. Discuss all with your surgeon and hematologist. Risk in surgery can be managed with good coordinated care.

Heparin certainly increases your risk but not using it can result in a disaster in your situation.  Thus you need to discuss all of the pros and cons with both physicians and make a decision about what is best for you.  Your surgeon may even consider using drains during your procedure and this should be discussed.  While drains don't stop frank bleeding they do evacuate a slow ooze that may result.  Best of luck!

First keep in mind that your best health care comes before cosmetic surgery. If your health care jeopardizes the safety of the cosmetic surgery, you should avoid the cosmetic surgery.

Yes, your condition creates a higher risk for blood clots. That is why you have been prescribed heparin (or Lovenox). With careful monitoring by a hematologist you should be ok. But be aware your risks are increased.

Yes, you should discuss this with both physicians. Heparin does increase your risk of bleeding, but by three days most of the risk will be behind you. I would stress diligence in following physical limitations, such as avoiding lifting heavy objects for the first week. 

It is not uncommon for patients seeking surgery, cosmetic or otherwise, to have anti-coagulation therapy prescribed, and the risks as always are balanced with the benefits. But the risks seem small if you are being given three days to recover before starting the heparin.

Best wishes. 

 I would strongly advise against starting heparin as soon as 3 days after breast augmentation because I believe a significant risk of Hematoma still exists at that time. I personally would not operate on anyone planning to take heparin at this point in the recovery. Lovenox is an excellent alternative and the additonal expense should be weighed against the potential cost involved with redo surgeries and complications should a hematoma happen.