Getting a Breast Augmentation with Brain Aneurysms?

Question

I've decided to get my breasts enlarged this summer. Over the weekend my parents brought up my aneurysms and asked if that would be an issue. Last year I found out that I have 3 aneurysms in my brain, 2 on my rt cartoid artery & 1 on the left, all 3 are under 2mm and nothing has been done to treat them other than placing me on anti seizure and blood pressure medicine. I am 29 and perfect health other than that. Is this something that will keep me from having my procedure?

Richard H. Tholen, MD, FACS · Answer

You are wise to ask the question, since elective surgery is, well, elective, and would not be appropriate if it substantially increased your risk of stroke, brain bleed, or death.

	You and your physician already know the exact size, location, and number of these "ballooned-out" areas of your brain arteries, but no one knows exactly just how much pressure variation would be necessary to cause one of these to "blow out." And if this occurred, just how serious (or fatal) it could be.

	You should already have an idea of limitations you and your doctor may have discussed regarding everyday activities that could cause blood pressure increase and potentially rupture brain aneurysms--things like sports, sexual activity, etc. Elective surgery needs to be another category within these discussions.

	Anesthesia providers can maintain blood pressure reasonably accurately in the operating room, but there are normal fluctuations, potentially dangerous ones, even in individuals without brain aneurysms, and more so in you.

	If you were my patient, this would be a discussion between me, my anesthesia provider, your physician, and of course, you. Everything in life has risks. We would just want to be as sure as possible (no guarantees) we are not taking excessive or unreasonable risks in order to enlarge your breasts. Best wishes! Dr. Tholen

Richard J. Brown, MD · Answer

Bottom line here... your team of doctors hast to risk stratify your situation and decide if you are low risk, moderate risk, or high risk for surgery. This is not a simple yes or no and you are good to go. You need all of your doctors to work together with you here. Ultimately your surgeon has to feel confident and comfortable with performing the surgery.

Todd B. Koch, MD · Answer

This is a question you should be asking your Neurosurgeon or a neurologist.  They would be better suited to address the risks of anesthesia and surgery with your present condition.  These are relatively small aneurysms and I do not think it would be a problem but I recommend covering all bases.

Steven M. Lynch, MD · Answer

Hi,

	  Even though it seems that there is increased risk in your case that might prevent you from having the breast augmentation, the final recommendations and support needs to come from your medical doctors.  They can tell you if the anesthesia/surgery would be contraindicated. 

	  Having said this, we do breast augmentations frequently on patients with medical conditions.   As long as your doctor gives you a medical clearance, then the doctors in the room for your anesthesia can keep this in mind while you are having your procedure. 

	  The surgery itself is under an hour and should have no effect on your condition.

	           Steven M. Lynch, M.D.

Herluf G. Lund, Jr, MD · Answer

Dear LissAK,  First, thank you for asking the question before proceeding.  A lot has been learned about management of brain aneurysms in the recent years allowing many patients with aneurysms to lead very full and active lives.  That being said, the person who can best answer your question is the doctor who is managing your aneurysm treatment.  Have a frank and honest discussion with your doctor and if they are comfortable proceeding with a breast augmentation, then select a plastic surgeon who is willing to work with your doctor and also has an anesthesia team that will make any adjustments needed for a safe procedure. Communication amongst all of the members of your medical team is the key to success and it sounds like you are off to a very good start in this process.

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