Breast Implants in Someone with Von Willebrands?

Question

I’m 20 years old & want to get breast implants. I am about an AA now and want to be a full B. I have Von Willebrands type I. I have 2 tattoos that cover my sides & had no issue with them healing. I also work as a Vet Tech & have had dog/cat bites/scratches MANY times and have had no problem with them. I want to know if there is a dr that would do my surgery. I am in NC and have had 2 dr turn me down even though my hematologist said I should be fine it just isn’t ideal.

Aaron Stone, MD · Answer

Von Willebrand's Disease is a form of hemophilia which involves defects on chromosomes other than the sex chromosomes X and Y. The bleeding tendencies are usually less in these cases than regular hemophilia but the severity of the bleeding disorder is highly variable. These patients have difficulty forming the initial platelet plug. The treatment of choice for mild von Willebrand disease is Stimate&reg; or desmopressin acetate (DDAVP), a nasal spray that stimulates the body to increase factor VIII and von Willebrand levels. It is given to patients to increase the amount of the von Willebrand factor long enough for surgery or dental procedures to be performed. DDAVP is a synthetic product that carries no risk of infectious disease because it is not isolated from the blood of other individuals.
	
	For excessive bleeding in Von Willebrand's Disease, infusions of a factor VIII concentrate rich in von Willebrand factor, such as Humate-P&reg;, Alphanate&reg;, Wilate&reg; or Koate DVI&reg;, may be required. Humate-P, manufactured by CSL-Behring, Alphanate, manufactured by Grifols and Wilate, manufactured by Octapharma are the only FDA-approved Factor VIII concentrate for use in von Willebrand Disease. The level should be raised to 80% or more of normal and maintained at that level for 10 to 14 days after surgery. These patients should have their surgery performed in a hospital.
	
	Aspirin and many of the drugs used for pain can aggravate bleeding because they interfere with platelet function. People who have von Willebrand disease can take tylenol for pain relief because it does not inhibit platelet function. They should avoid any aspirin containing medications.
	
	I hope you realize that this format of posting questions and receiving answers lacks the face to face direct communication required for you to make an informed decision regarding your surgery.
	
	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.

Gerald Minniti, MD, FACS · Answer

Hello,

	I understand why your docs said no to you, it is a risk, even with ddAVP.  I have done about a dozen breast augmentations on patients with VWD type 1, and I did have a hematoma on my second patient requiring a surgery to remove the blood three days later.  Since then, I've been giving a second or third dose 24 hrs after surgery, something not all hematologists recommend.  Maybe you can go to one of the Duke plastic surgeons (preferably one that is experienced in breast augmentation, not reconstruction) who will be willing to perform the surgery.

	Best of luck!

Lawrence Iteld, MD · Answer

One of the risks with any surgery is bleeding and breast augmentation is no different. There are several types of vWD. Most patients with type 1 only need treatment with a medication called DDAVP, while types 2 and 3 frequently require transfusions to manage bleeding problems.

	 

	I would recommend that your surgeon(s) coordinate with your hematologist. Together they will be able to gauge your surgical risk and advise you as how best to proceed. This is potentially a challenging situation and needs to be addressed carefully.

	 

	Good luck!

Breast Implants in Someone with Von Willebrands?

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Breast Implants in Someone with Von Willebrands?

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