Is Breat Augmentation on Patient with Antithrombin III Deficencey Possible?

I am 38yrs old and have Antithrombin III deficiency with history of one clot over ten years ago. Over all I am in great health. My Hematologist has approved breast augmentation surgery with proper care and blood thinners. I have consulted with 4 different plastic surgeons and they have all refused. Is breast augmentation possible for me?

Doctor Answers 5

Breast augmentation with antithrombin III deficiency

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I am sorry to hear that you have been refused surgery.  I frequently encounter patients with clotting problems and am happy to operate on them as long as I have advice and support from a haematologist.  I have perfomed much more extensive surgery than breast augmentation on patients requiring blood thinners and am surprised that you have been unable to find a surgeon who will take you on.  My advice would be to keep trying and good luck.

Breast augmentation with blood clotting disorder

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I can certainly understand the reservations that surgeons have regarding doing an elective, cosmetic procedure on a patient taking blood thinning medications. The risk of bleeding into the implant pocket is substantially higher. 

Possible but risky

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An antithrombin III deficiency is a medical condition where the clotting process is not controlled properly and can lead to unwanted clots. Obviously, if a blood clot occurs in a vital organ, or a clot breaks off an travels to a vital organ, serious injury or death can occur. Blood clots are often treated or prevented with blood thinners.

Breast augmentation is an elective procedure. Since it is elective and not necessary, we don't want to take unnecessary risks.  One of the risks associated with any surgery is bleeding.  If blood thinners are used around the time of surgery, this can greatly increase your risk of bleeding.

As you can see, there's a fine line between too much clotting and not enough.  The balance can be tipped in either direction. Even under the close surpervision of you plastic surgeon and hematologist, you're taking an unnecessary risk.  It looks like the four plastic surgeons you saw felt the same way. Breast augmentaion is a real surgical procedure with surgical risks.

  This question and answer format is for general information and the answer is based on the limited information provided in the question. The correct course of action can only be determined by you and your physician(s) after a thorough evaluation of your history and medical condition.  



James H. Schmidt, MD (retired)
Sarasota Plastic Surgeon

Cosmetic surgery and bleeding disorders

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The short answer is yes it is. The long answer is blood clot formation is a complex process involving first the accumulation of cells in the blood called platelets to form a plug and then a number of proteins/enzymes also called clotting factors that act upon one another in a specific sequence one after the other like dominoes dropping called a cascade to form a mesh that reinforces the platelet plug.

Antithrombin III is a protein in the blood that binds to thrombin or other protein/enzymes at the bottom of the cascade to put the brakes on, stop or slow the clotting cascade. Patients who have antithrombin III deficiency are prone to making too much clot. These patients are given a medication called heparin to increase the activity of whatever amount of antithrombin III is present. Since the 1980s a purified (low molecular weight) heparin has been available that is easier to take and does not have to monitored as closely for overdose. This form can be taken at home instead of being restricted to in hospital use. They can also be given Antithombrin III concentrate to bring the blood levels to normal or close to normal. Therefore under the guidance of your hematologist the Antithrombin III levels can be elevated to normal and while they are normal your risk for surgery would be no different than for the average population. Ask your prospective surgeon to speak to your hematologist before they make their final decision regarding surgery.

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.

Aaron Stone, MD
Los Angeles Plastic Surgeon

Is Breat Augmentation on Patient with Antithrombin III Deficencey Possible?

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Sorry for your issues not only with the hematologic problem but in having implants. I recommend your hematologist find a boarded PSs at the hospital he works in to have your surgery done only in a hospital setting fort your safety. I also would use drains in your pockets. Yes the fees will double but safety first!

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.