Diabetes and Abdominoplasty Tummy Tuck: Complications and Caveats. Insulin and Glucose Control
Abdominoplasty techniques are useful in the management of abdominal wall laxity, and redundancy of skin and fat along the lower abdomen.
There are several things to consider in planning an abdominoplasty.
- Anesthesia Risk
- Surgical Risk
- Postoperative Complication Risk
Always choose a well qualified, board certified plastic surgeon to perform your abdominoplasty operation. Second, never cut corners on anesthesia, surgery center, or surgical care. Choosing the best plastic surgeon available is always a wise choice. Methodical pre and postoperative review are also mandatory.
In diabetics, the important question is how well controlled their blood glucose levels are. If you are a non insulin dependent diabetic with good glucose control and normal Hemoglobin A1C levels, you are less of a risk in terms of anesthesia and surgery.
In terms of surgical risk, diabetics heal slower than non-diabetics. This should be clearly defined by your surgeon prior to surgery so that steps can be taken to maximize healing postoperatively.
In my Santa Monica practice, I perform abdominoplasty procedures on diabetics and have had a very low complication profile on this patient population. The key to success is meticulous surgical technique and a thorough preoperative optimization of the patients medical condition.
If your condition is well controlled, surgery is OK
Many people wanting elective cosmetic operations have an underlying medical condition such as diabetes, high blood pressure, or heart disease. The bottom line is: if your disease is under control, surgery should be a reasonable option. But the emphasis goes on the first issue, control of your underlying disease. So, if your blood sugars are well controlled, you shold be able to have a tummy tuck. There are few things, however, that should be attended to.
- If you are overweight, you should stongly consider weight loss prior to surgery. Your plastic surgeon can advise you on this.
- The doctor managing your diabetes should be aware of your intended surgery, and should be in agreement with going forward with this. Your plastic surgeon should have access to the records of your other doctor, and should review your recent lab work.
- You should meet with the anesthesiologist prior to the day of surgery. He or she will give you instructions on how to manage your insulin or other medications the day of surgery, and immediately afterwards.
- And, make sure you have adequate time to recover from your surgery prior to going back to work, or to your normal life style.
Type 2 Diabetes is not a contraindication for surgery on its own.
Having type 2 diabetes is not a contraindication to having an abdominoplasty on its own. However, it is advisable to only undergo this type of procedure if your blood sugars are well controlled. You should inform your surgeon of how your blood sugars range and what your A1C's run. You may need to undergo further medical workup including an EKG or a treadmill test and medical clearance. Your blood surgars should also be well controlled to also achieve better wound healing. Good luck.
Yes, but control is important
I agree that your diagnosis is not as important as the degree to which your diabetes is controlled in the period around your surgery. If your blood sugar is under good control on a stable dose of oral hypoglycemic, you should be at low risk of problems after surgery (although your risk would still be a bit higher than the general population). Managing your blood sugar after the surgery will also take extra care, as Dr. Di Sala mentions, so I would be prepared to take extra blood sugar measurements periodically or spend the night at the facility.
Diabetics can undergo cosmetic surgery with extra care.
Diabetics can undergo cosmetic surgery if they are in good control of their sugars. Even with this diabetes does increase the risk of infection and so you will need clsoe monitoring of your sugars after surgery. These are concerns that you should discuss with your primary care doctor as well as your plastic surgeon. That said with close monitoring and good communications between you, your primary care doctor and your plastic surgeon you should be able to consider cosmetic surgery.
As Dr. Seify accurated commented, type II diabetics can safely undergo tummy tuck surgery - with proper precautions. Careful pre-operative evaluation is necessary to make sure the procedure is tolerated without incident. Fastidious sugar management is important. Diligent post-operative care is a must.
That being said, I've done tummy tucks - even body lifts - on Type II diabetics, and they have all done well.
Good luck with your research!
Not a contraindication but ...!
Type 2 Diabetes by itself is not a contraindication for surgery but the following needs to be addressed:
1-Your blood sugar level should be under control. Clearance from your family doctor is a good idea.
2-Full labs and EKG.
3-Since the stress of surgery will increase the requirement for the insulin hormone. An overnight stay at a medical facility with nursing supervision might be a safe thing to do.
It is not uncommon to switch to Insulin in the first few days after surgery.
4-In general there could be a higher chance of infection and wound complications. However, with good medicine most of these problems could be avoided and if they occur treated early.
Can a type 2 diabetic undergo tummy tuck?
Hello! Thank you for your question! There are a few medical comorbidities that contribute to a higher risk during any surgical procedure including infections, wound complications, delayed wound healing, bleeding, anesthetic risks, etc. Diabetes is one that is known to have an increased risk for infections and wound healing issues. There are a number of both systemic and local host factors that can contribute to infections. Whether or not diabetics are truly at greater risk and the magnitude of the effect of diabetes on the risk of infection remain controversial. However, there is a known increased propensity to develop infections and delayed healing. Some of the hyperglycemia-related impairments on the immune response include vascular insufficiency, sensory peripheral neuropathy, autonomic neuropathy, and skin and mucosal colonization with pathogens such as Staphylococcus aureus and Candida species.
That being said, well-controlled diabetes should equate a minimal increased risk for the above and surgical procedures still safe and a reasonable decision. You should ensure adequate glucose control always, but also obtain medical clearance from your primary care physician that you are at an acceptable risk for undergoing a surgical procedure. Laboratory results such as HgbA1C is a good measure of control. Discuss all of your medical comorbidities and medication with your surgeon prior and discuss these risks. Measures will be taken to check levels as well as maintain proper glucose control with appropriate fluids and medications. This procedure should still be very safe for you and hope for an uncomplicated course with an excellent result! Hope that this helps! Best wishes!
Thank you for your post. Diabetes is a disease that should demand a healthy respect from both surgeon and patient in plastic surgery. It is a disease that affects the immune system and can increase the risk of infection, a disease that affects the healing potential of a wound and can cause opening of a wound, and is a disease of the circulation that can lower the blood flow to the operated tissue and cause necrosis or tissue death. This needs to be managed as follows:
1. Tight blood glucose control with diet, exercise, and medication. You need to see your internal medicine doctor regularly and make sure your diabetes is well controlled.
2. If you are overweight, then losing weight decreases your risk in tummy tuck surgery or any other surgery for that matter.
3. If you have high blood pressure, this needs to be managed and well controlled by your internal medicine doctor as well.
4. ABSOLUTELY NO SMOKING!
5. Consider with your surgeon HyperBaric Oxygen therapy pre- and post-op.
6. Make sure you understand from your surgeon and anesthisiologist what medications you should take or not take prior to surgery.
It is very possible to have a great outcome as a diabetic following tummy tuck surgery, but minimizing the risk is the most rational way of accomplishing this.
Pablo Prichard, MD
Can a Type 2 Diabetic Undergo Tummy Tuck?
Well controlled diabetes is not a contraindication to tummy tuck surgery and/or other elective plastic surgical procedures. Always best to check with your primary care physician or endocrinologist for “medical clearance” prior to surgery. Managing your diabetic medications around the time of surgery (to avoid hypo as well as hyperglycemia), while you will have altered oral intake, will be important. I hope this, and the attached link, helps.