What are the chances of developing a fat embolus or PE? I am having a tummy tuck, BBL and lipo.

Question

I’m 29 y/o, healthy, no co-morbidities. Will be flying out of state to have the procedure done.

Pey-Yi Kevin Lin, MD · Answer

Mizcurvas,
Although the risk of a DVT/PE or Fat embolus is relatively rare, these complications are extremely important to discuss with your plastic surgeon.  In general, the risk of PE/DVT with an abominoplasty (tummy tuck) alone is about 0.5% (as outlined in a 2015 article in Plastic an Reconstructive Surgery Journal).  With the addition of liposuction that risk increases to 1.1%.  But that was for all patients, male/female, different BMI, different ages, etc.  
For someone like you, who is young, healthy, and presumably no previous history of DVT/PE; your risk is likely very small.  Your plastic surgeon can discuss with you certain traits that may increase your risk, which can be found in the Caprini score.  
In order to reduce the chances of DVT/PE; there are certain steps that should be taken including the use of pneumatic compression devices during surgery, early ambulation after surgery, and if you are at an increased risk, the use of pre-operative anticoagulation such as heparin/lovenox.  
I agree with many of the other physicians that you should be wary of flying on a plane for a long flight soon after surgery.  If you do plan on flying, i would suggest frequently getting out of your chair and ambulating.

Robert M. Tornambe, MD · Answer

Mizcurvas.   Your age and lack of comorbidities decrease risk, however BBl and Tummytuck simultaneously increase those risks.  If expected fat transfer is modest, then it is a reasonable.  If extensive, consider staging the surgery.  Be sure to consult with a board certified plastic surgeon.  Good luck!

Daniel Barrett, MD · Answer

Dear Mizcurvas,while there is always a risk of PE or fat embolus, that risk for young, healthy individual is minimal. I would suggest you to discuss this with your plastic surgeon.Daniel Barrett, MD, MHA, MS 
  
Certified, American Board of Plastic Surgery  
  
Member, Am. Society of Plastic Surgery

Vasdev Rai, MD · Answer

Risk of DVT and Pulmonary embolism is always there.  It goes up with fat injections. Risk is higher if patient travels for extended times by car or airplane for up to three weeks after surgery.Get surgery done closer to home.

David Finkle, MD · Answer

Every patient whom undergoes a surgical procedure is given a Deep Vein Thrombosis (DVT) risk factor number.  This number is predictive of the risk an individual has of developing blood clots in their legs after surgery.  Blood clots in the legs can break off and spread to the lungs, causing a pulmonary embolism (PE).  People can and do die from pulmonary emboli, it is the most common cause of death after a surgical procedure.  Every precaution must be taken to prevent DVT.This number represents either low, moderate or high risk of developing DVT, more precautions need to be taken for the higher risk patient.  Some precautions taken are; the placement TED stockings before during and after the procedure, alternating pressure devices on the calves before, during and after the procedure, frequent ambulation, leg/ankle/calf exercises after the procedure, and even the use of blood thinner medications after the procedure.Some of the risk factors are:AgeLength of surgeryWeightRecent history of cancerUse of Estrogen products including BCPFamilial history of blood clotting disorderPast history of DVTRheumatoid ArthritisAnd others...Your surgeon will assign the number and then form a plan to prevent post op DVT.  But, they could still develop, so sometimes when the number is very high, we will not recommend elective surgery.  Always visit with a Board Certified Plastic Surgeon who performs body contouring surgery frequently to assure the best possible result.Good Luck!

Matthew H. Steele, MD · Answer

Thank you for your question.  The answer will really depend on your risk factors which we calculate using the Caprini index.   For a young healthy patient, your risk of DVT should be

Ronald V. DeMars, MD (Retired) · Answer

If your health is good, you don't smoke and are not obese, your chances of having a DVT or PE are extremely small. But other factors come in to play during the surgery such as keeping your temperature at a proper level, pneumatic compression leg cuffs, and keeping the time in surgery under a reasonable time. After surgery ambulation is critical and the state of the art in preventing clots includes having the patient on some medication like Lovenox postoperatively. Long travel after surgery raises your risk and you will need to check with your surgeon as to when it will be safe to travel and precautions you need to take. We would request you stay locally for two weeks if you are having muscle tightening and have plans in place to return for any serious complications that may arise, although that should be rare if you are choosing a very experienced board certified plastic surgeon.

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