What are the main causes of death from Liposuction, fat transfer and general anesthesia?

Question

Why do these causes of death happen from these surgeries specifically and what are some things that can be done to try to avoid this? I understand when it's your time it's your time but I would like to better understand why this could happen? Fat transfers to the lungs/heart? Cardiac arrest? Why does this happen to some people?

Fernando Colon, MD · Answer

When liposuction patients are selected appropiately the death rate is very low.
High BMI and the combination of BBL with lipo has shown higher mortality rates associated
with pulmpnary artery embolization but this may be reduce by good technique and patient selection.
Find an experienced board certified plastic surgeon to fully evaluate and discuss your options
and risks. Best wishes.

Mats Hagstrom, MD (license on probation) · Answer

When you add the word fat transfer then fat embolism easily goes to the top of the list in regards to fatal outcomes.

In particular fat transfer to the buttocks when fat is grafted into the gluteus muscle and accidentally penetrates into the vascular system through the gluteal vein.

Plastic surgeons now know about this single complication that has caused the BBL to be called the most dangerous cosmetic surgery procedure with a fatality of 1:3000.

American society of Plastic surgery moved swiftly once this information was obtained and came out with safety recommendations which includes not grafting fat into the gluteus muscle, using large blunt cannula‘s etc. etc.

Fat embolism‘s have not been reported as a consistent potential complication from fat transfer in other parts of the body like the face or breast though they probably have happened and can happen.

I’m not an anesthesiologist but I’m guessing that the primary cause of death from general anesthesia is malignant Hyperthermia. This is a dangerous reaction to general anesthetic agents that has a genetic predisposition.

Once the condition is recognized surgery has to be stopped and the patient is giving a drug called Dantrolene which can occasionally save the patient’s life. I’m sure there are published data on fatalities from general anesthesia if you just search under those terms. Overall general anesthesia is extremely safe and probably much safer than for example driving a car for one year. I’m a 57-year-old plastic surgeon. In my career I’ve never had a fatality from plastic surgery. I’ve only heard of one single case of someone dying directly from general anesthesia. That was my university chairman’s case and the patient was a child who developed malignant hyperthermia. This was almost 30 years ago. That single case includes all the surgeries and all the plastic surgeons I know.

With the exception of fat embolism I would say the causes for fatal outcomes of liposuction and fat transfer are relatively similar.

The primary reason patients have died in the past from Liposuction has been delayed the diagnosis followed by delayed intervention from either injuries to other organs structures or infections. This probably encompasses 90%(educated guess) of fatalities from Liposuction and or fat transfer.

The keyword in that statement is “delayed“. Unfortunately many of the patients who passed away could’ve survived if the correct diagnosis and intervention was done in an expedient manner.

Like I mentioned, I have personally not had a single fatality in my career in plastic surgery. During my residency training we had many patients who died but this included rotations in trauma, heart surgery organ transplantation etc.

The only case that I’ve ever heard of a patient dying from Liposuction of surgeons that I know was a patient who developed a serious infection called necrotizing Fasciitis or a flesh eating bacteria.

The patient developed severe pain a few days after surgery. Instead of bringing the patient to the hospital to do tests the surgeon prescribed stronger pain medication.  This seems like a reasonable approach since the complaint is pain.

An experienced intuitive and intelligent plastic surgeon should recognize that each day after liposuction pain levels should be going down and not up.

And experienced plastic surgeon should immediately recognize this is not normal.

The patient was eventually brought to a burn center and had most of his soft tissues removed from his torso but eventually died from sepsis.

This patient could have survived though he would’ve been disfigured from the condition.

Another example would be penetration of the abdominal cavity with puncturing the colon.

Typically patients with this condition will develop gradually increasing abdominal pain and need to be evaluated with a CT scan immediately upon showing symptoms.  if the surgeon doesn’t recognize that something is wrong and instead continues to encourage the patient to take more or different pain medications the diagnosis will be delayed and the patient will eventually develop sepsis which can be irreversible.

If a cannula penetrates into the chest collapsing the lung causing a pneumothorax the patient can overtime develop something called a tension pneumothorax. This can cause instant cardiovascular collapse and is only reversible with immediate intervention by placing a needle or catheter into the chest to release pressure.  If the first responders do not recognize the condition which isn’t always easy to do the patient may not survive.

Vascular injuries like penetrating the heart or a major blood vessel can cause bleeding to the point of hemodynamic instability and death.

This would most likely occur in the operating room or recovery room area.

Careful postoperative monitoring should pick this up. Providers not board-certified in plastic surgery and do these procedures casually without recognizing the importance of proper monitoring or thinking through all the potential outcome sequelae may not be properly trained or equipped to recognize and or intervene.

For example, most dermatologist who feel quite entitled to perform Liposuction have probably done very few trauma interventions and the number of critically ill patients they’veManaged can probably be counted on your fingers.

Postoperative infections typically present 3 to 5 days after surgery.

Again, the first symptom is usually increased pain or tenderness in the area. It may also show redness. Typically a few days after liposuction everything is tender and bruised.

Symptoms like fever typically happen once the infection has spread throughout the body.

Early diagnosis and intervention is absolutely critical.

Infections may require antibiotics, a change of antibiotics or surgical intervention.

When it comes to considering risks for this procedure the number one take-home statement is to confirm your provider is board certified by the American Board of plastic surgery, has a proven track record and extensive experience.

Plastic surgeons have a minimum of 10 years of medical training and often more than that.

This training is not exclusively in plastic surgery. Many plastic surgeons have done five or six years of general surgery including months to years of rotation in ICU and trauma surgery scenarios.

This experience isn’t necessarily pertinent to Aesthetic Liposuction but it is absolutely paramount when it comes to recognizing and intervening in patients who are in trouble because some thing went slightly wrong during the procedure.

Infections after Liposuction or fat transfer are probably primarily random and have little to do with surgeons technique or decision making. Almost all plastic surgeons will use a minimum of a single dose of anabiotic‘s immediately before the procedure. Most plastic surgeons have patients take anabiotic’s for a few days afterwards though this is not been proven to make a difference.

Penetration to other organ systems is a manual dexterity issue and it’s less likely to happen in someone with experience who is coordinated and has excellent surgical skills.

Someone who is not a surgeon, isn’t particularly coordinated and has done a few procedures is more likely to put the cannula where it doesn’t belong.

As I mentioned previously these providers may also not have the understanding or training to recognize and intervene early when something does go wrong.

This is not to say the plastic surgeons are not going to have complications, fatal outcomes or have missed early diagnoses and interventions. We have.

The question is instead who is most qualified and what is the difference should something go wrong.

I’ve been a board-certified plastic surgeon for over 20 years. For the last decade my career has been devoted exclusively to Liposuction and fat transfer procedures. I performed over 7000 Liposuction procedures to date.

With the exception of patients complaining of the aesthetic outcomes(this happens to all plastic surgeons) I have had four complications related to Liposuction and fat transfer.  One patient developed a pneumothorax. I diagnosed the patient immediately upon talking to her a few hours after the surgery. As instructed she went to a local emergency room and got confirmation with a chest x-ray and intervention with a small catheter placed and was able to be released from the hospital the next day without any negative consequence.

Three patients developed postoperative infections. Two of these patients were hospitalized. One of them required surgical intervention and a five day hospital stay. All of the patients did fine and other than having to spend a few nights in the hospital or having a small catheter placed and the one patient having a 2 inch incision nothing else happened long-term.

While this may seem somewhat dramatic to those who don’t work in the medical field it needs to be put into context of an overall complication rate that’s less than one per thousand cases.

Considering that the infection rate of all surgical procedures combined is 1:200 this is in astonishingly low complication rate.

When done by experienced talented board-certified plastic surgeons liposuction and fat transfer with the exception of incorrectly performed BBL procedure(grafting into the gluteus muscle) liposuction and fat transfer are some of the safest surgical procedures you can have.

Personally I perform these procedures without a general anesthesia instead using local anesthesia with mild sedation. I’ve been doing this for over a decade and find it to be advantageous over general anesthesia.

To minimize the chance of something going wrong I suggest the following.

Always insist on an experienced board-certified plastic surgeon.

Surgeons hit their prime about 10 years after their training.

Practice makes perfect and you should confirm the surgeon has done this procedure numerous times in the past. Do so by asking the surgeon to show all of their before and after pictures of the procedure during in person consultations. An experienced plastic surgeon should be able to show you a minimum of 20 sets of before and after pictures of the single procedure you’re interested in and preferably over 100.

Confirm that the surgeon has admitting and operating privileges in a local fully accredited hospital.

Read all the reviews on various physician review websites paying close attention to justified negative reviews.

The best providers typically have no or very few justified negative reviews.

There are risks we all take in life. The most obvious one is driving or riding in automobiles.

Other risks patients take regularly are living with high blood pressure without taking medication, smoking cigarettes or drinking alcohol, allowing themselves to be obese or not exercising on a regular basis, owning  loaded firearms etc. etc.

From the patient’s perspective I think the biggest fear or concern patients should have is not getting botched from the procedure. While this doesn’t leave you 6 feet under the ground it is something that is much more prevalent and causes serious decline in quality of life.

The chance of dying is remote even in the hands of hack surgeons who have poor qualifications. Unfortunately ending up with a bad outcome from body contouring happens not infrequently.

Competence and safety typically go hand-in-hand. I would focus all of your energy and simply finding the most competent experienced and skilled board-certified plastic surgeon in your area. I would do so by scheduling numerous in person consultations.

In the face of COVID-19 there is some inherent risk including the chance of fatal outcomes from human interactions.

Physicians are uniquely well educated in universal precautions and know better than anyone how to minimize the chance of infections for themselves and their patients but obviously there is some risk involved with in person consultations as well.

Best,

Mats Hagstrom MD

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