I've been diagnosed with activated protein C resistance - can I still get a BBL?

Question

I've been diagnosed with activated protein C resistance - asymptotic and it's heredity. I'm 26 and in good health, my BMI is 21.3. I've only had one prior surgery (rhinoplasty) and did not have any complication. Can I get a BBL?

Daniel Barrett, MD · Answer

Dear moreau97,
it is hard to tell for sure without an examination. You will need to get a clearance from your doctor prior to surgery. If you are considering surgery, I would suggest you consult a board-certified plastic surgeon. Only after a thorough examination, you will get more information and recommendations.
Daniel Barrett, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

Karl William Schwarz, MD · Answer

I would not suggest undergoing a BBL with activated protein C resistance as I would be worried about the development of a deep vein thrombosis leading to a pulmonary embolus which could be fatal. A BBL is obviously an elective procedure that inherently has a risk of developing a DVT (albeit low) but I don't see taking the risk when the possibility of a pulmonary embolus is at stake. You are still at increased risk during a rhinoplasty but the chance of a DVT or PE from a rhinoplasty is very low but for me personally I would not have performed a rhinoplasty under a general anesthetic either for the same reasoning. I don't think elective cosmetic surgery should be performed in anyone with a hypercoaguable state. There are certainly cases where surgeons do that and there are ways to mitigate your risk but the risk never goes to zero and I can tell you from personal experience as someone who completed a general surgery residency in a Level 1 Trauma Center that telling patient's families that someone has passed is a horrific experience and not a risk I am prepared to take when performing elective surgery. If you had cancer and needed surgery then that is a different story--you have to take the risk and there are things that can be done (IVC Filter, heparinization) to decrease the risk but that is a totally different situation where the risk of death from the cancer outweighs the risk of developing a blood clot.

Mats Hagstrom, MD (license on probation) · Answer

Each plastic surgeon will make their own determination regarding their comfort level and your candidacy for surgery.
For that reason, I suggest scheduling multiple in person consultations with plastic surgeons in your community.
Most likely any plastic surgeon, considering doing your procedure if you’re a good candidate will also need clearance from a hematologist.
The disorder you have put an increased risk for potentially life-threatening complications Not from surgery, but developing blood clots that could be related to having surgery during or after the procedure. 
Plastic surgeons may be apprehensive to do this type of surgery on someone who is an increased risk for having life-threatening blood clots.
You should also ask yourself if you’re willing to take that risk?
Consider talking to your hematologist and asking if they think you’re inappropriate candidate for this type of surgery, then schedule multiple in person consultations with plastic surgeons in your community who have extensive experience with the BBL procedure.
You can talk about your medical history during each consultation.
I personally would probably not do surgery on someone with your condition unless I could be convinced by hematologist that your risk for complications had been reduced to that of the normal population.
Best,
Mats Hagstrom, MD

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