How to avoid blood clot and cardiac arrest in mommy makeover surgery?

Question

I always want to have a mommy makeover - tummy tuck and breast augmentation. However, I'm so scared of blood clot post surgery. And I have heard many stories about cardiac arrest that people die in the operation room. i want to know what patient and doctor should do to minimize these deadly risks?

Lane Smith, MD · Answer

First thing you should do is only choose a Board Certified Plastic Surgeon to perform your procedure. Once you have chosen a board certified plastic surgeon they will have you perform lab work to make sure you are a suitable, heathy candidate to begin with. Then there are preventive measures that I’m sure each surgeon takes. Here at my office, we prescribe special injections to prevent clots, our patients are then given Sequential Compression Devices that they will wear at home that reduce clotting risk, as well as having our patients ambulate no less than every 4 hours. That’s on top of preventative measures that we take during your surgery. Feel free to set up a consultation with me at Smith Plastic Surgery if you would like to go over in more detail.

Kenneth Hughes, MD · Answer

Blood clots refer to clots in occluded vessels in the deep venous systems of the legs and sometimes arms that may dislodge and produce pulmonary emboli. These migrating clots may then prevent air exchange and lead to patient death.Obviously, these blood clots or DVTs are not favorable outcomes and they are to be avoided and prevented to the extent possible. These are many risk factors which can increase the risk for blood clots, pulmonary emboli, and death. Some of these are summarizes in the Caprini risk assessment index. Patients with previous blood clots or pulmonary emboli are particularly susceptible to a repeat occurrence. Patients who have family members with blood clots may have inherited conditions.Choose a ABPS board certified plastic surgeon who operates in a fully accredited surgery center, where the PS employees hospital staff anesthesiologists to provide the highest level of care possible along with potential overlap in personnel if necessary. These individuals are all experienced and highly skilled and are capable of managing any high stress situation. They have experience in emergency and critical care situations and preserve their skills by retaining their hospital positions, performing codes for patients at risk of death from heart attack, stroke, or embolus who require ACLS (advance cardiac life support) and beyond.

Pejman Aflaki, MD · Answer

Hello and thank you for your question. First, I would make sure to choose a plastic surgeon that is board-certified by the American Board of Plastic Surgery. Check the facility to make sure it is adequately credentialed. There are many things that can be done to reduce the risk of blood clots, including early post op ambulation, SCD machines, and prophylactic anticoagulation medications (subcutaneous heparin, etc). Your plastic surgeon will decide which one(s) to use based on the assessment of your particular risk. A discussion about blood clot prevention has to be an essential part of your preoperative evaluation. Best,Pejman Aflaki, M.D.
  
Johns Hopkins-trained double board-certified plastic surgeon

Vishnu Rumalla, MD · Answer

Thanks for your inquiry, first your general health is the most important factor.  If you have a history of heart disease or blood clots of course you should be concerned.  If not, pick a reputable board certified surgeon who only operates in accredited facilities. Sequential compression devices are a must during surgery to prevent blood clots, early ambulation is important and blood thinners can be considered.  Good Luck.

William Bruno, MD · Answer

There are several ways to reduce the risk of a blood clot (DVT) during a tummy tuck procedure. It really begins with the patient having a normal body weight, which is a Body Mass Index (BMI) under 25, which is normal. (25-30 is overweight). Also reducing risk factors such as smoking, birth control pills and a sedentary lifestyle. The surgery during should be brief and if needed anticoagulation may be required in certain cases. Discuss these issues in more detail with your plastic surgeon but the risk of a DVT is quite low, about 1-2%.Best wishes,Dr.Bruno

Miguel Delgado, MD · Answer

There are many protocols in place for maximum safety for surgery patients, risks are very low. However, there are always risks associated with surgery. Be sure to select a board certified plastic surgeon who uses a board certified anesthesiolgist. Discuss your concerns with your surgeon. Good luck.

Robert M. Tornambe, MD · Answer

Thriving9538 I completely understand your concerns and fears, however blood clot after this surgery is still fairly rare, especially if you do not have a history of previous blood clots. In any event, most board-certified plastic surgeons take all cautions to prevent this complication and all others. Special devices placed on the lower legs during surgery compresses them intermittently, moving the blood to prevent clots. It is also important to walk around right after suit surgery and days afterwards to keep blood flowing. Consult with a board-certified plastic surgeon who operates at a fully certified outpatient surgical facility to decrease chances of complications. Good luck.

Richard Nadal, MD, FACS · Answer

Hi and welcome to our forum!
 In the US, protocols have been developed and set into law to ensure maximum patient safety.
Preoperative evaluation is mandatory. Risk assessment is accomplished. Intraoperative patient monitoring includes BP, ECG, blood oxygenation, CO2 levels.  Emergency equipment is required by law, including various resuscitation drugs and a defibrillator. A plan is in effect for patient transfer to a local hospital if necessary.
Thromboembolism is a rare but real complication of any surgery. To prevent venous thromboembolism, sequential compression of the lower extremities  is performed during surgery, rapid ambulation is achieved after surgery, and the use of venous compression stockings are utilized in the early postoperative period. Mini-dose anticoagulation is recommended in higher risk patients.
Best wishes with your upcoming procedure. Safety is of primary importance.

Scott C. Sattler, MD, FACS · Answer

Blood clots forming in the deep veins within the calves and migrating to the heart and lungs is a real, but very rare risk with tummy tuck surgery. Over the years, I've placed my tummy tuck patients on a low dose blood thinner called Lovenox for a few days post-operatively. I also encourage walking and moving early in the post op period.

Daniel Barrett, MD · Answer

Dear Thriving9538,
One of the most important cause of blood clots in early post-operative period is lack of activity. That is the reason why most plastic surgeons recommend their patients early mobilization in order to reduce the risk of blood clots formation. Also, some use compression socks or medicines in high risk patients. If you are considering a surgery, I would suggest you to consult a board-certified plastic surgeon. Only after a thorough examination you will get more information and recommendations.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery