Tummy tuck - previous PE. Am I too high risk?

Question

I’m a 30 year old woman, I’m 5ft 10 and weigh 161 lbs, I have had two previous c sections and the first resulted in a PE, I have no clotting disorders or family history, I am also diabetic but is diet controlled, I understand all operations have risks and there is no certain answer but am I too high risk or would I be eligible for a tummy tuck and thigh lift ?

Randal Haworth, MD, FACS · Answer

Having a history of previous c-sections and a pulmonary embolism (PE) can potentially increase the risks associated with any surgical procedure. However, the eligibility for a tummy tuck and thigh lift would depend on various factors, including your overall health, the severity of your diabetes, and any other underlying medical conditions.

Given your history of a PE, it's crucial to inform your plastic surgeon about this prior to considering any elective surgery. They will assess your medical records, conduct a thorough evaluation, and likely consult with other healthcare professionals involved in your care to determine the level of risk involved.

In general, surgeries like tummy tucks and thigh lifts are major procedures that require careful consideration. The surgeon will need to evaluate your overall health, including your diabetic control, and take precautions to minimize potential complications. It's important to discuss your concerns and expectations with the surgeon and carefully weigh the potential risks and benefits.

I hope this helps,
best of luck !

J. Timothy Katzen, MD, FACS · Answer

Thank you for your question regarding the possibility of undergoing a Tummy Tuck and Thigh Lift with a history of having a PE. It is essential to approach this matter with utmost caution and care. To determine the feasibility of the procedures, I recommend a thorough consultation with both your plastic surgeon and a Hematologist who specializes in blood clotting disorders.
As you have a history of PE, there is a significant risk involved in undergoing these surgeries. However, after careful evaluation, you may still consider proceeding with the Tummy Tuck and Thigh Lift if you are considered a suitable candidate. Nevertheless, it is essential to recognize that a history of PE increases the chances of developing another one.
To minimize the risk of post-surgery complications, I strongly advise the use of sequential compression devices for at least 2 to 3 weeks after the surgery. Additionally, you should consider lovenox injections for at least two weeks after your tummy tuck to further reduce the risk of blood clots.
It is crucial not to combine the Tummy Tuck and Thigh Lift procedures simultaneously. Instead, I recommend staging them, performing the Tummy Tuck first, and then considering the Thigh Lift at a later time. Ultimately, the decision to undergo the surgery is personal, and you will need to weigh the potential benefits against the associated risks.
I hope this information helps address your concerns and clarifies whether you can undergo a Tummy Tuck and Thigh Lift given your history of PE.
Sincerely,
Dr. Katzen

Daniel Barrett, MD · Answer

Dear Magical920644,
it is hard to tell for sure without an examination. You will need to get 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

Cem Berkay Sinaci, MD · Answer

Hello, pregnancy itself is one of the risk factors for PE. There are some prophylaxis before and after the surgery for PE. In my practise my patients who has history or risk of clotting disorders start using medication 1 week before the surgery. Medication goes on the first week of the surgery on all the patients, sometimes 1 month. In these kind of cases early and continuous mobilization is very important. You may have the tummy tuck surgery under these conditions but I dont recommend that combination even on healthy population. A patient with a PE history is too risky for that. Regards.

Michael Kreidstein, MD, FRCS(C) · Answer

All operations incur risk;  the question for you and your surgeon is whether the rewards justify the risk.  A history of pulmonary embolism highlights your risk of this problem with surgery, and any surgical plan should consider steps to decrease this risk.  
A hematology consult to determine if you have a blood disorder that predisposes to venous thrombosis should be considered.
Limiting your surgery to either a tummy tuck or a thigh lift may decrease your risk.
A venous ultrasound should be performed prior to surgery to confirm you aren't already harboring a thrombosis.
Measures during and after surgery, including extended (one month) blood thinners, hydration, mobilization, compression stockings, and repeat ultrasound of your legs should all be considered.
Finally, a reflection on other potential risks is important.  It is common to become so distracted by obvious risks that the little things can be missed.

Connie Hiers, MD, FACS · Answer

Your medical doctor would be the one to help determine if you could be cleared for surgery. Once cleared, you should do the two procedures separately to decrease general anesthesia time and lower the risk of clots.

Camille Cash, MD · Answer

Your health history does put you in a higher risk category.  More information is needed to determine if it is "too high".  Meet with your hematologist to discuss your interest in plastic surgery.  You will also need medical clearance from your primary care physician or whomever manages your diabetes.  If clearance is given on both accounts there are still other preventative measures that will be taken to minimize risk as much as possible.

David Janssen, MD, FACS · Answer

Your risk is higher after a prior PE.
Have you had a hematology workup for clotting disorders
Are you having your muscle tightened or just skin. When the muscle is tightened below the umbilicus, it changes the flow out of the legs as shown by Dr Leroy Young. 
Would you use pre op lovenox
These are all considerations you might consider prior to a surgery.

Mats Hagstrom, MD (license on probation) · Answer

Plastic surgeons will have different opinions. Some may ask to get clearance from a hematologist. You should also remember that ultimately you were the one taking the risk not so much the doctor.
It’s not the doctor. Who’s going to end up with a blood clot if it happens, it is you.
Hematologist may be able to give you some statistics on what the incidence of having a second blood clot or possible pulmonary embolism would be from an elective surgical procedure. Generally speaking the longer and more extensive the surgery is more likely the chance of having medical complications.
I suggest having multiple in person, consultations with local board-certified plastic surgeons in your community. You can at that time. Get an assessment in regards for your appropriateness for the procedures and also get a first-hand response regarding each plastic surgeons review on scheduling surgery on someone medical history.
Best,
Mats Hagstrom, MD

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