Factor V Leiden Gene: Is a Tummy Tuck Still Possible?

Factor V Leiden is a genetically-inherited clotting disorder seen in about 5-6% of US and European Caucasians who are heterozygous (one copy of the abnormal gene), or 1 in 5000 (0.02%) of persons who are homozygous (two copies of the abnormal gene, one from each parent). People with one copy of this abnormal gene can form blood clots 4-8 times more commonly than the normal population, and people with two copies of this gene are 80 times more likely to form a clot than the general population.
Since the overall risk of developing clots is about 1 in 1000 per year, heterozygous Factor V Leiden patients have increased risk ranging from 1 in 250 to 1 in 125. Homozygous FVL patients' risk increases to 1 in 12.
By way of comparison, healthy, normal women taking oral contraceptives have a 3-4X increased risk of developing a blood clot compared to women not taking oral contraceptives. Women with FVL on oral contraceptives see their risks increase by 35X.
Thus, as long as you are under the care of a hematologist or internal medicine specialist who can consult with your plastic surgeon about minimizing your 4-8X risk of clotting (which is nearly identical to women taking oral contraceptives), elective cosmetic surgery is not only possible, but just about as safe as operating on women who take oral contraceptives, which we do all the time (with "standard" precautions)!
I have operated on thousands of women taking oral contraceptives without DVT or PE (1 case in 24 years that I am aware of), and several patients with known Factor V Leiden, also without complication. Just like operating on diabetic patients, who do have elevated risk of infection compared to non-diabetic patients, you would have somewhat higher risks (0.4 to 0.8%) of developing blood clots. That is a low and perhaps unacceptable risk for some patients or surgeons with regards to elective surgery. For others, properly managed, it is one of many minimal but accepted risks we elect to take in order to accomplish something positive (tummy tuck).
Talk with your surgeon and regular physician (or hematologist) and get the details, pros, cons, and risks. Then you can truly make an informed decision! Good luck and best wishes!  Dr. Tholen

I did not perform surgery  on a patient with Factor V leiden.I elected to refer the patient to the hematologist  for assistance and the patient decided not to proceed with the surgery after the consultation.

So, as a good measure go first to your hematologist and let him/her guide you on the course of therapy prior to the surgery.

Dear Isabelle,

I have operated on a number of patients with factor V Leiden. I usually ask for the opinion from a haematologist because, as you say, you need to be careful with the anticoagulation. But I have performed often quite major surgery with no adverse outcomes, so I am sure that you will be fine. Good luck.

You would need to have your hematologist work with your plastic surgeon.  I sometimes put my patients at higher than usual risk for blood clots on Lovenox.  This requires that the patient learn to give themselves injections and it involves extra careful attention to controlling any oozing during surgery, but I have not yet had any intraoperative or postoperative bleeding issues.  If I had you as a patient and you were anatomically a good candidate for the surgery and your hematologist gave the go ahead, I would likely do your abdominoplasty with Lovenox but might pass on the liposuction because of the lack of exposure to control oozing blood vessels.   

A tummy tuck and other cosmetic procedures can be done usually with minimal increased risk. I usually get medical clearance from my patients hematologist and let him quide me as to what extra precautions need to be done. Watch my video.