Low heart rate. Is it safe for me to get a mommy makeover?

If you have a low heart rate (bradycardia), it’s important to consult with your primary care physician or a cardiologist before undergoing a mommy makeover. Bradycardia can sometimes indicate underlying health issues, like electrolyte imbalances, heart conduction problems, or metabolic concerns, that could impact surgical safety and anesthesia tolerance.

Once you have medical clearance, communicate openly with your plastic surgeon about any heart-related concerns, as this will allow them to take extra precautions during surgery and anesthesia planning.

Sincerely,
Dr. Emmanuel Mallol

Thank you for your question. It sounds like your low heart rate episode was likely due to vagal stimulation, which can occur during liposuction, anesthesia, or under the stress of surgery. Since your cardiologist cleared you, that’s a positive sign. However, if your vitals were stable after the episode and your cardiologist gave moderate clearance, your surgeon might proceed at their accredited surgical center, provided they have the proper monitoring equipment. But, if your heart rate remains unpredictably low or you have recurrent vagal episodes, a hospital setting may be safer, where they can manage complications with immediate intervention. Since your cardiologist found no underlying heart issue, it’s possible that your vagal response was a one-time event. But your anesthesia team must be aware of this history. Discuss with your anesthesiologist beforehand. Some anesthetic techniques, such as avoiding excessive sedation and using vagolytic drugs, if necessary, can help prevent another episode. Additionally, consider opting for local anesthesia combined with intravenous sedation instead of general anesthesia, if it is appropriate for your procedures.

Your response of a low heart rate during your first procedure does sound like a vagal phenomenon. With a clear cardiac exam showing no abnormalities of the heart, you should be fine to proceed with the procedure. I would however, do it in a hospital setting where there is more supportive staff should something occur again. Hope this helps.

Your entire entire previous operative record should be reviewed to see if there is any reason, medication‘s or otherwise, that could have contributed to your decreasing heart rate. Then you should have a complete cardiac workout by your cardiologist. If all of this is normal, you should be able to proceed with the rest of the procedure, however, considering that one episode, it might make most sense for you to have it done in a hospital with it’s support staff.

It’s great that your cardiologist cleared you and confirmed that your heart is healthy, though I understand the concern about your heart rate dropping during the procedure. The mention of the vagal nerve likely refers to a vasovagal response, which is a common but sometimes alarming reaction where the vagus nerve is stimulated, causing a sudden drop in heart rate and sometimes blood pressure. This response can be triggered by various things, including stress, pain, or the body's reaction to anesthesia or surgical manipulation.

Vasovagal Response:
A vasovagal response is generally benign, especially if your cardiologist found no underlying heart issues. It’s essentially a reflex that can slow your heart rate temporarily. In the operating room, if this happens, it’s normal for the surgeon to stop the procedure out of caution, as your surgeon did. However, once the cause is identified and your heart is cleared as healthy, the event itself is not necessarily a long-term concern.

Surgical Setting: Surgical Center vs. Hospital
Whether you should proceed with the rest of your surgery at your doctor's surgical center or move to a hospital depends on several factors:

When a Surgical Center Might Be Safe:
Proper Equipment: If your doctor’s surgical center is accredited and well-equipped for emergencies (such as sudden changes in heart rate or blood pressure), it could still be a safe option. Many surgical centers have protocols in place to handle vasovagal responses or other minor complications, and they would monitor your vital signs closely during the procedure.

Monitoring and Anesthesia: An experienced anesthesiologist is key. Given your history of a vasovagal response, the anesthesiologist would be prepared to monitor your heart rate closely and intervene immediately if needed.

Cardiologist's Confidence: Since your cardiologist gave you a "moderate" clearance and found no issues with your heart, this suggests that, in the cardiologist’s opinion, it’s not a heart-related risk that would require a hospital setting for safety.

When a Hospital Might Be Better:
Higher Monitoring Needs: If you or your surgeon feel more comfortable with a higher level of monitoring or want to take extra precautions, a hospital setting could be preferable. Hospitals have more advanced equipment, critical care teams, and cardiology support available on-site in case of any emergencies.

Peace of Mind: If you’re feeling anxious about your next procedure after the previous experience, opting for a hospital could provide peace of mind knowing that every possible resource is available in case something unexpected happens again.

Surgeon’s Recommendation: Ultimately, it’s important to have an open conversation with your surgeon about the incident. They will have the best perspective on whether continuing the procedure at the surgical center is safe or if a hospital setting would be more appropriate given your previous response.

Key Considerations:
Preparation: Discuss with your surgeon and anesthesiologist how they plan to monitor your heart rate during the next procedure and how they would respond if the vasovagal response occurs again. Clear communication about the specific protocols they will use can help you feel more confident moving forward.

Additional Monitoring: You might request that the anesthesiologist be extra vigilant in monitoring your heart rate and blood pressure, especially during the parts of the procedure that might trigger a vagal response (like liposuction or other manipulations of the body).

Conclusion:
If your surgical center is well-equipped and your surgeon is confident in handling any potential vasovagal reactions, it could still be a safe place for your next procedure. However, if you or your surgeon have any doubts, or if you want the additional safety net of having hospital-level care on standby, you may consider opting for a hospital setting.

Something very important for you would have to be your safety, and it is not that you do not have it in a surgical center, however the safety you have when you are in a hospital is superior and more with the background you had. Even though the cardiologist has already told you that you are healthy, the hospital is always very important to prevent any complication.

A low heart rate, known as bradycardia, can be a concern when considering any surgical procedure, including a mommy makeover. It's essential to discuss your specific health condition with your healthcare provider or a cardiologist before proceeding. They can assess your overall health, evaluate the cause of the low heart rate, and determine whether it's safe for you to undergo surgery.
Here are a few key points to consider:
1. Medical Evaluation: Ensure you have a thorough medical evaluation to understand the implications of your low heart rate on surgery.
2. Anesthesia Risks: Anesthesia can affect heart rate and function, so your anesthesiologist will need to be informed of your condition.
3. Surgical Risks: Your surgeon will consider your heart rate and overall health when planning the procedure, as certain conditions may increase surgical risks.
4. Postoperative Care: Make sure to discuss postoperative care, as a low heart rate may affect recovery.
Always prioritize open communication with your medical team to ensure a safe and successful surgical experience.

That may have been a one-time event, but I suggest having your procedure scheduled at the hospital just in case you need support or an overnight stay.

This is a conversation that you will need to have with your surgeon. Safety is always the number one priority in surgery. Be sure that your surgeon is board certified and if you have your procedure in a surgery center that the center is accredited. You can discuss with your surgeon about an emergency plan if it arises. If the procedure is performed at the hospital be aware that the costs may increase some.

Cardiac issues are best answered by a cardiologist.
Plastic surgeons focus on plastic surgery.
Ultimately, each plastic surgeon will have to make their own decision based on all available information.
Knowing how long your heart rate was low for and evaluating everything that happened during surgery would be fairly important.
Did you have an anesthesiologist during your first procedure?
Having an anesthesiologist input is probably far more important than that of a plastic surgeon.
Surgery is never 100% safe.
There is no yes or no answer to your question.
Best,
Mats Hagstrom MD