Managing risk of complications in patients over 50 during an abdominoplaty - how should I prepare?

Hi yetigrrl,
Patients with personal history of deep vein thrombosis can safely have plastic surgery, but only after a complete and thorough discussion with yourr surgeon about the risks and benefits. Sometimes, these conversations result in surgeon and patient deciding to move forward. Sometimes, these conversations result in surgeon or patient deciding that moving forward is not the best option. Being 100% transparent with your surgeon about your medical history is a helpful place to start.
Many surgeons will perform individualized risk stratification for blood clot risk, using something called the 2005 Caprini score. This score creates a personalized risk score, which can be used to help estimate your risk for clots. In addition, completion of the score can identify risk factors which potentially require additional workup or can be directly modified in the preoperative setting. This can potentially further decrease, but not eliminate, your risk for blood clots around the time of tummy tuck.
Once optimized, and assuming you are having surgery, in the operating room your surgeon will likely use sequential compression devices. These help to keep venous blood from pooling in the lower extremities during your surgery, and their use for surgeries under a general anesthetic is known to be associated with decreased risk for clots.
There is a linear relationship between time spent in the operating room and risk for blood clots. As such, you should carefully consider with your surgeon the risks of adding additional procedures to a tummy tuck.
Abdominal plication, or the right to left tightening the 6 pack muscles, hopes to accomplish the improvement in the core shape which many women her looking for. This tightening can also increase her risk for clots by increasing her intra-abdominal pressure and thereby making it more challenging for blood to get out of the lower extremities. The role of plication for you would be important to discuss with your surgeon.
After surgery, early ambulation (walking) will be very important. Avoiding dehydration is important as well.
In terms of postoperative care, I would discuss your baseline risk and personal history of deep vein thrombosis with your surgeon. She or he may elect to put you on a postoperative blood thinner, after a careful discussion with you about the benefits and risks. of note, your surgeon will have to generalize data from inpatient plastic surgery patients in order to discuss the potential risk reduction that she would receive from a blood thinner. Full discussion of the risks of the blood thinner, namely bleeding, would be important to discuss as well.
The attached link will send you to a recent review article written on this topic, specifically blood clot risk identification, modification, and reduction (but not elimination) in the aesthetic surgery population
Hope this helps.
Best,Christopher Pannucci, MDBoard Certified Plastic SurgeonPlastic Surgery NorthwestSpokane, Washington

Thank you for your question.Yes it is possible to have this procedure at your age. But first, for safety reasons, to be a good candidate for the procedures you want at the same time, your labs and cardiovascular preoperative evaluation must be optimal.

Kind Regards,
Dr. Emmanuel Mallol Cotes.-