Is it safe to have apron surgery if I have type 2 insulin dependent and congestive heart failure?

Thank you for your question.There is no doubt that your risks are higher (infection, skin necrosis, heart problems, lung problems, etc.) and that extra precautions will be required prior to embarking in an elective surgery.We also know that removing your apron will help you in the long run in getting back to exercising and a better health.  The panniculectomy may also positively affect your sugars, your heart and your blood pressure.  Bringing your BMI under 30 would be beneficial but not always easy to achieve.You should not be a smoker.You endocrinologist will need to be involved to control your sugar levels preoperatively and also to guide the dosage around the surgery.More importantly, your congestive heart failure needs to be quantified and optimized by the cardiologist.  Do we know what the congestive heart failure is due to?  Any previous heart condition? valve issue? etc.The panniculectomy is a shorter procedure than a tummy-tuck (abdominoplasty) and likely safer in your situation; the idea is to remove the excess of skin only and close.  In Canada, the panniculectomy does not include muscle tightening, liposuction nor umbilicoplasty.Your procedure in Canada would be done in a hospital setting.  Make sure you seek a board-certified plastic surgeon.Let us know if this information was useful and good luck.



Best regards,



Dr. Marc DuPéré, Toronto aesthetic plastic surgeon and body
surgeon

Thank you for your question regarding if it's safe to have apron surgery if you have type 2 insulin dependent and congestive heart failure. This is an excellent question. It is essential that you, your internist, or GP and plastic surgeon need to coordinate a game plan. If your internist believes you are healthy enough for surgery. Then I would suggest surgery. The surgery could help your diabetes and perhaps your contested heart failure. While eliminating the excess skin of your abdomen, you should be able to exercise better and perhaps control your diabetes and congested heart failure better. Therefore, I would consult a plastic surgeon to see if they will perform your surgery. Then I would meet with your internist if you are healthy enough for the procedure. Since you have lost a hundred pounds, you are probably healthier now than you were. There are risks and complications with any surgery. However, weighing the risks and complications versus the benefits would be best. The risks and complications can be poor wound healing, wound opening, and scars. These are the most likely complications. The benefits could be the elimination of excess skin and fat and the ability to exercise better. Also, eliminating more fat can improve your diabetes and heart failure. Therefore, I suggest you consult your plastic surgeon about apron surgery or a panniculectomy.

The short answer to your question is, "Yes", you can get a panniculectomy.The answer I would give a dear friend or family member is, "let's think about this very carefully...".Diabetes is the kind of problem that will bite you from behind if you aren't very careful, and frankly sometimes even if you are.  I would recommend losing more weight or doing whatever it takes to get your A1C level within normal for a few months before rushing to the operating room. At 270 lbs, an infection in your wound could be very dangerous.  Make sure you work with a board certified plastic surgeon AND Endocrinologist from the same hospital before you take this one on.Good Luck!

Hi, pdxqzt.  Thanks for your question.  Given you medical co-morbities, it would not be safe to undergo elective cosmetic surgery.  Your congestive heart failure needs to be corrected; diabetes should be under control. Please be evaluated by your cardiologist and endocrinologist.  Once your cardiologist clears you for surgery, consult a board-certified plastic surgeon to find out if you would benefit from panniculectomy.Best wishes.

You are a candidate for a panniculectomy to remove the excess skin from your abdomen.  Since this is an elective procedure (not an emergency) you will want to take some additional steps to make the surgery as safe as possible.  You need to make sure that your diabetes is well controlled and this can be measured by keeping your hemoglobin A1C level lower than 7.  If it is greater than 7, then you are at a higher risk of having an infection.  Optimally, you would like to get your weight to about 220 pounds (Body Mass Index of 30) prior to surgery to lower your risk of wound healing issues and deep venous thrombosis (blood clots in your legs).  You might not be able to make it down to 220 pounds, but you should try and this is something that your surgeon will discuss with you.  Since you have congestive heart failure, you need to see a cardiologist to determine how significant of CHF you have (grade I is not so bad, grade IV is bad) and look at your ejection fraction to make sure that you are "optimized or tuned up" for surgery. Also if you lose weight, it puts less strain on the heart and can help your CHF.  Please look for a board certified plastic surgeon that focuses on post-bariatric body contouring as they will have experience taking care of patients that have significant medical co-morbidities. Good luck on your surgery.

Congratulations on your weight loss.   First you will need to get medicine or endocrine clearance for your insulin dependent diabetes.  It is important to get your Hemaglobin A1c (a measurement of how well your sugars have been controlled) as low as possible.   In addition you will need formal cardiology clearance for your heart issues.   Your diabetes may increase your risk for delayed healing, healing problems and infection.   You should be prepared for this in the postoperative setting after a panniculectomy. As per your cardiac issues, the question is how bad is your congestive heart failure?  What is your current cardiac function?  And is it safe to opt for any elective surgery?  Your cardiologist can best answer these questions.  Then, I would visit with a board certified PS to review your options.  Best wishes,Dr. BasuHouston, TX

Congratulations on your weight loss. This I'm sure was a tough road, but the end result will be worth it. I would recommend you lose more weight and then your risk should go down for elective plastic surgery. Once you're within your goal weight you would need to see your Endocrinologist and Cardiologist for clearance. Diabetes will cause delayed healing which will increase your risk of infection. Once the extra skin is removed, this will help with some of the weight loss. Then when you continue to lose weight, you will have loose, saggy skin in that area again, and will need a revision surgery. I would suggest delaying this surgery for you to get the best possible results. Good luck with the continued weight loss.

Hello and thank you for your question. Congratulations on your weight loss. Yes it is possible. Typically I get clearance from your pcp or GP before proceeding. Sometimes a panniculectomy is covered by insurance, sometimes not.Peter Fisher M.D