C-Section Vs Tummy Tuck Risks?

Question

Are the risks from a c-section and a tummy tuck equal? I mean do you have the same level of risks with either procedure. I have had 3 c-sections and with each one fear blood clots so I make sure to wear my boots, get up, walk walk walk.. But with my tummy tuck my fear is greater is a tummy tuck a greater risk for clots compared to a section?

Adam Tattelbaum, MD · Answer

Thank you for your questions. 
	I'm commonly asked which hurts more a C section or a tummy tuck ?
	 In general I think the tummy tuck will hurt slightly more because in a full tummy tuck the muscles are tightened from the bottom of the rib cage all the way to the pubic area, whereas in a C section most of the surgical focus and suturing is just in the lower abdomen.
	C-section has its own inherent risks when dealing with and suturing a uterus.  I really can't comment on those additional risks because most of what I do, most of what plastic surgeons do lies outside the abdominal wall.
	Unfortunately, any surgical procedure has the risk of blood clots and pulmonary emboli.  Fortunately, these risks are relatively small. Many plastic surgeons provide prophylaxis to minimize the risks of the venous thrombosis.  You may wish to discuss how your plastic surgeon approaches these issues.
	One of the theories about why Venus blood clots occur during tummy tuck is that the intra abdominal pressure is increased when the abdominal wall muscles are tightened.  This increase in pressure slows down Venus return from the lower extremities.  When Venus flow is slowed down there can be a higher incidence of a blood clotting. 
	During pregnancy an enlarged uterus can also compromised Venus return from the lower extremities leading to stasis and even varicose veins. 
	Fortunately, while these things are true the risk of deep vwnous thrombosos in either surgery is relatively small.  Unfortunately, the risk is not zero so you must be comfortable in accepting these risks before you embark on surgery.
	Lastly, I feel that it is very important for anyone who undergoes the surgeries to have support  at home.  Walking clearly improves the situation and minimize the risk of lower extremity DVT.  I find that most of my patients do better when they have someone at home to help them in and out of bed and encourage them to ambulate.
	 
	Best wishes as you decide whether to embark on your surgery.

Ronald J. Edelson, MD · Answer

Venous thrombosis, or clots, is the complication we worry about the most with a tummy tuck. The risk overall is low, and all precautions should be taken to reduce the risk. These include the use of compression stocking during surgery as well as early ambulatory. I do not advocate the use of blood thinners in tummy tucks.

Richard H. Tholen, MD, FACS · Answer

C-section patients have just had their pelvic veins decompressed from uterine pressure during the pregnancy. The gravid uterus causes lower extremity venous dilation (this is why varicosities and hemorrhoids occur more frequently with pregnancy), and after the C-section, the venous blood flow can be more sluggish, activities may be temporarily reduced while recovering, and hydration may also be diminished, especially with breast-feeding. All leading to an identifiably slightly higher risk for blood clots.

	Tummy tucks do not involve a gravid uterus or pressure on pelvic vessels, but tightening the abdominal wall can cause increased intra-abdominal pressure that decreases venous return slightly, causing a identifiably slightly higher risk for blood clots.

	But to try to compare these would require statistical analysis, and the risk-reduction/prevention is a topic of vital concern to plastic surgeons and gynecologists alike, and much more pertinent!

	Hydration, compression stockings, early ambulation, and intra-operative sequential compression boots or leggings are all things most if not all plastic surgeons utilize to reduce risks as much as possible. Some surgeons will also add anticoagulant therapy (especially in higher-risk patients such as Factor V Leiden, or previous blood clot patients), but that is done on an individual basis taking into account and weighing the pros and cons of increased bleeding and re-operation risk! (2 operations doubles the "whatever" risk of blood clots, so this may actually not be a wise decision).

	Bottom line here: talk to your surgeon and listen to his/her advice. But nothing is gained by being irrationally fearful. Yes, blood clots rarely occur with tummy tuck. But so do traffic accidents on the way to your tummy tuck. Wear your seat belt and drive defensively. Wear your compression booties, TED hose, stay hydrated, ambulate early, and "pump" your feet while in bed or chair to keep your blood moving. You will then have done the best possible, and you should do just fine! Best wishes! Dr. Tholen

James F. Boynton, MD, FACS · Answer

It is hard to give you a "percentage" of which procedure is more risky for blood clots without knowing a bit more about you. Pregnancy in general has a risk of like a fourfold increase in thromboembolism (blood clots) from baseline or non pregnant patients, so C-Sections in general are probably a bit higher risk. It also depends on your genetics- if there are family members with history of blood clots, and your BMI (body mass index). All plastic surgery procedures I perform are done with maximum "blood clot" preventive measures, such as SCDs (sequential compression devices), limiting time under anesthesia, and even using lovenox (preventive "blood thinner" medication) when necessary. I would recommend you seek out a board certified plastic surgeon and you will find that any of us will absolutely NOT compromise on your patient safety.

Mark A. Schusterman, MD, FACS · Answer

The risks are higher in both than other operations. Sequential compression boots and early ambulation should be encourage no matter what operation you have. The big issue is whether post operative anticoagulation should be used. Your doctor can over the advantages and disadvantages with you on that issue.

Jourdan Gottlieb, MD · Answer

There are numerous risk factors for blood clots after surgery. These include surgery lasting greater than 60 minutes (therefore all TT's), patient age over 40, use of hormone replacement therapy, family or personal history of clots. 

	You can google "Caprini score" to get a worksheet and tabulate your score, which your surgeon can use to guide therapy. Anyone having a TT should have sequential compression devices during surgery, and have early ambulation encouraged. The score will help decide if you should recent an anticoagulent, Lovenox, which is given by self injection daily for a week to decrease the risk of clotting. 

	I am not sure that there is comparison data. Tummy tuck (and other skin reduction operations)  is the riskiest common plastic surgery procedure in terms of clotting risk.  C-sections are riskier than vaginal delivery, such that compression devices are urged for all c-section mothers during the birth and until they are walking. 

	Thanks for your important question. When you ready for an in person consultation, RealSelf has listings of surgeons in your area. You should consider cross referencing the listings from the The American Society of Plastic Surgeons (plasticsurgery dot org). A listing in the ASPS website assures you that your surgeon is not only board certified,  but also is a member in good standing of the major plastic surgery organization in the U. S.  If your surgeon is not familiar with the Caprini score, look for another opinion. 

	Thank you for your question, best wishes.

Stuart B. Kincaid, MD, FACS (in memoriam) · Answer

Tummy tuck is a big surgery, so keeping yourself mobile is extremely important. The risks are about the same.

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