I am scared of dying as a result of a DVT after my tummy tuck. How common is that?

Question

hello,i am 28 years old and healthy. i had 2 c-sections and i am willing to have a tummy tuck.

Joubin Gabbay, MD · Answer

While it is certainly important to be aware of the possible complications associated with abdominoplasty, the risk of death from DVT is exceptionally small: Well under 1%. Additionally that risk is not the same among all patients. In a young, non-obese, healthy person with no other major medical issues, the risk of DVT and death from pulmonary embolism is even less then in the average rates reported for the operation. There are risk stratification scores that your plastic surgeon may use to help determine what treatment options will work best for you with your procedure. These options include the use of serial compression devices in the operating room and early mobilization postoperatively (which should be done in all cases regardless of your risk factors) to using more aggressive techniques such as certain blood thinners or the use of compression garments after surgery.It is critical that you seek the advice of an experienced surgeon who is certified by the American Board of plastic surgery when deciding to proceed with your operation. This will give you the safest results with the best outcomes.I wish you the best.Dr. Gabbay

Richard H. Tholen, MD, FACS · Answer

Published mortality rates associated with tummy tuck range from 0.02% 
to 0.16%. These include all causes of death for one month after surgery,
 with the most common one being pulmonary embolism (blood clot from legs
 to lungs). To put this in perspective, the death rate for elective 
C-section delivery is about 0.02%, with emergency C-sections having a 
slightly higher risk. Even a normal vaginal delivery has a death rate of
 0.0067%, by some estimates.

These statistics may be misleading, however, as recognition of these risks and attempting to minimize them can reduce the likelihood of any complication, including death.

For example, in the 24 years our accredited in-office surgical facility
 has offered general anesthesia capability, I and one or more partners 
have performed about 17000 general anesthesia procedures without a 
single death, heart attack, or stroke. We have experienced two 
(proven) blood clots which were not fatal or had any long-term 
consequence. We now provide active (compressor-driven pumper booties) anti-embolism stockings for EVERY 
patient, not just those with long operations or higher risk factors. I 
insist on early patient ambulation, which helps keep the blood moving in
 the patient's extremities, and  I see almost all of my surgical 
patients the day after surgery (yes, even on weekends), which forces 
them to get up, get ready, and come to the office for recheck. We take 
care to keep the patient well-hydrated during and after surgery, 
minimize blood loss with careful technique during surgery, and in 
general do as many of the things possible that most plastic surgeons do 
to keep their patients safe.

I personally believe that inpatient hospital care after tummy tuck is a
 "hidden" risk factor that I avoid with outpatient surgery. My (accredited) office surgical facility patients 
are not kept (immobile) in recovery for 2-3 or more hours after 
inhalation anesthesia like hospital patients, and are not put in a hospital bed with side rails
 and a button to push if they want a pain shot, a bedpan, or a drink of 
water. At home, my patient must do these things herself, and the 
movement and activity helps to prevent blood pooling and stasis that 
occurs when a patient is (un)safely and comfortably asleep (sedated) in 
the hospital with all of the sick patients and bad bacteria surrounding 
her!

So are there risks? Absolutely! Could you be "the one?" Yes. But is it 
likely? Honestly, in a good place with a good surgeon, staff, safety practices, and outpatient TIVA anesthesia, not 
really! A hospital may actually be part of the cause of DVT or PE as compared to an excellent outpatient facility. Best wishes! Dr. Tholen

Jeffrey A. Sweat, MD · Answer

I often find that mothers are worried about having a complication after an elective surgery such as a tummy tuck, so you are certainly not alone.  Thankfully, DVTs are very uncommon after a tummy tuck, and you should ask your surgeon what type of prevention he or she uses to avoid a DVT.  Keep in mind that the blood clot in your leg (DVT) has to travel to your lungs (PE--pulmonary embolism) in order to be fatal, and while DVT occurrence is uncommon, PE is even more uncommon.  It is important to use appropriate intraoperative prevention measures and for you to be up and around as soon as possible after surgery.  Best of luck!

M. Scott Haydon, MD · Answer

Thanks for your question. I can appreciate that as a mother you are concerned about complications. To reduce these risks we don't operate on obese people (BMI should be less than 30 and ideally closer to 25). We also don't do large volume liposuction at the same time. We try to get out patients ambulating soon. Provided you don't have a family history of blood clots and fit above criteria you should do well. The fact that you've had 2 C-sections w/o problems is also positive. Hopefully you can find a Board Certified Plastic Surgeon who is an ASAPS member and expert in cosmetic body contouring surgery to help you with your decision. Best of Luck!

Jonathan Amspacher, MD · Answer

Death after abdominoplasty is very uncommon if it is performed in an accredited facility by a ABPS board certified plastic Surgeon with licensed anesthesia personnel. If you want to reduce yor risk of DVT further you can talk to your surgeon about lovenox a blood thinner that can be used in certain cases. It is also very important that you get up and ambulate (walk) soon and every few hours during the day. Also you should be in general good health with regular physical exams.

Robert D. Wilcox, MD · Answer

Dear farahmak,

A deep venous thrombosis and the more
fearsome pulmonary embolism is a risk, although a very small one following tummy
tuck. You should raise this issue with your consulting surgeon. Though the risk
is very small, if you are particularly concerned about this, you should go
through a checklist of things that will absolutely minimize the risk. Things in
your history that would suggest a higher incidence include age over 40, history
of DVT in the past, use of birth control pills. If you are on birth control
pills you should consider stopping them a month before surgery and using a
different form of birth control.

On the surgeon’s facility side, you should
ask whether some type of prophylaxis is being employed. In our center every
patient who undergoes general anesthesia regardless of type of surgery gets
sequential compressive hose placed on their calves. These squeeze the calves
every 10-15 seconds to avoid blood stagnating and leading to a clot. Others
prefer to use injectable blood thinners, although that would increase the risk
of postoperative bleeding. Both means of prophylaxis are equally effective.

I hope this has been helpful to you.

Robert D. Wilcox, MD

Nicholas A. Flugstad, MD · Answer

That is a very good question. It is so important to be informed and really consider the possible complications. Thankfully, DVT (clot in your leg) and PE (clot that has traveled to your lungs) after tummy tuck are quite rare. Your surgeon should carefully consider your risk factors and family history. Preventative measures including some blood thinning medications are sometimes necessary. Best wishes to you.

Robert T. Buchanan, MD (retired) · Answer

DVT (Deep Vein Thrombosis, clotting of the veins in the legs) and subsequent PE (Pulmonary Embolism, migration of one of the clots to the lung which is what can kill you) is quite rare. The risk is <1%, but, to put it in terms related to your everyday life, the risk is less than the risk of dying from driving 25 miles. Most people do not worry about dying when traveling this distance. Also, essentially all abdominoplasties done by board certified plastic surgeons, since they are done in accredited OR's, are done with pneumatic alternating pressure leggings to help reduce the risk of DVT. They also evaluate you for increased risks to determine if you need any other preventative measures. These measures help reduce the risks even further.

I am scared of dying as a result of a DVT after my tummy tuck. How common is that?

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