Fat Transfer Breast Augmentation with bleeding disorder

Any disorder of the normal blood clotting mechanism can cause an increased risk of excessive bleeding, which may be an acceptable risk for necessary surgery, but less acceptable for elective cosmetic surgery. And, of course, if bleeding DOES occur, you would expect your surgeon to step up and deal with the problem, which may involve additional surgery to drain a hematoma,  cauterize bleeders, or deal with loss of adequate circulation leading to dead tissue and/or skin. Your dead skin, both your surgeon's and your headache!That being said, type I von Willebrand disease is both common and variable in its bleeding risk. von Willebrand patients may also have Factor VIII deficiency ("classic" hemophilia). so hematology work-up is essential, particularly before considering larger procedures such as brachioplasty or tummy tuck, where skin flaps are raised and adequate circulation is a concern (along with bleeding or excessive bruising that can lead to ischemia and dead skin).With appropriate Hematology work-up and successful clearance for other medical concerns/health risks, there are many plastic surgeons who will be happy to discuss your requests and assess your risks. Then you both can decide together.One final concern is about fat grafting for breast augmentation. In general I do not recommend this, despite some of my colleagues who think it is "just fine." I think all of us would agree that "some" of the injected fat dies (though the percentages vary widely depending on which side of the issue you fall on), and this can range from 20-60%, depending on whom you read or talk to. BTW, this leaves only 30-80% of the fat that survives, and visible breast enlargement without creating blobs of dead fat, scar fibrosis, and microcalcifications that can interfere with the detection of breast cancer via mammogram is IMHO a "dicey" proposition. I would not want to risk my patients' lives that these are "no problem, mon." Read more about breast enlargement via fat grafting in my Comprehensive Guide to Breast Augmentation by clicking on the web reference link below, and carefully consider that you do NOT need one more unnecessary risk. Best wishes! Dr. Tholen

The best person to discuss this with is your hematologist.  Measures can be taken to reduce the risk for both minor and major surgery such as administration of DDAVP or Von Willebrand Factor.  The procedure should be done in a facility that can monitor you.  The medications will reduce your risk bleeding but not eliminate it.  You and your hematologist and surgeon can make the final decision after understanding the risks of additional bleeding and effects of the medications. 

As long as you have a hematologist involved, your procedures can be done in a proper facility. A medication called DDAVP is commonly used to minimize bleeding. Tumescent fluid infiltration with dilute epinephrine can also decrease bleeding. See link below for examples. 

Von Willebrand's disease is not an uncommon disorder and is well known to most plastic surgeons. The amount of bleeding is variable.An evaluation by a hematologist is typically indicated prior to elective surgery.Liposuction and fat transfer are typically procedures with little blood loss when done correctly and with appropriate use of tumescent solution. You should not need to travel to see a specialist to take care of you. My practice is devoted almost entirely to body contouring using liposuction and fat transfer.I have had several patients recently with Von Willebrand's disease. All of them did fine and each one had a thorough evaluation prior to their procedure. I suggest consulting in person with an experienced, board-certified plastic surgeon in your community. He or she can help determine if you are a candidate for this procedure and can start any needed medical workup regarding your bleeding disorder.Best of luck,Mats Hagstrom, M.D.