I Have Lupus, My Rheumatologist Has Given Me a Green Light for a Mommy Makeover?

I was diagnosed with lupus three years ago. I've lost 50 pounds in six months. I work out 3 to 5 times a week. I'm on a low dose of prednisone...5mgs. Three weeks ago it was taken down to 2.5mgs. My rheumatologist said I would be okay for surgery. She says once I get a schedule surgery date she would stop the prednisone. She says the plaquenil I take 200 mg twice a day would not effect surgery.

Doctor Answers 11

Mommy Makeover

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Most of the medications used for treatment of RA have potential toxicities, though Plaquenil is widely believed not to add significant risk to surgery and to wound healing. The lower the prednisone dose, the better. I am not sure from the narrative whether or not you have seen a plastic surgeon yet. That will be the best resource in evaluating the benefits and risks of your proposed surgery. Many patients have undergone successful procedures while taking prednisone, but the risks are higher. 

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. Thank you for your question, best wishes.

Seattle Plastic Surgeon

Lupus is not an absolute contraindication to elective aesthetic surgery.

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Although risks increase with associated medical conditions many times they are often not a contraindication to surgery. Taking low-dose steroids will increase the risk for infection in wound healing issues. Still the risks are low and if the patient is willing to accept those risks elective aesthetic surgery can be performed.

SLE (Lupus) and Mommy Makeover

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      If you are off prednisone for several weeks prior to surgery, this surgery may be reasonable provided that your heart and kidneys function well. 

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Lupus and MM

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It’s not unreasonable to perform mommy makeover surgery on patients who have systemic lupus provided their medical condition has been optimized by their rheumatologist. This procedure can be performed safely in this group, but there is a slight increase in the potential for complications under these circumstances.

                Lupus is a collagen vascular disease that can potentially impact the circulation of skin flaps. For this reason, an increased incidence of both wound healing problems and infection may be seen in this group of patients. Furthermore, steroids and other drugs utilized to treat this condition are also associated with wound healing problems and infection.               

Although, there’s a slightly higher risk of complications in patients with systemic lupus. These patients still can derive significant benefit from mommy makeover surgery. In this situation it’s important to co-ordinate care with the patient’s rheumatologist. When these steps are taken the potential for complications is decreased and the majority of patients are extremely happy with their mommy makeover.

Surgery and Immunosuppressive Drugs

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The general consensus is that steroids and immunosuppressive drugs can increase your risk of complications.  The decision to proceed with surgery and what type of surgery can really only made by you and your surgeon.  Finding a qualified board certified plastic surgeon is in your best interest, particularly in this situation.
Not so sure that stopping steroids right before surgery is such a great idea.  Patients on steroids are given stress doses (of steroids) around the time of the procedure as their adrenal glands may not be functioning as well as necessary for surgical stress. If you have been on steroids for 3 years now, that may pertain to you.  Personally do not feel that this is an absolute contraindication to surgery, but you need to do your homework here.  Best of luck.

Ronald A. Lohner, MD
Philadelphia Plastic Surgeon
4.7 out of 5 stars 21 reviews

Higher risk on infection for patients with lupus

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Hello. You are at a much higher risk for surgical site infection and poor wound healing the average cosmetic patient. You should talk to a board certified plastic surgeon to schedule a consultation so the surgeon could assess your specific situation. I personally would not perform an elective surgery on a patient with lupus do to the high risk involved, especially for a big case like a mommy makeover.

Jaime Perez, MD
Mommy Makeover Specialist
Plastic Surgery Center of Tampa

Jaime Perez, MD
Tampa Plastic Surgeon
4.8 out of 5 stars 81 reviews

Lupus and surgery

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This is a very complex question.

It seems you are on very low dose of cortisone and you might be in remission.

Your plastic surgeon needs to talk with the rheumatologist and discuss your specific situation. As you probably know lupus can affect all organs of the body including blood vessels. Your liver function should be normal, your kidney function should be normal, your heart function should be normal.

Also surgery is a stress on the body and stress canexcacerbate lupus and you may need to go back on cortisone.

Do one procedure at a time.

Samir Shureih, MD
Baltimore Plastic Surgeon

Abdomnioplasty on steroids

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Is good to see that you have taken the proactive step of speaking to your rheumatologist prior to surgery.  I have performed abdominoplasty in patients who have been on steroids in the past.  Specific precautions must be taken in addition to perioperative additives to decrease complication rates of wound healing.  Best of luck.

Kevin Tehrani, MD, FACS
New York Plastic Surgeon
4.7 out of 5 stars 112 reviews

Your surgery can be done, but carefully

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You need to make sure to speak with a board certified plastic surgeon about your situation. He/she will need to take extra precautions because of you condition.

Yes but

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You still need to speak to a board certified plastic surgeon who agrees to do you. Your rheumatologist is not going to do the surgery or deal with the possible problems from having you on prednisone. Talk to your doctor and fully inform him as to your medical conditions.

William B. Rosenblatt, MD
New York Plastic Surgeon
4.2 out of 5 stars 12 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.