How can I safely have a breast augmentation if I have had a pulmonary embolism?

Question

Hello, I had a provoked PE in 2015 due to pregnancy, and they did testing for a general clotting disorder, and I do not have any clotting disorder. I then had another pregnancy in 2022 and was put on Lovenox for the whole pregnancy, and everything went well. I would like to get a breast augmentation, but I am a little scared. What do you guys recommend?

Jacob Carlson, MD · Answer

Seeing as how you developed the blood clot during pregnancy and were found not to have a genetic clotting disorder, the blood clot probably developed as a result of the hormonal changes your body was going through during pregnancy. As you said, thankfully being on lovenox during your subsequent pregnancy helped prevent a recurrence of this issue.
Since you are now a few years out from your most recent pregnancy, your body has had the chance to return to its 'baseline' and is not being impacted by as many hormonal fluctuations as occur during pregnancy. To be extra cautious, you could find a plastic surgeon who operates in the hospital setting so that they could manage a DVT/PE if this same issue were to happen again. I think that the likelihood of you having a recurrence of this issue for a ~1 hour surgery while not being pregnant is already very low, but to be extra cautious, having it performed at a facility that can manage that complication would be the safest way to go.

Gianfranco Frojo, MD · Answer

If you have seen a board-certified hematologist/oncologist for a full work up regarding your pulmonary embolism and management, I do not believe it is inapproproaite to proceed with a breast augmentation. Your surgeon should review all the documentation from the heme/onc and also communicate with that physician directly to confirm the safety/plan.

Mehmet Ozdemir, MD · Answer

It is completely understandable to feel nervous given your history, but the fact that your 2015 pulmonary embolism (PE) was "provoked" by pregnancy and that you tested negative for a genetic clotting disorder is highly reassuring. Because you don't have an inherited thrombophilia, you are still a candidate for breast augmentation, though your history does require proactive safety measures. To protect your health, your plastic surgeon will coordinate with a hematologist to create a tailored risk-mitigation plan, which typically includes using leg compression sleeves during surgery, ensuring you walk soon after waking up, and potentially using a short, preventative course of Lovenox once surgical bleeding risks have stabilized. Sharing this detailed history with your medical team will allow them to safely support your goals while keeping your health the absolute priority.

Waylon Zeng, MD · Answer

Hi there, thank you for your question. Pregnancy can actually increase your risk of blood clots (hypercoagulable state). This question would actually be better answered by your primary care doctor, who would do a proper assessment and risk stratification to clear you for surgery. No surgery is without risk, and risk for thromboembolism is always a risk for any kind of surgery with general anesthesia. We often times will use a scoring chart (Caprini score) to determine the risk for clots and whether anticoagulation would be needed around the time of surgery. Ultimately, it is a discussion to be had with you, the surgeon, and your primary doctor. Hope that helps!

Camille Cash, MD · Answer

I encourage you to begin by visiting with your hematologist to discuss your interest in breast augmentation.  If given clearance you can then meet with a board certified plastic surgeon near you for a consultation.  Some preventative measures may be taken pre or post op (or both) to help minimize the risk of blood clots.

How can I safely have a breast augmentation if I have had a pulmonary embolism?

Answers (5)

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