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?

Brian K. Reedy, MD · Answer

Thanks for your question! Do you take any anticoagulants now? I would definitely consult your hematologist and plastic surgeon to make sure everyone is on the same page. It is not my preference to do Lovenox, but every doc is different. Best of luck!

James N. Romanelli, MD, FACS · Answer

Dear Leahliany

In my practice I would recommend a hematology consultation prior to the breast augmentation.  That the PE was provoked is reassuring, but I would want a recommendation from a hematologist.

Best of Luck
Dr. Jim Romanelli
631*424-3600

Emre Guvercin, MD, FEBOPRAS · Answer

Yes, many patients with a history of a provoked pulmonary embolism (PE) successfully undergo breast augmentation, but careful preoperative planning is essential. The fact that your PE was pregnancy-related, your thrombophilia workup was negative, and you subsequently completed another pregnancy with prophylactic Lovenox without complications are all reassuring factors. Nevertheless, any elective surgery requires individualized risk assessment, ideally with input from your hematologist and surgeon.From a thrombosis-risk perspective, the safest approach is generally to minimize operative time, reduce immobility, and avoid unnecessary surgical trauma. For this reason, a preservation-based augmentation such as Preserve can be particularly attractive, as it can often be performed under local anesthesia with sedation rather than prolonged general anesthesia, allows early ambulation, and typically involves a faster recovery. Early mobilization, mechanical DVT prophylaxis, adequate hydration, and a personalized anticoagulation plan (if indicated by your hematologist) are all important components of risk reduction.The most important step is obtaining a formal preoperative assessment to determine your current VTE risk profile. With appropriate planning and preventive measures, a history of a pregnancy-related PE does not automatically prevent you from having breast augmentation.

Ted Eisenberg, DO, FACOS, FAACS · Answer

It is possible to have a safe breast augmentation with your history. Medical clearance by your doctor would be recommended prior to your surgery. That has been my experience. Dr. Ted Eisenberg, Board Certified Plastic Surgeon and Author. RealSelf Distinguished Hall of Fame Inductee. Philadelphia, Pa., USA

Frank Agullo, MD · Answer

You have plenty of reason to be frightened, but in practice this is favorable. An acute pulmonary embolism provoked by an easily identifiable event (pregnancy) along with an unremarkable inherited thrombophilia screening is a different beast compared to spontaneous clots in the face of Factor V Leiden or antiphospholipid syndrome. Your 2022 pregnancy on Lovenox prophylaxis without a recurrent event is a promising signal. Here is what I tell my patients in this predicament: do not put surgery on the calendar until after meeting with hematology. Perioperative prophylaxis runs with low molecular weight heparin (Lovenox), typically beginning 12 hours after surgery for 7 to 14 days. Compression boots stay on through the operative case.

The procedure could be done under IV sedation, which decreases risks significantly.

I get patients up and walking the evening of their operation. I also aim to get surgeries done in under two hours. Patients should abstain from oral or transdermal estrogen birth control for the months around the operation. The risk is not zero, but with a provoked PE and a negative screening, well-executed VTE prophylaxis brings the risk back into the same range as a healthy primary augmentation. Consult with a board certified plastic surgeon who will coordinate directly with your hematologist before scheduling anything.

#StayBeautiful,

@RealDrWorldWide

Kadir Berat Oyur, MD · Answer

I completely understand your anxiety given your medical history, but please let me reassure you that having a history of a provoked pulmonary embolism (PE) from a past pregnancy does not mean you cannot safely have a breast augmentation. Because your previous clot was "provoked" by the specific hormonal and physical changes of pregnancy&mdash;and subsequent testing confirmed you do not have an underlying, chronic blood clotting disorder&mdash;your baseline risk is significantly lower than someone with an unprovoked condition. To ensure your absolute safety, we manage patients with your history by implementing a strict, proactive VTE (venous thromboembolism) prophylaxis protocol, which typically includes using sequential compression devices during surgery, starting blood-thinning medications like Lovenox shortly after the procedure, and getting you up and walking immediately after waking up. I highly recommend scheduling a joint consultation with your plastic surgeon and a hematologist or your primary care physician to thoroughly review your past medical records, clear you for anesthesia, and map out a customized perioperative safety plan that gives you complete peace of mind.

Daniel Barrett, MD · Answer

Dear leahliany,

it is hard to tell for sure without an examination. If you are considering surgery, I would suggest you consult a board-certified plastic surgeon. Only after a thorough examination, you will get more information and recommendations.

Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Donovan Rosas, MD · Answer

Prior pulmonary embolus does not necessarily rule out the possibility of safe augmentation.

Based on your narrative, prior clotting incident was likely related to your hormonal/hypercoagulable state. This is echoed by a negative workup.

Coordination of surgeon, anesthesiologist, PCP and hematologist can ensure a safe and uncomplicated peri-op period.

As always, discuss your concerns with a board certified plastic surgeon (ABPS).

Semih Yildiz, MD, FEPOBRAS · Answer

A past provoked pulmonary embolism does not automatically mean breast augmentation is impossible, especially with a negative clotting-disorder workup, but it does make this an elective surgery that needs formal risk planning before a date is chosen. Your surgeon should review the PE records, pregnancy anticoagulation history, current medications, smoking or estrogen use, BMI, and family history, and should usually coordinate clearance with your primary doctor, hematologist, and anesthesia team.
If they agree surgery is reasonable, the plan may include a perioperative clot-prevention strategy such as sequential compression devices, early walking, hydration, minimizing operative time, and sometimes medication such as Lovenox, but that decision has to be individualized. With a prior PE, an accredited facility and a surgeon who is comfortable creating a written VTE prevention plan are important before elective breast augmentation.

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.

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

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