Breast reduction & abdominoplasty with Factor V Leiden and history of PE for a healthy, non-smoker and no oral contraceptives?

Question

I am a 31-year-old female and mom of 3-year-old twins. After their delivery, I was diagnosed with a pulmonary embolism (PE) and tested positive for Factor V Leiden. Pre-pregnancy, I was a 34DD, during pregnancy I was up to a 36F and am now a 34DDD. I also have a three-finger abdominal separation and have been developing a large curve in my spine. My first consult with a plastic surgeon was grim. He referred me to a hematologist and a spinal surgeon. Does the risk out way the possible results?

Vladimir Milovic, MD, FRACS · Answer

Thank you for your question.  You are a mother of two, you already had a serious complication such as PE after your delivery.  You have been diagnosed with Leiden Factor V positive genetic mutation which puts you in the category of people with 3-5 times fold increased risk of thrombosis.  Sorry to disappoint you, however, I think that you have a high risk for serious complications such as DVT or recurrent PE.  I think that the advice given by your PS is correct and I would take it seriously.

Mary Lee Peters, MD (retired) · Answer

Thank you for your question. It is possible and safe to do surgery with patients who have some forms of Factor V Leiden. Their coagulation needs can be addressed with something called Bridge therapy if they are a candidate for it. Your hematology team can work with your surgeon to decrease risk and assist in a positive outcome.

Robert Savage, MD (retired) · Answer

You are certainly at increased risk for DVT/PE and must give that very serious consideration especially with your beautiful children.By no means should you do the two procedures together in my opinion, because longer anesthesias compound those risks.If after all is said and done, and your physicians feel it is not unreasonable to proceed you should definitely use chemical prophaylaxis against clotting,venodynes  and early ambulations.You can also consider having either done with a costal block anesthesia,or tumescent fluid and heavy sedation rather than general.

Breast reduction & abdominoplasty with Factor V Leiden and history of PE for a healthy, non-smoker and no oral contraceptives?

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Breast reduction & abdominoplasty with Factor V Leiden and history of PE for a healthy, non-smoker and no oral contraceptives?

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