Previous Pulmonary Embolism due to Birth Control, Can I still have a Tummy Tuck and Lipo to the flanks?

I had a PE in 8/2009 after giving vaginal birth to my son on 5/2009. I was told by my Dr. that it was due to my birth control that my doctor but me on a month after having my baby. I have not had a reoccurring Blood clot/PE since 2009. I just gave birth to my last baby Jan. 25 2016 vaginally and I have not had any issues with clotting. During my whole pregnancy and 6 weeks after giving birth I was on Heparin twice a day. I want to have TT/lipo , what are you thoughts on the risks?

Doctor Answers 12

Pulmonary Embolism: Is it safe to have surgery?

Thank you for the question. I am very sorry to hear about your complicated medical history and struggles with pulmonary embolism. As I am sure has been explained to you, this can be a very serious complication. I would say that this question truly needs to be directed at your hematologist, because only he/she knows why you had the pulmonary embolus, along with what your risk of having another one is. Best of luck!

Previous PE and tummy tuck

I believe you are at an increased risk for a blood clot, PE or DVT after this operation. You would definitely have to see your hematologist first and more than likely they would either advise against it or give specific recommendations for perioperative use of blood thinner such as the heparin shots, lovenox or xarelto. Please talk to your hematologist. Congratulations on your baby! It been 7 months now, if you are at your goal weight, it is time to at least discuss this with your hematologist. 

W. John Bull, MD
Chicago Plastic Surgeon
4.4 out of 5 stars 16 reviews

Your risks are certainly higher

You can have a tummy tuck and liposuction as long as you are willing to accept risk of another pulmonary embolism and blood thinners.  A hematological evaluation prior to surgery will also be needed. 

Vasdev Rai, MD
Dallas Plastic Surgeon
5.0 out of 5 stars 21 reviews

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Previous Pulmonary Embolism due to Birth Control, Can I still have a Tummy Tuck and Lipo to the flanks?

Good question! You are at an increased risk for another DVT with any surgery, but at an even higher risk with the procedures in which you've expressed interested. We would recommend a hematologic consultation to assess for any clotting conditions if you haven’t already had a work up done. You should ask what her plastic surgeon does to prevent DVTs post op; Important interventions may include blood thinners post op (eliquis, xaralto, lovenox), Sequential Compression devices on your calves so blood does not pool in your legs, early ambulation after surgery, and potentially an overnight stay in a hospital or care facility so that you can be monitored for complications. Good luck!

Kahlil Andrews, MD
Cedar Rapids Plastic Surgeon
4.7 out of 5 stars 11 reviews

History of Blood Clots

Thanks for your inquiry and you are right to be concerned about blood clots.  Given your history, you will need to be on Lovenox or Heparin around the time of surgery.  The risk of being on the blood thinner is that you are at higher risk of hematoma and bruising.  Please discuss your history in detail during your consultation with your plastic surgeon.  Good Luck. 

Tt and dvt

the answer is yes. I would have you see a hematologist first and have you on anticoagulants after. I would also give you a serious talk about the risks of dvt/pe for an elective surgery

Jonathan Saunders, MD
Newark Plastic Surgeon
4.7 out of 5 stars 59 reviews

DVTs and Tummy Tucks

Hi Phenomenalwoman
Sorry for your scary complication, but glad you did fine ultimately.
Tummy tuck is the riskiest of plastic surgery procedures for DVT.  You have had one episode so you already are at risk.
This does not rule you out from the procedure, you just need to understand the increased risks and make an informed decision.
My recommendation is to find a board certified plastic surgeon willing to take you on.  I also recommend that you get fully evaluated by your primary care doctor and either a pulmonologist/hematologist to be sure that there are no other reasons to increase risk for DVT.  Their input will also be invaluable to navigate the procedure with as little risk as possible.
All the best.

Tummy Tuck with History of PE

Thanks for the question.  Tummy tucks are not contraindicated in patients with a history of a pulmonary embolus.  The best method to assess your risk for a pulmonary embolus (PE) with a tummy tuck is to undergo an assessment by your plastic surgeon with the Caprini risk assessment score.  This will allow your plastic surgeon to calculate your level of risk for a deep venous thrombosis (DVT) which is a precursor to a pulmonary embolus.  Based on this score, the proper preventative measures can be taken to lower your risk for venous thromboembolism (VTE).  This can involve the use of compression stockings, sequential compression devices (SCDs) and/or Lovenox or heparin.  Based on my limited assessment of the information provided, your score would be at least 5 indicating the need for both SCDs and Lovenox.  The one other caveat would be an assessment by a hematologist to determine if you have any genetic predisposition to DVTs.  This may have been done with your history of PE, but would be needed if not previously done.  In short, with proper preoperative evaluation you can have a tummy tuck.  You can check out my recent article in aesthetic surgery journal on contraceptive vaginal rings and venous thromboembolism for more information.

Tummy Tuck with a History of Blood Clots to the Lungs

Having had a previous blood clot increases your chances for another by a factor of 15 in some studies. Any time we operate on an obese person, a smoker, someone taking hormones, someone with a family history of blood clots (DVT) and/or we increase the pressure inside the tummy or operate for more than 3 hours the risk for blood clots goes up. In your case, I would recommend you be studied by a Hematologist to look for any conditions associated with clotting if it had not been done already. A Tummy Tuck may be done on you but precautions should be used. Depending on what the findings of the hematological work up is, your surgeon has several options to greatly reduce the odds of another DVT/PE. 
Dr. Peter A. AldeaMemphis, TN

Peter A. Aldea, MD
Memphis Plastic Surgeon
4.9 out of 5 stars 101 reviews

Tummy Tuck with History of Pulmonary Embolism

You might still be able to have a tummy tuck. A tummy tuck with liposuction is certainly a risk factor for developing a deep venous thrombosis. See a plastic surgeon to determine if you are a candidate for this procedure in the first place. If you are, I would have you see a hematologist for preoperative testing and clearance regarding your prior history of PE. They will do blood tests to ensure that you do not have an inherent clotting abnormality. Without these tests it is just a guess that your birth control was the cause of your prior clot. Furthermore they can work with your plastic surgeon to advise the best peri-operative anticoagulation plan to minimize your risks. 

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.