I Have a Protein S Deficiency and Would Like Breast Augmentation. Can I Still Have the Procedure?

I've always wanted to increase the size of my breast permanently but recently found out I have clotting disorder ( protien s deficiency) . Would I still be a candidate for surgery, if so what questions should I be asking the surgeon?

Doctor Answers 13

Protein S Deficiency

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Yes, you can have elective surgery with Protein S deficiency with careful planning.  I recommend you see a surgeon who is comfortable with this and has done surgery on patients with Protein S deficiency before.

It is a good idea to get instructions for a specific anticoagulation regimen --before, during, and after surgery--from a hematologist who can make arrangements for this if your surgeon doesn't feel comfortable doing so.  Follow the directions to the letter.

It is not possible to reduce your chances of forming a clot to zero but following the appropriate regimen will greatly reduce the risk.

Proceed carefully and follow your doctors instructions.  Best of Luck.

Nashville Plastic Surgeon
5.0 out of 5 stars 221 reviews

Protein S deficiency and breast augmentation

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Unfortunately you are receiving many conflicting answers.  Some have correctly stated that there is a 'clotting' risk and others have incorrectly commented on a 'bleeding' risk with this disorder.  Like any busy physician, I have seen and cared for my share of patients with a variety of blood disorders.  With a Protein S deficiency, you are more likely to clot, NOT more likely to bleed.  It would be important to know what led to your diagnosis.  A hematology evaluation is certainly important and should be required for any patient with a coagulation disorder prior to any surgery.  I do believe that you could, with the appropriate perioperative care, undergo a breast augmentation in a very safe manner.   This is a relatively short procedure and is not typically associated with a significant risk of blood clots.  I also do not believe that you would need a blood thinner (such as heparin), although this specific recommendation would be between your surgeon and the hematologist.

Good luck.

Blood dyscrasias and surgery

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I have had my share of patients with blood clotting abnormalities. Commonly,they get a hematology work-up and with proper guidelines set by the hematologist the surgery can often be accomplished with little risk. if any.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Protein S Deficiency and Cosmetic Surgery

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Hi there-

With proper hematology management in concert with your surgery, you should be able to proceed.

It is important for you to understand that your peri-operative risks will necessarily be higher than a patient without your problem, and you will need to accept this elevated risk.

Plan carefully with your surgeon and hematologist.

I Have a Protein S Deficiency and Would Like Breast Augmentation. Can I Still Have the Procedure?

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The be as safe as possible I would recommend in hospital surgery with your hematologist available in recovery or during surgery. This will add costs to the operation. But your safety is paramount. 

Breast augmentation in patients with bleeding disorders

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Protein C and S inhibit the pathways involved in clot formation specifically at Factor VIII and Factor V. Therefore genetic deficiencies of these proteins means the patient makes more clot than normal (6 times more likely to do so than individuals with normal protein S levels) especially in the veins. Protein S deficiency can be hereditary or due to vitamin K deficiency, sex hormone therapy, liver disease or chronic infections. Inherited Protein S deficiency occurs in 1 in 500 people in the US. Those who also are inactive, have a previous history of blood clots, smoke, are obese or are taking birth control pills are at a very high risk for forming blood clots. Protein S deficient patients therefore need to execise regularly, stop or never start smoking, control their weight and stay away from birth control pills.

The primary goal in protein S deficient patients is to prevent the first big clot.  Once that forms future ones are much more likely to form. Surgery can damage blood vessels stimulating the clotting cascade which in these cases can over react to the surgical stimulus. If the over reaction is severe enough it can be life threatening.

You will need prophylactic anticoagulation with heparin before, during and after surgery with a hematologist directly involved in your care. In contrast to protein C and antithrombin, there is no purified form of protein S available for clinical use. Therefore your surgery needs to be done in a hospital in case fresh frozen plasma (FFP) is required in the event that the clotting cascade starts to over react. That is the only way to replenish your Protein S stores. Safety should be your first priority and given your pre-condition surgery in an office operating room is not safe.

I hope you realize that this format of posting questions and receiving answers lacks the face to face direct communication required for you to make an informed decision regarding your surgery.

My response to your question/post does not represent formal medical advice or constitute a doctor patient relationship. You need to consult with i.e. personally see a board certified plastic surgeon in order to receive a formal evaluation and develop a doctor patient relationship.

Aaron Stone, MD
Los Angeles Plastic Surgeon

Blood Clotting disorder and plastic surgery

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Protein S Deficiency usaually increases the risk fo bleeding, but it is not an absolute contraindication for plastic surgery or breast augmentation. Altimately, the most important test is a bleeding time test which not only checks your coagulation cascade but your overall ability to form clots and stop bleeding. A hematologist can perform a bleeding test as well as to check the severity of your protein s deficiency. If you do not bruise easily, don't have heavy periods, and don't easily bleed from your gums when you brush your teeth, most likely your overall bleeding risk is very low.

Finally, a hematologist can recommend medications to take at the time of your surgery to prevent bleeding.

Sean Younai, MD, FACS
Beverly Hills Plastic Surgeon
4.4 out of 5 stars 51 reviews

Proteins S deficiency and breast augmentation

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There are two things that should happen prior to getting a breast augmentation.  You should get at least one and perhaps two hematologist evaluations to estimate your bleeding risk.  Second, your plastic surgeon should perform the surgery in a bloodless manner under direct visualization with electrocautery.  Your pocket will have to be made precise and you should be wrapped for 24-48 hrs afterwards. 

All the best,

Dr Repta

Remus Repta, MD
Scottsdale Plastic Surgeon
4.9 out of 5 stars 173 reviews

Clotting disorder and breast augmentation

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I recently saw a patient with exactly the same problem. Most hematologists would not clear you for an elective cosmetic procedure and, as inability to clot is a major issue in any operation, I would not be comfortable with operating on you. For my facial rejuvenation patients with clotting issues, filler and Botox are good alternatives. For augmentation, perhaps the state of the art will change going forward and offer you some alternatives. The important thing is to focus on staying healthy!


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A short acting blood thinner may help minimize chances of an embolic event with small increased chance of  hematoma.  The amount and timing of treatment should be directed by a hematologist.  Best wishes.

Mark D. Wigod, MD
Boise Plastic Surgeon

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.