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

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.

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.