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

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.

There are many different types of clotting disorders and you need to have your situation looked into further if you are considering having any surgery.  Many questions need to be addressed.  How do you know you have a clotting problems?  Have you had problems with surgery before? Do you take aspirin or other blood thinners.?  Your individual situation needs to be further elucidated to make sure you can undergo the surgery safely or what precautions may need to be taken.  Good luck

A protein S deficiency makes it more likely for a patient to have a clotting problem during or after surgery such as a DVT or a PE.  This is a serious issue.  Before going forward with any elective surgery this issue should be discussed at length with a hematologist (a doctor who specializes in blood clotting issues).  A hematologist should be able to provide a patient with this disorder with a plan to decrease the likelihood of an unwanted clot.  Above all else, remember there is nothing more important in cosmetic plastic surgery than patient safety.

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.

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.

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.

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.

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. 

Hello,

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