Alpha Thalasemia - is Liposuction and Tummy Tuck a risk for me?

Question

I have alpha Thalasemmia. My hemo is9.7 , A2 quant 2.0, 33 hemocrit. Im a weight loss patient who would like a extended Tummy tuck and Lipo, but Most surgeons will not take me unless hemo is 12+, my doc says I will never be over 10 with Alpha Thalasemma. Is the lipo my risk? Or the extended Tummy Tuck my risk? What would be a safe way to address my post weight loss skin/shape with my blood condition? mcv=71, mch=20.6, rdw=19.3

Alan Gonzalez, MD, FACS · Answer

Hello @awilliams530 thank you for your question. You need clearance from a hematologist before surgery and discuss this issue with your Plastic Surgeon because low hemoglobin is a risk and it depends on every specialist the requirements for every surgery. However low hemoglobin levels is a risk for any surgery. Best wishes!

Ronald J. Edelson, MD · Answer

You should see if the surgeon will do one of the procedures and not the other at the same time. Less surgical time, less blood loss to worry about. A reasonable way to go about it

Daniel Barrett, MD · Answer

Dear awilliams530,
it is hard to tell for sure without an examination. If you are considering surgery, I would suggest you consult a board-certified plastic surgeon. Only after a thorough examination, you will get more information and recommendations.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Gilbert Lee, MD · Answer

Thank you for your questions. With any significant medical history, it is a requirement to have medical clearance from the medical doctor who manages your health care. During your potential surgery, your surgeon and doctor will work together to develop the best plan for you. I recommend you schedule a consultation with a board certified Plastic Surgeon. In our office we offer 3D imaging to give our patients an accurate idea of what their final result will look like. Good luck!

Douglas Taranow, DO, FACOS · Answer

You are correct.  Without a blood transfusion, you will probably not obtain a Hb of greater than 10.0
What type of Alpha T. do you have?  There are 4 types.  My guess would be you suffer from:
Alpha thalassemia carrier-little or no symptoms other than anemia.
If you are asymptomatic, have a stable Hb of 9.0 or greater and a note from your hematologist, you should be able to have elective surgery.
I have done over 3 Thalasemia patients in the past couple of years without issues.
Best wishes.
Dr. Taranow

Samir Shureih, MD · Answer

Regardless of your hematocrit level. having alpha thalassemia, What are your symptoms? How frequent do you need transfusions? What is the level of Iron? What is the condition of the spleen, and liver and your heart.
Then if you have any bleeding, you may require multiple transfusions. Many hospitals and the red cross have shortages in many types of blood in blood banks.
Why take the risks?

Darryl J. Blinski, MD · Answer

The issue is your safety for doing that large of a surgery/ies. Plus no photos were posted? In my over the Real Self internet opinion you are a candidate for surgery, an extended TT with limited liposuction as an hospital surgery case is the only safe way to proceed. You will need hemo clearance and possible available blood units for transfusion. All this adds to the expense, I would think you are looking at $30,000 in fees.

Mats Hagstrom, MD (license on probation) · Answer

This is something you’re going to have to work out with plastic surgeons and your hematologist.

Blood loss during surgery can be limited by using good surgical technique. For liposuction this means using adequate amounts of tumescent solution in all areas treated and giving it proper time to work.  tumescent solution contains a drug called epinephrine which creates basal constriction and significantly reduces blood loss during liposuction.  During the tummy tuck surgeons need to cauterize yeah yeahs meticulously and rely on local anesthesia with Epinephrine injections if they want to keep blood loss at a minimum.

If despite these measures your blood loss is significant then you may end up requiring blood transfusions after.

Hematocrit and hemoglobin levels can be increased using erythropoietin but this is not necessarily standard of care in preparation for elective surgical procedures.

These are issues your local doctors need to work out for you.

Plastic surgeons have the right to say who they are willing and not willing to operate on and likewise patients are free to choose their plastic surgeon.

I do all of my Liposuction work with patients awake using local anesthesia with mild sedation.  Keeping patients awake requires absolutely but all areas are properly injected with to mess in solution and I usually let this sit in an absorb for 20 minutes before starting the procedure.  When doing it this way we rarely have any significant blood loss with Liposuction and because of that bruising is kept to a minimum.

Surgeons who rely on general anesthesia which is almost always required for a full tummy tuck are often less diligent with the injection of tumescent solution because it isn’t as important for pain control.  This can lead to slightly increased blood loss during the procedure but surgeons Who are meticulous should be able to keep blood loss down during even fairly extensive procedures.

You didn’t include pictures but based on what you describe perhaps Liposuction isn’t needed.

Most weight loss patients don’t have fat issues but rather just need extensive skin surgery. Patients sometimes believe loose skin represents fat because it often looks and feels like it.

Generally speaking weight-loss patients just need skin surgery and typically don’t need liposuction.

Continue having consultations until you feel you found a plastic surgeon who is the right one for you.

Best,

Mats Hagstrom MD

Alpha Thalasemia - is Liposuction and Tummy Tuck a risk for me?

Answers (8)

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