Am I disqualified from panniculectomy/monsplasty with a history of PE?

Question

I am a 50 year old male and have lost about 140 lbs due to a change of diet and activity. My weight has been stable at 220 lbs for about 6 months. Unfortunately now I have a lot of loose skin in the belly and pelvic area so I am considering surgery to correct it. About 2 years ago I had a pulmonary embolism. No cause was ever determined. There is no family history of clotting issues but I elected to stay on blood thinners as an precautionary measure. Does this automatically disqualify me?

J. Timothy Katzen, MD, FACS · Answer

Thank you for your question regarding whether you would be disqualified from panniculectomy/monsplasty with a history of PE. No, a pulmonary embolism or PE history does not disqualify you from undergoing a panniculectomy. Before you undergo a panniculectomy, I would insist you visit with your hematologist to ascertain any other possible causes of your PE. If no other reasons can be identified, you should still be able to qualify for a panniculectomy. Before your surgery, you will need to stop the blood thinners. Depending on the blood thinner and its half-life will determine how many days before surgery you will need to stop. It will be vital for you to heal and stop bleeding before the blood thinners are restarted. I've operated on many patients with a history of PE very successfully. Just because you have a history of PE does not mean you can not have surgery. I hope this helps encourage you to undergo the panniculectomy and eliminate excess skin and fat.

Tommaso Addona, MD · Answer

Thank you for your question.
With any elective procedure, you will be required to undergo medical clearance prior. This typically is with your primary care provider who will ensure that you are well enough to undergo anesthesia. With your past medical history, you will likely need clearance from a hematologist. I recommend speaking with a board certified plastic surgeon to discuss your concerns.

Christopher Pannucci, MD, MS · Answer

Hi SeattleDavid,
A personal history of blood clots does not automatically disqualify you from being a surgical candidate. I would suggest the following, prior to consultation with a plastic surgeon:1. Gather as much information about your pulmonary embolus as possible.2. Talk to your PCP, and ask to be referred to a hematologist.3. Have the hematologist perform whatever workup is needed (this will probably include a detailed history about you and your family, plus an extended discussion of the circumstances surrounding your clot, plus multiple labs to look at clotting levels and for hypercoagulable state).4. Bring a letter from the hematologist, which would describe your baseline risk, potentially modifiable risk factors, and proposed clot prevention plan, to your initial consult with your plastic surgeon. He or she can review, and then have an educated discussion with you about the risks and benefits of a surgical procedure. 
Hope this helps.
Best,Christopher Pannucci, MDBoard Certified Plastic SurgeonPlastic Surgery NorthwestSpokane, WA

Daniel Barrett, MD · Answer

Dear SeattleDavid,
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

Camille Cash, MD · Answer

Having a history of PE does not automatically disqualify you from considering surgery, however it does put you in a higher risk category.  A good place to begin is to visit with your hematologist to discuss your interest in surgery.  If given clearance you can then meet with a board certified plastic surgeon near you for a consultation.

Am I disqualified from panniculectomy/monsplasty with a history of PE?

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