Should Diabetics Avoid Tummy Tuck?

Diabetics can have successful surgeries.
Diabetic patients should optimize their health and weight before having surgery. They should also optimize their glucose management. An internist should be on board and assist with the preoperative and postoperative glucose management. The surgeon and anesthesiologist should be skilled with the metabolic problems of diabetes and their management. The surgery should be tailored to the patient's health issues.
The risk of having surgery for diabetic patients will be slightly to moderately higher than nondiabetic patients, depending on how well controlled the diabetes is, the health of the patient. etc. Both the doctor and the patient must accept this risk.
Some doctors are unwilling to take on this risk. Others are ignorant of the issues involved.
If a doctor is not comfortable performing your surgery for whatever reason, you should move on.

Hello My Body in Raleigh, NC. Thank you for your question regarding the feasibility of undergoing a tummy tuck as a type 1 diabetic.

It's excellent to hear that you've managed your diabetes effectively, maintaining regular exercise and tight glucose control, as evidenced by your HA1C level of 5.8 during pregnancy. These factors are crucial in determining whether a diabetic patient is a good candidate for elective surgery, such as a tummy tuck.

Diabetes and Surgical Risks:
Diabetes, particularly if not well-controlled, can complicate surgery due to several factors:

Increased Risk of Infection: Diabetics have a higher risk of postoperative infections.
Delayed Healing: High blood sugar levels can slow down the healing process, affecting how surgical wounds heal.
Blood Sugar Management: Fluctuations in blood glucose levels during and after surgery can complicate anesthesia and recovery.
Why the Mixed Opinions?:
The differing opinions you received from various surgeons reflect the variability in individual risk assessments based on a surgeon’s comfort level and experiences with diabetic patients. The surgeon who refused might adhere to a more cautious approach, considering the potential complications associated with diabetes.

Your Path Forward:

Consult with a Specialist: Consider consulting with an endocrinologist or your primary diabetes care provider about your desire for a tummy tuck. They can provide a detailed assessment of your overall health and potential risks based on your long-term diabetes management.

Seek Multiple Opinions: It’s wise to consult with several board-certified plastic surgeons who have experience working with diabetic patients. They can offer insights into how your diabetes could impact surgery and the specific precautions that would be necessary.

Detailed Pre-Surgical Evaluation: Any plastic surgeon surgeon you choose should conduct a thorough pre-surgical evaluation, including detailed discussions about your diabetes management, recent blood sugar control (such as HA1C levels), and any potential adjustments to your diabetes medication before and after surgery.

Post-Surgical Care Plan: Ensure that your plastic surgeon’s post-operative care plan includes close monitoring of your healing and blood sugar levels, along with strategies to minimize infection risks and promote wound healing.

The fact that you maintain excellent control over your diabetes and lead an active lifestyle are positive indicators for undergoing surgery. However, it is crucial to proceed with a surgeon who is not only skilled in performing the procedure but is also knowledgeable and comfortable managing the additional risks associated with diabetes.

In summary, while being diabetic does introduce additional complexities to elective surgeries like a tummy tuck, with careful planning and management, it can be safely performed. Ensure that you have a robust support system and medical team who understand the nuances of diabetes care in the context of surgery. I wish you the best.

Sincerely,

J. Timothy Katzen, MD, FASMBS, FICS
Plastic Surgeon

Hello! Thank you for your question! There are a few medical comorbidities that contribute to a higher risk during any surgical procedure including infections, wound complications, delayed wound healing, bleeding, anesthetic risks, etc. Diabetes is one that is known to have an increased risk for infections and wound healing issues. There are a number of both systemic and local host factors that can contribute to infections. Whether or not diabetics are truly at greater risk and the magnitude of the effect of diabetes on the risk of infection remain controversial. However, there is a known increased propensity to develop infections and delayed healing. Some of the hyperglycemia-related impairments on the immune response include vascular insufficiency, sensory peripheral neuropathy, autonomic neuropathy, and skin and mucosal colonization with pathogens such as Staphylococcus aureus and Candida species. That being said, well-controlled diabetes should equate a minimal increased risk for the above and surgical procedures still safe and a reasonable decision. You should ensure adequate glucose control always, but also obtain medical clearance from your primary care physician that you are at an acceptable risk for undergoing a surgical procedure. Laboratory results such as HgbA1C is a good measure of control. Discuss all of your medical comorbidities and medication with your surgeon prior and discuss these risks. Measures will be taken to check levels as well as maintain proper glucose control with appropriate fluids and medications. This procedure should still be very safe for you and hope for an uncomplicated course with an excellent result! Hope that this helps! Best wishes!

Thank you for your question.   It sounds as though your diabetes is in excellent control.  Although diabetes does increase the risk of infection and surgical healing problems, it is not prohibitive by any means.  I think with careful glycemic control and close involvement of your endocrinologist, the operation can be done very safely. I would not be upset by the office practice of one surgeon.   I would continue to interview surgeons in your area or even outside, until you find someone that you are confident with.  I wish you all the best.Dr. Gill

Diabetic patients can still be excellent candidates for a tummy tuck. Choose a board certified plastic surgeon that is expert and experienced with performing tummy tuck with patients with diabetes. Have a medical clearance from your internist/primary care physician/endocrinologist, and check to see if internist/primary care physician/endocrinologist will speak directly with MD Anesthesiologist and board certified plastic surgeon.

Thank you for your post. Diabetes is a disease that should demand a healthy respect from both surgeon and patient in plastic surgery. It is a disease that affects the immune system and can increase the risk of infection, a disease that affects the healing potential of a wound and can cause opening of a wound, and is a disease of the circulation that can lower the blood flow to the operated tissue and cause necrosis or tissue death. This needs to be managed as follows:1. Tight blood glucose control with diet, exercise, and medication. You need to see your internal medicine doctor regularly and make sure your diabetes is well controlled. 2. If you are overweight, then losing weight decreases your risk in tummy tuck surgery or any other surgery for that matter.3. If you have high blood pressure, this needs to be managed and well controlled by your internal medicine doctor as well.4. ABSOLUTELY NO SMOKING!5. Consider with your surgeon HyperBaric Oxygen therapy pre- and post-op.6. Make sure you understand from your surgeon and anesthisiologist what medications you should take or not take prior to surgery.It is very possible to have a great outcome as a diabetic following tummy tuck surgery, but minimizing the risk is the most rational way of accomplishing this.Best Wishes, Pablo Prichard, MD

Well controlled diabetes is not a contraindication to tummy tuck surgery and/or other elective plastic surgical procedures. Always best to check with your primary care physician or endocrinologist for “medical clearance” prior to surgery.  Managing your diabetic medications around the time of surgery (to avoid hypo as well as hyperglycemia), while you will have altered oral intake, will be important.  I hope this, and the attached link, helps.

The performance of a full tummy tuck involves the separation of the tummy skin from ALL its underlying direct (perforators) blood supply and tightening the stretched out underlying abdominal muscles followed by the trimming of the excess skin and re-creating the belly button. For all of this to heal properly afterwards, you must have ample and effective circulation in the tummy skin and adjacent regions.
It is a well-acepted fact that diabetics have wound healing complications which are related to a reduced effective blood flow. While keeping your HgA1C within normal limits and your sugar controlled will reduce higher complication rates, in my opinion, everything else being equal, you will still take on a higher likelihood of complications than someone with your history who is not diabetic.
Being cognizant of the fact that a Tummy Tuck is a cosmetic procedure (meant to improve appearance - not restore function or save life) incurring complications by such a procedure needs to viewed critically by both surgeon and patient.
Just because a surgeon refuses you does not mean that he did not "like" you. Maybe he had adverse experiences in the past which taught him not operate on diabetics.
Just because another surgeon chose to operate on you does not mean that he is your friend. Maybe he is more interested in the financial rewards of doing your operation or maybe his past experiences with diabetics has been favorable.
Think about it and do your homeword.

While diabetes is not an absolute contraindication, I would perform the surgery on an individual with diabetes as long as their sugars are well-controlled. Yes, they do have a higher risk of complications. On the other hand, I think you are a bit young at 19 to have a tummy tuck. If you are contemplating having more children, then I would wait.

It sounds as if you keep a very tight control on your blood sugar and HgA1C. That is probably the most important part of minimizing your risks for surgery. You probably already know that diabetes affects many organ systems in the body, which does equate to some higher risks for surgery. Diabetes is NOT an absolute contraindication to elective cosmetic surgery as long as you understand your risk category. Some plastic surgeons, for many reasons, may elect not to operate on any patient with diabetes. There are many excellent board certified plastic surgeons in your area, so seek out one who is comfortable with the slightly higher complication rate that your condition represents. Good luck!