Treatment Approach for Patient with a Genetic Clotting Disorder, but No History of Thrombosis?

I'm heterozygous for Factor V Leiden, but have no history of thrombosis. Condition was discovered through a blood test while in fertility treatment. What would be the recommended approach to keeping me safe from developing clots following a tummy tuck or any other plastic surgery?

Doctor Answers 1

Cosmetic Surgery in Patients with Predisposition for Blood Clotting

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Clotting of the deep veins (DVT) is usually associated with immobilization (eg, staying in bed, travel, surgery), estrogen use and birth control pills, pregnancy, some cancers, and clotting disorders such as yours and other diseases such as  lupus anticoagulant, antithrombin III deficiency, protein C and protein S deficiency.

People with the Factor V Leiden mutation are unable to tone down their clotting and are very prone to form clots in their deep veins (DVT) which may migrate to the lungs as Pulmonary emboli. Up to 5% of Americans may have this congenital disorder. it is commonly diagnosed when working women up for spontaneous abortions, miscarriages and still births since it is associated with clotting of the placenta.

Every Plastic surgeon would have his/her own philosophy on this topic and I'll give you mine.

Cosmetic surgery is NOT "a right", nor is it "necessary". You will not suffer severe consequences or death by NOT having it done BUT there is a small chance that you may suffer them if you DO have cosmetic Surgery.

There is NO way to make surgery absolutely safe. Despite the huge advances in surgery and Medicine, Surgery is safer than ever but it is NOT absolutely safe and unforeseen complications may happen.

You have a genetic disorder which is responsible for an estimated 30% of all cases of DVT and pulmonary emboli in this country WITHOUT Cosmetic surgery. You are considering having a Tummy Tuck which is probably the cosmetic surgery operation with the highest risk of blood clots in people without a hypercoagulable clotting disorder. In my opinion this makes your risk inordinately high and I would strongly suggest you re-consider.

If you insist on going ahead and you had a supporting letter from a good Hematologist, I would advise you to have a reversible Vena Cava filter placed to catch such clots and undergo blood thinning therapy which would reduce the likelihood and severity of blood clot formation but would increase the risk of post-surgical bleeding.

Memphis Plastic Surgeon

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