I have had 3 C-Sections my last in Jan 2009 a month after I developed a Pulmonary embolism (PE)in my left lung Doctors state it was due to the Pregnancy. My question is how safe is it to have a Tummy Tuck and Lipo after this? This has been something I have wanted for sometime but have gotten mixed reviews due to the previous PE. In Addition I am a healthy non smoker 29yrs old never had any previous issues with cloting.. Thank you
Tummy Tuck & Lipo After a Pulmonary Embolism (PE)
Doctor Answers 16
Once you've had this history there is a higher likelihood that you'll develop another one. Be sure to consult with an internist, your hematologist and your board certified plastic surgeon in order to see what measures you can take to avoid this to recurr in any possible way.
Pulmonary embolism and tummy tuck
Having had a previous pulmonary embolism, you are at significantly higher risk to have another one. You are having an operation under general anesthesia (risk factor) and one that takes more than 1 hour (risk factor). Do you use birth control pills? Has your blood been checked for factors that cause a hypercoagulable state? There are a number of risk factors to consider.
I'd start by having you see a hematologist, to evaluate if you have any of these coagulation problems. If they are present, your risk of having another PE would be very high. In that case, many surgeons - myself included - would feel that the risk of PE would be excessive, and not operate.
You might want to read about the Caprini risk factor scale to calculate whether your risk of PE. It's available online, and will give you some ideas of the percentages.
This is not something to take lightly!! Best wishes,
Tummy tuck and liposuction after a pulmonary embolism
In our practice, we tell our tummy tuck patients that our top five priorities for their surgery are patient safety, patient safety, patient safety, patient safety, and obtaining a beautiful result. Please understand that if you have had a pulmonary embolism after abdominal surgery then you may be at high risk for developing this complication again. Be as honest as possible with your plastic surgeon and inform them of your entire medical history. It is imperative that with your medical history you only work with a plastic surgeon that is board-certified by the American Board of plastic surgery and has a great deal of experience in abdominoplasty and complicated body contouring procedures. Your plastic surgeon will require the medical records of the specialists that treated your pulmonary embolism. Keep an open mind with the recommendations your surgeon will provide and do not be disappointed if they state that you are too high risk and are not a candidate for the surgery.
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Abdominoplasty (tummy tuck) with prior history of blood clot (DVT/PE)
I would recommend a full evaluation by a hematologist to rule out Factor V Leiden or other clotting disorder. If you remain interested, you could undergo the procedure with anticoagulants which could thin the blood and cause bleeding requiring surgery/transfusion, or undergo the surgery under local/regional monitored anesthesia care or at a slightly increased risk with non-medical prophylaxis such as compression stocking and sequential compression devices.
Tummy Tuck after Pulmonary Embolus
Plan your tummy tuck with both the plastic surgeon and hematologist working closely together. I would study you in advance to be sure there is no residual deep venous thrombosis, and be sure you do not have a thrombogenic diathesis (predisposition to clotting) by screening hematology laboratory assay. Then, stratify your risk (Caprini scale is the one I use), and prophylax accordingly.
The risk of a PE is certainly increased, but may be acceptable.
You are certainly at an increased risk for a pulmonary embolism with a previous history of such and you are now considering an operation which is one of the riskier operations for having another PE. Have a workup by a hematologist to determine the cause of your PE. Armed with that information, I would then ask your plastic surgeon and hematologist to give you a percentage chance of having another PE, assuming that you would be on an anticoagulant after surgery. The risk may be so low that you are willing to take the chance.
Abdominoplasty and past blood clots in legs or lungs
Given your past history of PE, you will be at risk for a recurrence. This can be minimized by having a blood thinner after surgery, by doing the surgery under sedation instead of general anesthesia, and by not staying in bed after surgery. You should be evaluated by a hematologist to make sure you don't have an underlying blood clotting disorder and that any other possible risk factors are reduced (hormonal medications & contraceptives). Keep in mind that a tummy tuck has a higher risk of blood clots in your legs (DVT) and in your lungs (PE) than do most other plastic surgery procedures. If you decide to have this surgery (or any other surgery) make sure surgeon knows about this. You and your surgeon may want to refer to the Caprini scale to know what your risk factors are.
Most plastic surgeons with experience have performed abdominoplasties on patients with similar histories. In a way you are fortunate as the suspicion is high should symptoms occur. In other words, your surgeon will be very prepared. I agree that in these cases, a hematologist should have seen you to determine your relative risk to that of the rest of the population. Perhaps that has already been done. If you can avoid tightening the muscles to remove skin only, it may reduce your risk as well despite that it may not optimize your results.
Tummy tuck after a PE
I have treated one patient that had a PE just after pregnancy. She had a medical work-up by her hematologist who cleared her for breast augmentation surgery. You are at higher risk than patients that never had a PE, I would strongly consider not doing it, but if you do, you need a work-up by your doctor.