I have the MTHFR gene mutation - can I have cosmetic surgery. Help!

Question

Hey, Back in 2014 I was told that I have the MTHFR genetic mutation, ever since then I always had in it the back of my mind. Now, coming 2025 I was considering getting a tummy tuck and breast augmentation, however consulting with a surgeon in Miami, I did not qualify. What are the next steps moving forward?

J. Timothy Katzen, MD, FACS · Answer

Thank you for your question. Having the MTHFR gene mutation can add complexity to surgery planning, but it doesn’t automatically disqualify you from undergoing cosmetic procedures. The MTHFR mutation can affect how your body processes folate and homocysteine, potentially increasing the risk of blood clots, poor wound healing, or complications related to anesthesia. However, the severity of the mutation varies, and many individuals with MTHFR can safely undergo surgery with proper precautions.

If a surgeon has determined you’re not a candidate, consider consulting with another board-certified plastic surgeon experienced in managing patients with genetic or medical conditions. Additionally, a hematologist can assess your clotting risk and help develop a tailored perioperative plan. Preoperative testing, including advanced blood work to evaluate homocysteine levels and other clotting factors, can provide crucial insights. If your levels are elevated, your medical team may recommend interventions such as folate supplementation, B12, or other lifestyle adjustments to optimize your safety for surgery.

With proper protocols in place, many patients with MTHFR successfully undergo surgery. These precautions might include the use of blood-thinning medications to prevent clots, close monitoring during and after surgery, and nutritional optimization to support healing and minimize risks. It’s important to communicate openly with all your providers about your medical history and concerns. A team approach, involving your surgeon, a hematologist, and your primary care doctor, can ensure your care plan is tailored to your unique needs.

While the MTHFR mutation requires careful consideration, it doesn’t necessarily prevent you from achieving your goals. By working with an experienced surgeon and the appropriate specialists, you can move forward with safety and confidence. Always prioritize your health and collaborate with professionals who understand the complexities of your condition.

Sincerely,
Dr. Katzen

Daniel Barrett, MD · Answer

Dear Affectionate318508,

it is hard to tell for sure without an examination. You will need to get a clearance from your doctor prior to surgery. 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

Jeffrey M. Darrow, MD · Answer

Your MTHFR mutation causes elevated levels of homocystine in your blood. This can potentially lead to hypercoagulability and blood clotting. You should check with a hematologist to find out whether there are ways that this could be managed around the time of your surgery. If your hematologist feels that it could be handled easily then you may consider proceeding, however, your health and safety come first.

Gerald Minniti, MD, FACS · Answer

People with that gene defect, one that converts folate consumed in food with the bioactive one needed for cellular processes, can have a variety of medical issues depending on the location of the mutation of the gene. The three known medical problems include high levels of homocysteine, which can increase your risk of cardiovascular disease, neural tube defects in offspring, and higher risk of methotrexate toxicity. What this gene has no connection with is the potential for increasing your risk for symptoms you believe are attributed to your breast implants (SSBI, formally BII). This is a fanciful allegation by BII activists that has been shown not to have any correlation in controlled scientific studies. At this point in time, your risk of SSBI is most closely associated with self reported anxiety disorder, health anxiety disorder, increased age, and your predilection for acquiring medical information on the internet more than getting it from a physician. Other studies have looked at blood and tissue levels of 20 different heavy metals, the dna of a variety of different bacteria, their endo- and exotoxins, and patient immune system communicating hormones known as cytokines. What was found is that there is no difference seen in women with implants and symptoms, women with implants and no symptoms, and women who never had implants, aka the control group. Further, removing all the capsule or none of the capsule had no effect on perceived reduction of subjective symptoms. Bottom line: at this time SSBI/BII is a psychosomatic disorder. Get your implants and you'll be fine.

Connie Hiers, MD, FACS · Answer

You might gain benefit with IV vitamin infusions prior and after cosmetic surgery. I would suggest not doing the tuck and the augmentation at the same time so that you have smaller areas to heal.  You will need medical clearance for surgery.

Camille Cash, MD · Answer

Safety is always the number one priority in surgery.  Though your risk may be higher because of the gene mutation you still may be a candidate.  Your surgeon may want extra lab work or specialist clearance before determining if it is safe for you to proceed.  Extra precautions during surgery and post operatively may also be recommended.

I have the MTHFR gene mutation - can I have cosmetic surgery. Help!

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