Would any plastic surgeon even consider a male breast reduction for a patient who is on warfarin therapy with a target INR of 1.5-2.0 (mechanical On-X aortic valve replacement due to congenital bicuspid valve), by working with the patient's cardiologist on the appropriate Lovenox bridging plan? My husband is extremely unhappy with his appearance and I want to help him. Thank you.
I would be happy to meet you and your husband for consultation. If we agree that he is a good candidate for the procedure, I will work with your cardiologist to come up with a safe plan for the operation. I perform such surgeries at hospitals in Sarasota where my office is located.
Orlando Cicilioni MD
Certainly many patients on blood thinning agents undergo surgery. Warfarin is usually stopped a few days in advance and low molecular weight heparin (lovenox) is then used during the perioperative period until the warfarin is resumed. The biggest risk is bleeding, leading to excessive bruising or even hematoma (a collection of blood under the skin surface) that might require a return to the OR to wash the blood out. If your husband is otherwise a good candidate for surgery, and his cardiologist is on board, then a board-certified ASPS member surgeon in your area should be comfortable caring for him.
Thank you for your great question. One has to outweigh the risks and benefits of stopping Warfarin and bridging to Lovenox and the cardiologist can help figure out exactly these risks. With something like this, the warfarin is usually stopped a few days prior and then Lovenox is started. Lovenox is stopped 6-12 hour prior to surgery. Following surgery Warfrain is started again, however either Lovenox or a Heparin drip must be started until the INR is at a theraputic level. If your cardiologist feels that post op, a heparin drip is required, this necessitates a stay in the hospital until INR is theraputic. In my experience with my own patients, this can take anywhere from 2-4 days. Some cardiologists are very cautious and do not let people go home until an INR is at an acceptable level.
You also face two types of risks with this procedure. There is a risk of a thromboembolic event when the blood thinners are stopped, and risk of bleeding when blood thinners are started again.
Yes, I am sure we can coordinate everything with your cardiologist. Gynecomastia I treat with either liposuction ultrasonic or with what is called a subcutaneous mastectomy. You could send photos for an evaluation. The former is definitely less invasive.
Dr. Edward Jonas Domanskis is Certified by the American Board of Plastic Surgery
Newport Beach, San Francisco,Miami, EU, Anguilla
Assistant Clinical Professor of SurgeryWOS-Plastic,University of California (Irvine)
Orange County’s Physician of Excellence/America’s Top Physicians/Top Doctors
Plastic Surgery- 2005-2018
President,American Society of Bariatric Plastic Surgeons
Organoderm Skin care/ScaRxTape
Yes, I have had patients on anticoagulant therapy for various reasons and we are usually able to work with the cardiologist to get the procedure done.