American Society of Plastic Surgeons
For Medical Professionals
one year ago

Pulmonary embolism

Hi, I’m 43 years old and had a pulmonary embolism after a C-section, in 2012. I got a bunch of testing done after to see if I had a blood clotting disorder, which I don’t, the PE was just from the C-section. I’m get a tummy tuck and breast lift at different times but I’m very nervous that I will develop another blood clot. Am I at a higher risk bc I had a previous PE?

Procedure: Tummy Tuck
Location: Seaford, NY

Replies 5

Gary Culbertson
ASPS Surgeon
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Yes, you would be determined to be at increased risk for perioperative PE/DVT with a Tummy Tuck or Mommy Makeover. Plastic Surgeons & hospitals today often screen/ evaluate their patients for this possble life threatening event BEFORE surgery. There is a light at the end of the tunnel. Consider seeing a Hematologist for a Hypercoaguabilty profile/work up and/or consider getting a Factor V Lyden Defeciency blood test. A positive Factor V Lyden Defeciency test can be considered one of the conditions of patients with hypercoaguability that requires anticoagulation before surgery.

Many plastic surgeons today are going to consider giving theirTummy Tuck or Mommy Makeover patients an anticoagulant like Xeralto or Eliquis after their surgery if they have an increased risk for PE/DVT. In our office this is done in all our Tummy Tuck or Mommy Makeover patients as part of a Critical Pathway of Care to reduce perioperative complications.

Seek out an ASPS member familar with PE/DVT.

Kenneth Francis
ASPS Surgeon

Dear sabby,

Yes, with a history of PE, at age 43, undergoing a prolonged surgery, you would be considered in the highest risk category for another blood clotting event. This would require anticoagulation during and after your surgery. Many surgeons would decline you as a patient. Since your coagulation workup took place over 10 years ago it would be wise to see a hematologist and have it repeated since advances in coagulopathy diagnosis have been made since then. Also, the hematologist would become involved with your anticoagulation protocol for surgery. Good luck!

Shana Kalaria
ASPS Surgeon

Yes you are at a higher risk after a previous PE. Things that make you at higher risk are your age, planned long surgery, and most importantly the previous PE. You would need anticoagulation after your surgery. You should see a hematologist for bloodwork and recommendations on anticoagulation given your history and the fact that a long surgery is planned. Please see a board certified plastic surgeon to manage your complex case. Good luck!

Alfred Antonetti
ASPS Surgeon

Both of those procedures can be done at the same time. Yes, you are at a higher risk but probably not prohibitive. With good assistants and even some liposuction this could take around 3 hours and this is not too long. Abdominoplasties have a higher incidence for deep vein thrombosis and PE's so many plastic surgeon take a lot of precautions. I do abdominoplasty as an outpatient under general anesthesia even when combined with other procedures, try to limit the time that it takes for the procedure, we use SCD's during the procedures and send the patient home with portable SCD's, walk from recovery to their cars, get out of bed at least every 3 hours 1st night and walk around the house from the bedroom to kitchen, we see the patient in the office the next day and walk into the office, use no drains and start Lovenox (anticoag)the next day after surgery and use it 5 days. Every surgeon has his or her own protocol and yours has one also. Preop hematology consult good idea. You will do OK

Tanongsak Panyawirunroj
ASPS Int. Surgeon
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Yes, you are high risk of another blood clotting event with previous history of PE and at the age of 43. You would need anticoagulation during and after your surgery. You should see a hematologist for bloodwork and recommendations on anticoagulation given your history and the fact that a long surgery is planned before undergoing the surgery.


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