American Society of Plastic Surgeons
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Hajrie
one year ago
Answered

28 yr old female seeking medical advise for tummy tuck with lipo to flanks. I lost 86 pounds.

I am aware that TT has the the highest risk for VTE I have a caprini score of 6 w/hx of varicose veins & and familal hx of cva my gma had a PFO which lead for her to have 3 cvas by the time she was 25(i dont have that)both gfathers had CVAS bc they were sedentary VTE is an obvious concern for me. what precautions should i take? previous hx of oophorectomy 14 years ago w/no complications. TY!

Procedure: Tummy Tuck
Type: Question

Replies 6

Gary Culbertson
ASPS Surgeon

Hajrie,

Great question. Sounds like you have done some reasearch on the VTE/ TT issue. A personal or family history of VTE are two of the most important concerns. Consider a visit to a Hematologist for a Hypercoagulabilty workup. The most important test is called a Factor V Leiden (FVL) mutation test. Then, consider an ASPS member in your area familiar with your concerns. They are experts on the a issue of VTE & TT's. Best,

Gary R Culbertson, MD, FACS

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Steven Wallach
ASPS Surgeon
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It sounds reasonable to be worked up and to see what your risk factors are. Based upon that, a hematology work up may be reasonable and based upon the hematologist recommendations, you likely will be able to proceed. Good luck

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Lawrence Glassman
ASPS Surgeon
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Strategies to reduce the risk of VTE include early ambulation after surgery, sequential compression devices, and chemoprophylaxis (blood thinners). If your personal or family history suggests a hereditary thrombophilia (increased clotting propensity), then you would require an evaluation by a Hematologist. The workup includes blood tests that look for a multitude of possible factors that increase VTE risk. If you have one, the operation can usually be done using chemoprophylaxis.

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Nelson Castillo

Thank you for sharing your question and for performing your research. There are both mechanical and chemical ways to reduce a patient's risk of blood clot formation and based on yours I would recommend seeking out a hematology workup to ensure no genetic issue exists that can be treated prior to, or after, surgery. Hope this helps.

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Susan Buenaventura
ASPS Surgeon
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Congratulations on your weight loss and educating yourself about VTE. Two important factors within your control are body mass index (BMI) and not smoking. BMI if 30 or less is ideal; BMI of 32 is acceptable.. Risks for VTE appear higher in the outpatient/ambulatory setting. Adequate hydration, pain management and patient experience is optimized with an overnight stay. Use of Ted stacking, sequential compression boots, proper positioning ( hips flexed, knees bent) and sometimes lovenox injections post operatively all help. If I have a patient whom I consider high risk I will obtain help from a hematologist. Early ambulatory is critical, and the fact that you have gotten through a previous major procedure without difficulty is a good sign. Make sure you Have a board certified anesthesiologist caring for you.

I hope that is helpful!

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Edward Domanskis

I would highly recommend that you have besides sequential stockings at surgery and until you leave facility, surgery time less than 3 hours and levonox for several days as well as early ambulation. I do this in my high risk patients.

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

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