Managing risk of complications in patients over 50 during an abdominoplaty - how should I prepare?

I must be very honest. Once you have had an episode of DVT means you have in your body the genetic or the tendency to develop clots and clots may travel as emboli. The risk of pulmonary embolism is higher in procedures which the intrabdominal pressure will increase as is the abdominoplasty.
So you must be covered by your medical insurance if you want to still proceed with your surgery.
Must stop hormones couple of months before surgery and do cardio as exercise to improve blood supply amongs tissues.
Be encouraged.
Dr. Cárdenas

Dear yetigrrl,

Your situation is unique, given your medical history, and it's crucial to approach an abdominoplasty with a clear understanding of the associated risks and preparations needed. Here are my recommendations for preparation and the kind of questions to ask your surgeon during your consultation:

Discuss Your Medical History: Make sure your surgeon is aware of your entire medical history, including your history of DVT, endometriosis, and hysterectomy. Ask about how these conditions might affect the procedure and what precautions will be taken to mitigate any additional risks.

Estrogen Usage: Discuss your estrogen usage with both your surgeon and the physician who prescribes your hormone therapy. In some cases, you may need to discontinue use prior to surgery, but this should only be done under the guidance of your healthcare provider.

DVT Prevention: Given your history of DVT, ask what steps will be taken to prevent a recurrence during and after surgery. This may include medications, compression devices, or early mobilization post-surgery.

Fitness and Nutrition: Engaging in regular exercise and maintaining a balanced diet can help your body prepare for surgery and aid in recovery. If you're not already doing so, consider starting a regimen that includes both.

Pre-Surgery Testing: Depending on your medical history, your surgeon may recommend certain pre-surgery tests. Ask what these might be and when you should have them done.

Recovery Plan: Understand what to expect during recovery — how much help you'll need at home, when you can return to work, and when you can resume normal activities.

Revisions and Complications: Ask about the risk of complications and the potential need for revision surgery.

If a loved one with your medical history was preparing for an abdominoplasty, I would urge them to take these steps and discuss these questions with their surgeon. Remember, your health and safety are of the utmost importance.

Sincerely,

Dr. Katzen

Thank you for your question. Each Surgeon will have their own pre surgical recommendations for patients. In regards to helping prevent DVT's, it is normally recommended to stop all hormone replacements minimally 2-4 weeks before and after surgery. Increasing Vit C and Iron are always helpful to help boost the immune system. Being done in the hospital maybe a suggestion/ requirement with the history of having DVT's. Hematology clearance and possibly blood thinners post surgery maybe recommended. I would suggest speaking with your Surgeon and following their recommendations. Best of luck to you.

Hi yetigrrl,
Patients with personal history of deep vein thrombosis can safely have plastic surgery, but only after a complete and thorough discussion with yourr surgeon about the risks and benefits. Sometimes, these conversations result in surgeon and patient deciding to move forward. Sometimes, these conversations result in surgeon or patient deciding that moving forward is not the best option. Being 100% transparent with your surgeon about your medical history is a helpful place to start.
Many surgeons will perform individualized risk stratification for blood clot risk, using something called the 2005 Caprini score. This score creates a personalized risk score, which can be used to help estimate your risk for clots. In addition, completion of the score can identify risk factors which potentially require additional workup or can be directly modified in the preoperative setting. This can potentially further decrease, but not eliminate, your risk for blood clots around the time of tummy tuck.
Once optimized, and assuming you are having surgery, in the operating room your surgeon will likely use sequential compression devices. These help to keep venous blood from pooling in the lower extremities during your surgery, and their use for surgeries under a general anesthetic is known to be associated with decreased risk for clots.
There is a linear relationship between time spent in the operating room and risk for blood clots. As such, you should carefully consider with your surgeon the risks of adding additional procedures to a tummy tuck.
Abdominal plication, or the right to left tightening the 6 pack muscles, hopes to accomplish the improvement in the core shape which many women her looking for. This tightening can also increase her risk for clots by increasing her intra-abdominal pressure and thereby making it more challenging for blood to get out of the lower extremities. The role of plication for you would be important to discuss with your surgeon.
After surgery, early ambulation (walking) will be very important. Avoiding dehydration is important as well.
In terms of postoperative care, I would discuss your baseline risk and personal history of deep vein thrombosis with your surgeon. She or he may elect to put you on a postoperative blood thinner, after a careful discussion with you about the benefits and risks. of note, your surgeon will have to generalize data from inpatient plastic surgery patients in order to discuss the potential risk reduction that she would receive from a blood thinner. Full discussion of the risks of the blood thinner, namely bleeding, would be important to discuss as well.
The attached link will send you to a recent review article written on this topic, specifically blood clot risk identification, modification, and reduction (but not elimination) in the aesthetic surgery population
Hope this helps.
Best,Christopher Pannucci, MDBoard Certified Plastic SurgeonPlastic Surgery NorthwestSpokane, Washington

Thank you for your question.Yes it is possible to have this procedure at your age. But first, for safety reasons, to be a good candidate for the procedures you want at the same time, your labs and cardiovascular preoperative evaluation must be optimal.

Kind Regards,
Dr. Emmanuel Mallol Cotes.-

I recommend a consultation with your hematologist when I see patients with DVT history. Keep that separation for DVT prevention and management so that the plastic surgeon can focus on what he or she is good at. Certain things can be done during surgery to minimize DVT risk but it is not 100% and early ambulation is the key. The other key is going to a plastic surgeon who can get you the cosmetic outcome you are aiming for. Not a tummy tucks are the same and not all surgeons have the same technique- so do your homework and go with the surgeon who gets great outcomes and who you get along with. Best Wishes!!

First, it needs to be determined why you had a DVT, i.e. provoked or unprovoked. Next, a full assessment and grading on the Caprini scale would indicate just how likely a DVT/PE would be after a tummy tuck. Assuming it was provoked, and that you have a Caprini grade greater than 7 (I think you do), then a prudent surgeon would most likely use a 'fractionated heparin' like drug to thin your blood after surgery for about a week.

There are typically precautions used to reduce risk of blood clots that most surgeon use. I would ask your surgeon specifically. Also have you been tested for Leyden factor? It could be related to your previous clot.

Make certain that your plastic surgeon knows your entire medical history. You would need to have medical clearance from your primary physician. Your primary physician should do a full history and physical as well as run the appropriate labs and tests. Questions in regard to your previous DVT would need to be discussed. Also patients on estrogen/hormone therapy will need to stop the medications usually 4 weeks before and 4 weeks after to decrease the risk of having a DVT.

Hope that helps.

Dear yetigrrl,
every plastic surgeon has his own preoperative protocol which he recommends to his patients. I would suggest you to discuss this with your plastic surgeon.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery