This week, James E. Craigie, MD, of The Center for Natural Breast Reconstruction answers your question.
Question: My Dad had a DVT 5 years ago—it was out the blue no known cause. I had a consult online with PRMA and another doctor who asked for “blood clotting" blood work to be done because of my fathers history. It came back showing the Factor V Leiden and activated protein C resistance. I personally have not had any problems with clots, DVT.
Answer: Many people can have abnormal clotting tendencies and never know it. There are different kinds of disorders and some factors can increase or decrease for different reasons. Many of the clotting abnormalities are grouped together and referred to as a condition called thrombophilia. The concern is that people who are positive for thrombophilia have an increased risk for DVT (like your father)—especially during or after surgery. A DVT is a potentially life threatening condition as you may already know. The blood clot can possibly cause a pulmonary embolism.
The other concern associated with thrombophilia and DIEP breast reconstruction is an increased risk for failure of the tiny blood vessels that we connect under the microscope to stay open after the microsurgery. Clots can form and may prevent the new breast from receiving the blood supply that keeps the new breast alive. This can happen in patients without thrombophilia. There is no consensus on the exact risk when it comes to procedures like DIEP breast reconstruction. In our practice we have had patients with factor V leiden and protein C resistance successfully have DIEP surgery with no problem. We treat all of our patients as if they potentially have thrombophilia by giving them a light blood thinner(lovenox) before and after surgery. This is the most effective way to reduce the risk of a DVT. Also if we know a patient is positive for thrombophilia before surgery, we always have them seen by a hematologist before surgery. There are many different types of thrombophilia and some of the factors increase and decrease depending on other medical factors. This allows us to determine if the risk is relatively high or low. If its high we may wait until it goes down. Also the treatments may change and the hematologists are the experts at keeping up to date with any changes in the treatments or tests and can look at your labs and determine your precise risk.
I personally am reviewing our practices experience with 1184 breast reconstructions with DIEP, GAP and PAP procedures. Our overall success rate is 98.5%. Of the patients who have had a flap (DIEP) failure at least one had factor V leiden thrombophilia. If someone has a thrombophilia it is most likely that they have a higher chance than normal of losing a flap (DIEP). It is important to know what the “normal" risk is for any practice that offers these procedures. In that one patient however she also had a successful flap at the same time on the opposite breast, and later went on to complete her reconstruction with a third flap procedure. Again, all our patients that we have known before surgery that they had thrombophilia have done well. We also know that some patients have had it and we never knew. So I would recommend getting the advice of an hematologist before surgery, but would not say at this time that you could not have DIEP breast reconstruction. Please send me any questions you might have.
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