Can I undergo plastic surgeries despite having antiphospholipid syndrome or is it a death sentence for my dream?

[Strawberry_999]

This post is a bit long. If you aren't interested me going on about why I might not have this condition and why I might still be a good candidate for plastic surgeries even if I have APS, just skip to paragraph 6.

1.Hi everyone, I am a 22-year-old woman who is suspected of having APS. I am going to see a specialist on December 20th and he's going to find out whether I actually have APS or not.

2.What I find strange is that I have never had any blood clots, thrombosis, etc. even when circumstances in my life were conducive to symptoms manifesting themselves or to the syndrome flaring up in general.

3.I used to be very obese so much so that my family practitioner said that if I didn't lose weight I wouldn't be here in five years anymore. (Back then neither he nor I knew that I might have APS.)

4.Also, back in 2021 I had COVID-19 which is known for making latent conditions active or already active conditions worse.

5.I also have hormonal issues which require me to take estrogen which can cause APS to get worse too. There were times when my estrogen levels were dangerously high. In fact, my endocrinologist even urged me to go off estrogen for 4-6 weeks. During those times, I could have easily gotten thrombosis or anything that's linked to APS and yet, nothing happened. So who knows, maybe I don't have APS but I'll let the specialist do his job because I am a layperson after all.

6.But that's beside the point: I really want to get five plastic surgeries in order to feel comfortable in my own skin and I am so terrified that having APS is going to dash my dream of undergoing those five cosmetic procedures.

7.If it's of any relevance, these are the five surgeries I'd like to get done:

1. Facial Feminization Surgery: I was born a woman but I still have masculine features that I'd like to have eliminated because they make me depressed.

2. Saggy skin removal. In the past 2 years, I have shed a substantial amount of weight and now I have some loose skin on my stomach, thighs and arms.

3. Removal of the floating ribs.

4. Buttock augmentation with implants

5. Breast augmentation with implants.

8.Here's some general information about my current life style:

-I watch what I eat.

- I walk 4 miles a day at a brisk pace.

- I don't smoke.

- I don't do drugs.

- I don't consume alcohol at all. I hate the way it tastes.

- And now I have completely removed foods loaded with vitamin K out of my diet. (Even though I love broccoli and brussel sprouts. )

Do you think I can still undergo those surgeries or not? 😔

[lupus-support1 Administrator]

Welcome!

I am very sorry to read your story. No one here can advise you other than to give you this message: only your medical specialists can advise you.

First, see your specialist to determine whether you have APS & what risks you would face having cosmetic procedures.

Second, to see a plastic surgeon, the best you can find. These specialists will be attached to teaching hospitals.

You should also seek help from you GP or primary practitioner as the first.

Please don’t take any advice other than from a medical practitioner.

With good wishes,

Ros

[Strawberry_999 in reply to lupus-support1]

Thank you for the answer.

[HollyHeski Administrator]

Ok I hear you - no one including me should judge! We are so unique with our APS that only you and your specialist can advise?!On a personal note - do what you believe and trust is the right thing for you?! Weigh up risks and then decide - we have all had to make that decision one way or another in our lives. Good luck xxx

[Strawberry_999 in reply to HollyHeski]

Thank you.

[Jumper99]

I think you need to get a definite answer on whether or not you have APS before thinking of other things. Then talk over with your consultant because they would be the only ones who can advise you. You need a knowledgeable consultant to discuss the dangers with you, both of oestrogen and of having operations.

Completely removing the intake of all vitamin K from what you eat may reduce the likelihood of a clot but it could cause other problems as vitamin K is needed by the body for other things too. Please discuss this with your doctor.

[Strawberry_999 in reply to Jumper99]

Thank you

[user666 in reply to Jumper99]

Do not remove vitamin K ! Even if on warfarin doctors advise you eat at least the daily recommended amount and adjust your warfarin dose accordingly. Warfarin patients who eat consistently high amounts of K are in range with their INR more often than those trying to avoid it and their health is better too.

[Strawberry_999 in reply to user666]

Thank you. Do you think I'll be able to get all those surgeries?

[user666 in reply to Strawberry_999]

People on warfarin often have elective surgery. We bridge off of warfarin and use lovenox injections before and directly after surgery so yes I think you should be able to get the elective surgeries. Good luck.

[Strawberry_999 in reply to user666]

Thank you so much! 🥹♥️

[GinaD]

Vita,in K is not the enemy. In fact, K has a lot of work to do inside your body. Do speak to a doc who has experience in treating APS IF follow up tests confirm you have it. I make sure I eat vitamin K every day -usually 2servings of spinach, kale, brocolli ot brussel sprouts. I take a midly fluctuating dose of warfarin I have had 3 joint replacements and each time i " bridged," which is a procedure wherein the patient switches in a timely manner to injectible anti-coagulants that have a short life span, ( And no, I know injectable drugs are not alive, but using the word " life span" seemed applicable.) So... don't despair. Make decisions in order. First step is to confirm you do or don't have APS.

[Strawberry_999 in reply to GinaD]

Thank you. But can I still undergo those surgeries even if I have APS?

[GinaD in reply to Strawberry_999]

Maybe But you should, again, consult with specialists who can evaluate your individual situation.

[Strawberry_999 in reply to GinaD]

Thank you.

[Lure2]

What Doctor has told you you may have APS? On what grounds?

They do blood tests of Kardiolipin, Beta-2-Glycoprotein 1 and Lupus Anticoagulans twice within a 12 weeks period to determine if you are positive to one, two or three of the antibodies.

We need a Specialist of APS as this is a very rare illness and so few Doctors know about it.

Wait for December 20. If he is a Specialist he knows you must take those blood tests to start with.

Good Luck from Kerstin in Stockholm

[Strawberry_999 in reply to Lure2]

Hi Kerstin. Thank you so much. My endocrinologist had a lab run two blood tests within 12 weeks and both showed that the antibodies were present in my blood in an amount that's a bit higher than the normal range. However, my endocrinologist noted that the lab wasn't fully equipped to make a definitive diagnosis. That lab is used to detect the possibility whether someone has a disease or not. So it's kind of like a Jack of all trades but a master of one. So now there's only a suspicion that I might have APS and the specialist will confirm whether I actually have it or whether it was just a false alarm because as I said patients taking estrogen in any form can have a larger amount of antibodies in their blood but still not have APS.

[user666]

Without a clotting incident it is unlikely you will be treated with warfarin. All surgery comes with clotting risks and often patients without APL antibodies are put on blood thinners afterwards to prevent issues.

Your heart and liver health will matter more than your APL status in determining if you qualify for surgery. Your plastic surgeon will do the necessary preopt evaluation for you.

[Strawberry_999 in reply to user666]

Thank you. Fortunately, I don't have any liver and heart issues.

[user666 in reply to Strawberry_999]

People with APS are candidates for elective surgery so just make sure your surgeon knows all of your health history. If you are put on warfarin then you would need to bridge off of it and use lovenox injections before and after surgeries. Good luck!

[Strawberry_999 in reply to user666]

Thank you so much! 🥹♥️

[KellyInTexas Administrator in reply to Strawberry_999]

It is certainly not the case that “all people with APS are candidates for elective surgery”; however, the rest of the statement certainly applies and would have been asked on your health history questionnaire.

Case in point, I have been told by APS specialists that I am only to have surgery that is life saving, and only then after careful consideration if it’s truly the only option.

This highlights the point the APS is a spectrum disorder. It’s not a one size fits all- what may be true for one patient might not be true for another.

Make sure whoever you consult is well versed in APS, and consults with your APS specialist ( including hematologist and anesthesiologist) before any action is taken.

If it is deemed you do have APS, ( by a qualified APS specialist) I would also ask for an additional consultation ( even if you’ve already been seen by one before) in endocrinology of your rheumatologist’s preference.

But as Raw57 says, cart/ horse dilemma… but a plan is nice to have.

[Strawberry_999 in reply to KellyInTexas]

Thank you.

[Raw57]

I think you are putting cart before the horse. If you have not had an unprovoked clotting event or miscarriages 3 times and high positive to APL antibodies or a positive lupus anticoagulant test you will not be diagnosed with APS.

As said above Vitamin K foods do not cause clotting. It may interfere with absorption of Warfarin but can be managed by eating it a consistent amount daily and adjusting dosing as needed.

If you were diagnosed and required to take Warfarin, protocols to prepare for surgery and recovery safely would be prescribed by a hematologist.

Personally, I’ve had more than a dozen surgeries without incidents of clotting. The surgeon and my hematologist work together to create a safe surgery. The surgeries were not plastic surgeries so I cannot speak about how that works. Please chose surgeon who allow open dialogue and answer all your questions happily. Good luck!

[Strawberry_999 in reply to Raw57]

Thank you so much!!! 🥹♥️

[milkwoman]

As others have stated, discussions with a licensed plastic surgeon is the best advice. That being said, I also am suspected to have APS (the tests I have had are mixed so no formal diagnosis; full disclosure, I also have lupus (SLE), Sjögren’s syndrome, hypothyroidism, and I’m on BHRT). I’ve not had any thrombosis or clots.

I have had several surgeries and my surgeon was well aware of the possible APS so I would get a shot of heparin administered right before the surgery. Happy to report there were no clotting issues with any of the surgeries.

I think if you are open in your communication with your doctors about this, it can be managed and you should be able to have your surgeries. They might advise to start with the simplest/shortest procedure to “test the waters” (so to speak).

You seem to be taking very good care of yourself (eating right, exercising, etc) so now does appear to be a great time to approach all that you want to have done surgically. Best of luck!

P.S. FWIW, I take vitamin K2 on a daily basis and have done so for years. No one has ever advised me not to.

[Strawberry_999 in reply to milkwoman]

Thank you so much! 🥹♥️

[Burtie-bengal]

I have obstetric APS so not on blood thinners when not pregnant.

I had a tummy tuck and all my surgeon needed was for me to have a private consultation with a haematologist. He arranged this for me and it cost me around £200 on top of the surgery cost. He also had me take heparin for around 2 weeks after surgery

[Strawberry_999 in reply to Burtie-bengal]

Thank you.