Do cosmetic surgeons consider estrogen-containing drugs to be of significant risk in the development of thromboembolism?

BACKGROUND

Well-documented evidence shows that estrogen increases the risk of deep vein thrombosis (DVT), and that the effects of DVT are compounded by the stress of surgery and an anesthetic.

METHODS

This study sought to determine the current views and practice of plastic surgeons regarding combined oral contraceptive and surgery. In the United Kingdom, 285 consultant plastic surgeons were identified, and postal questionnaires were distributed to each surgeon.

RESULTS

Of 286 postal questionnaires distributed to consultant plastic surgeons, 53% were returned and analyzed. Most of the surgeons considered combined oral contraceptive and surgery to be a risk factor for DVT, although only 54% discontinued it before surgery. Approximately 50% believed hormone-replacement therapy (HRT) is a risk, but fewer than a one-fourth of surgeons stopped its use before surgery. There was a range of distribution for the length of time HRT was discontinued for surgery. The majority of consultants discontinue HRT use for 5 to 6 weeks before surgery and until full ambulation after surgery. Data retrieved were used to compare documented evidence relating to combined oral contraceptive and surgery and its association with DVT.

CONCLUSION

This survey shows that the management of patients taking estrogen-containing medication before plastic surgery varies, and guidelines regarding this should be sought.

Estrogen and thromboembolic disorders: should patients stop hormones prior to cosmetic surgery?

Oral contraceptives and replacement estrogenic hormones have been associated with a significant risk of thromboembolism. Cosmetic surgery consists of elective procedures in otherwise healthy individuals. The prospect of thromboembolism should be diminished in these patients by avoiding those factors that may give rise to the problem. Stopping oral contraceptives and replacement estrogens three weeks before surgery to two weeks after surgery is not difficult for most patients and should be part of the custom and practice of all cosmetic surgeons.