What it is
Blood clotting is a normal protective process. After surgery, several things push that process too far in one direction: injured tissue releases substances that promote clotting, immobility slows blood flow through the deep veins of the legs, and dehydration thickens the blood.
A clot forming in a deep vein is a deep vein thrombosis. It causes pain, swelling, warmth and redness, usually in one calf or thigh. That is serious in itself.
If part of that clot breaks away, it travels through the circulation to the lungs. That is a pulmonary embolism, and depending on its size it causes breathlessness, chest pain, coughing blood, collapse or death.
This sequence is the reason that early mobilisation is emphasised so heavily after surgery, and the reason that a national framework exists for assessing and preventing it.
Why body contouring is a particular concern
Several features of these operations stack the risk factors together.
- Duration. Body contouring operations are often long, and clot risk rises with time under anaesthesia.
- Immobility afterwards. Pain, drains, compression garments and posture restrictions all reduce movement in the days when risk is highest.
- Abdominal surgery specifically. Abdominoplasty involves tightness that limits deep breathing and movement, and a period of flexed posture.
- Patient factors. Higher body mass index, hormonal contraception or hormone replacement, previous clots, family history, smoking, pregnancy and some medical conditions all add to baseline risk.
- Combination procedures. Which lengthen the operation, as discussed at combination and staged procedures.
- Travel. Long-haul flights independently raise clot risk, which is why surgery abroad places two risk factors on top of one another. Covered at cosmetic surgery abroad.
The assessment you should have
NICE guideline NG89 sets out the national framework for reducing the risk of hospital-acquired deep vein thrombosis and pulmonary embolism in people over sixteen. It applies to surgery generally, and elective cosmetic surgery is surgery.
What you should expect:
- A formal risk assessment before your operation, taking account of both the procedure and your individual risk factors.
- A conversation about what that assessment concluded.
- A plan for prevention proportionate to the risk identified.
- Reassessment if circumstances change.
If nobody has raised any of this with you, that is a significant gap and it is entirely reasonable to ask directly: what is my VTE risk assessment, and what are you doing about it. A provider who cannot answer is not following the national standard.
What prevention involves
Measures are chosen according to the assessed risk and the operation, and a plan may include several of the following.
Early mobilisation. Getting up and walking regularly from the first day. Simple, free and the single most useful thing you can do.
Hydration. Maintaining fluid intake reduces blood viscosity.
Graduated compression stockings. Worn as instructed, and distinct from the compression garment used for the surgical result.
Intermittent pneumatic compression. Calf pumps used during and sometimes after surgery.
Anticoagulant medication. Where the assessed risk warrants it, including in some cases for a period after discharge.
Stopping or adjusting hormonal medication. Some hormonal contraception and hormone replacement raises clot risk, and stopping in advance may be advised. This should be discussed with the prescriber rather than decided unilaterally, since stopping contraception has its own consequences.
Not smoking. Which also affects wound healing.
Symptoms, and what to do
These are the symptoms for which you do not wait, do not phone the clinic in the morning and do not talk yourself out of it.
Suggesting a deep vein thrombosis: pain, tenderness or cramping in one calf or thigh, swelling of one leg, warmth, redness or discolouration. Contact a doctor the same day.
Suggesting a pulmonary embolism: sudden breathlessness, chest pain that is worse on breathing in, coughing up blood, a racing heart, light-headedness or collapse. This is a medical emergency. Call 999 or go to an emergency department immediately.
Tell whoever assesses you that you have had recent surgery, what operation, when, and where. That single piece of information changes how quickly you are investigated.
The risk period extends well beyond discharge. Symptoms appearing two or three weeks after an operation are still relevant, and people frequently dismiss them because they feel recovered.
Flying
Surgeons advise an interval before flying after body contouring, and the interval varies with the operation and with your individual risk. Ask for it explicitly and get it in writing.
Where surgery is being combined with travel, the ordering matters. A package that flies you home within days of a long operation is structuring your itinerary against the clinical advice. If a provider will not tell you their recommended interval before you book, that is informative in itself.
Questions to ask
- What is my VTE risk assessment, and what does it conclude?
- What prevention will I have during the operation and after it?
- Do I need anticoagulant medication, and for how long?
- Should I stop my hormonal contraception or HRT, and who do I discuss that with?
- How long before I can fly?
- What symptoms should I act on, and how urgently?
Why this is the page to read if you read only one
Almost everything else in body contouring is about appearance. This is the part that is about whether you are alive at the end of the month, and it is the part with a national standard, a clear evidence base and a set of preventive measures that work.
It is also the part that receives no marketing attention whatsoever, because there is nothing appealing to say about it. A provider who raises it unprompted, assesses you formally and gives you a written plan is demonstrating something more important than any technique they could name.