Abdominoplasty consult

Identifying Information:  
Thank you for your referral of Emily Carter for Plastic Surgery Consultation. She was examined on December-01-2025.  

Clinical History:  
Ms. Carter presents for further discussion and planning regarding abdominoplasty in the context of ongoing reconstructive surgical needs. She is interested in combining a medically indicated procedure with an elective abdominoplasty. She has a history of deep vein thrombosis (DVT) triggered by prior surgeries, for which she has used postoperative anticoagulation for approximately one month after each procedure, with good effect and no recurrence. She is not currently on long-term anticoagulation but acknowledges that another thrombotic event would necessitate indefinite therapy. Ms. Carter reports ongoing difficulty achieving weight stability, attributing this to hormonal factors since her cancer diagnosis. She inquires about the definition of weight stability and expresses concern regarding fluctuations related to dietary interventions. She continues to attempt weight reduction prior to surgery. She denies any history of noncompliance with prescribed medications or follow-up appointments and reports no additional functional or psychological symptoms related to her surgical planning.  

Past Medical History:  
- Bilateral mastectomies (2021)  
- Radiation therapy to the left chest  
- Completed chemotherapy  
- History of deep vein thrombosis triggered by prior surgeries, managed with postoperative anticoagulation  
- No radiation on the right side  
- No current chemotherapy  

Past Surgical History:  
- Bilateral mastectomies (2021)  
- Two subsequent plastic surgical procedures for residual skin and contour irregularities  
- Fallopian tube removal  
- Gallbladder surgery  
- Laparoscopic appendectomy  

Allergies:  
No known allergies  

Medications:  
Synthroid, Aspirin. No current use of blood thinners.  

Physical Examination:  
No muscle separation noted. No hernia observed. No masses or rectus diastasis. No particularly thick scars observed on the chest. Abdominal circumference is 111 centimeters. Waist circumference is 101 centimeters. Hip circumference is 121 centimeters.  

Investigations:  
None  

Plan:  
After having the patient redress, discussed the surgical management plan for abdominoplasty in conjunction with ongoing reconstructive needs. The purpose of the abdominoplasty is to remove excess skin and fat and to address any muscle separation if present, although none was noted in this case. Risks reviewed include bleeding, deep vein thrombosis, pulmonary embolism, wound infection, wound healing problems, and permanent numbness in the lower abdomen. Longer-term concerns include scar quality and the potential for thicker scars in areas of delayed healing. Alternatives discussed include performing the procedures separately or conducting all procedures in a private clinic, which would significantly increase costs. Recovery involves staying in xxx for a couple of nights postoperatively to monitor for complications such as bleeding. Early mobilization and the use of calf compressors are recommended to reduce the risk of deep vein thrombosis. Follow-up care includes monitoring for calf pain or signs of DVT, with imaging such as ultrasound if necessary. Weight stability is emphasized as critical to ensure the longevity of surgical results, as significant weight changes postoperatively could lead to additional loose skin. A referral to xxx will be sent to assist Ms. Carter in her weight loss efforts. A quote for abdominoplasty will be provided, and booking for her chest scar revision will continue.