Important considerations for diabetics seeking plastic surgery

Diabetic patients, once considered risky for any type of surgical procedure, are now more freely able to pursue any number of elective procedures without fear or doubt. With advancements in blood glucose monitoring and well-established relationships between surgeons and primary care teams, they are now better able to set themselves up for success both pre- and post-surgery.

Yet, with any preexisting health condition such as diabetes, there are some considerations and steps that need to be taken both prior to surgery and immediately following in order to mitigate the associated risk levels.

What steps do diabetic patients need to take? Are there any factors that surgeons need to consider pre- and post-surgery for diabetic patients in particular? To answer these questions and more, we reached out to ASPS Member Surgeon Katherine Hein, MD, a leading expert in this field.

Important considerations for diabetic patients

For patients with type 1 or type 2 diabetes, several factors should be considered prior to pursuing any type of surgery, including plastic surgery. Initially, it's important that patients ensure that they are in good health. This is often achieved by working with their primary care physician to address any outstanding issues, such as unstable blood sugar, prior to reaching out for a surgical consultation.

This can also involve considering other health problems that the patient may have in conjunction with diabetes, such as coronary heart disease.

"Overall, diabetic patients do have a higher risk of coronary heart disease," said Dr. Hein. "If your patient is a 30-year-old diabetic, you might not order an EKG pre-surgery. But for a 45-year-old diabetic who is at higher risk, it will likely be a requirement for surgery."

After taking a closer look at health history, the next step for any surgeon and patient is to examine their chronic and acute blood glucose levels. This is often done in conjunction with the physician helping the patient manage their diabetes.

"The important thing is to always manage these patients with their primary care provider," said Dr. Hein. "You want to make sure that they have had a recent acceptable range of hemoglobin A1C. In addition, you will need to keep really tight glucose control postop – their risk of infection goes up with blood glucose levels over 180."

Another crucial factor to consider for diabetic patients is the recently popular use of injectable GLP-1 medications for the purposes of diabetic treatment and to aid in weight loss.

"Some of the newer injectable GLP-1s are often used in combination with other treatments for diabetes," said Dr. Hein. "These medications need to be stopped approximately a week prior to surgery. They can slow gastric emptying, which increases the risk of aspiration for patients during the procedure. If patients are using them to help control their diabetes, we will also need to have increased blood glucose monitoring prior to and following surgery."

Another factor to consider is the rate of infection post-surgery for diabetic patients.

"For diabetic patients, the infection rate is higher if their blood glucose rates are higher," said Dr. Hein.

Patients run the risk of increasing their chances of infection following a surgery if blood glucose levels are mismanaged. This is why it's extremely important to monitor this closely throughout the process for both patients and surgical teams.

The preoperative and postoperative process for diabetics may seem daunting and extremely comprehensive, but it's important to remember that when used effectively, closely monitoring blood glucose levels and tapering GLP-1s can actually help to mitigate much of the risk for diabetic patients.

"If you are highly attentive to glucose control and you know that their diabetes is well-controlled, these patients are not as high-risk for these types of procedures," said Dr. Hein.

With the right team in place to help manage glucose levels pre- and post-surgery, patients with diabetes can be set up for success and the amazing results they've been dreaming of from the onset.

"We will typically work closely with their primary care provider to manage diabetes medications and blood glucose levels. It takes a lot of teamwork," said Dr. Hein.

Common procedures for diabetic patients

Since diabetes is not necessarily a hindrance to plastic surgery, there has seemingly been a resurgence of patients seeking these procedures in recent years. No one procedure is more common than another for those patients with diabetes, but there are some that can be correlated.

"Some of the massive weight loss patients that we see are current or past type 2 diabetics," said Dr. Hein. "They will often come in for skin removal procedures post weight loss."

Modern advancements in blood glucose monitoring mean diabetes is no longer stopping patients who are considering pursuing plastic surgery. Once considered challenging due to higher rates of infection with poor blood glucose management, diabetics can now actively pursue any number of elective surgeries with good health and proper supervision from medical professionals, which includes a board-certified plastic surgeon who is an ASPS member.

If you have consistent chronic and acute blood glucose monitoring, appropriate hemoglobin A1C levels and a close partnership between surgeons and primary care providers, you can be set up for success and amazing results with any plastic surgery procedure.

To find a qualified plastic surgeon for any cosmetic or reconstructive procedure, consult a member of the American Society of Plastic Surgeons. All ASPS members are board certified by the American Board of Plastic Surgery, have completed an accredited plastic surgery training program, practice in accredited facilities and follow strict standards of safety and ethics. Find an ASPS member in your area.