flap reconstruction and history of dvt/pe?

Hi ladies,

I have Essential Thrombocythemia, a condition where my bone marrow over-produces platelets, which was diagnosed about the same time as my bc in 2012.

During my chemo treatments I developed large blood clots in my leg, which embolized to my lungs. My hematologist says it was probably a combination of having cancer, 2 surgeries, then chemotherapy, all of which are risk factors for clotting, quite apart from the high platelets! I had a few months on LMW heparin (Lovenox) injections, and am now still on warfarin.

So now I'm considering TRAM/DIEP flap reconstruction bilaterally, with a prophylactic right mastectomy. I saw the plastics surgeon last week, and he thinks it is a reasonable option, except he was concerned about my blood clot history, and said it was reasonable to assume my risk of flap failure (due to clots forming or lodging in the anastamosed vessels) would be higher than usual, although he was not able to quantify that. 

He wants to discuss my case with my hematologist, but did get me to sign a consent for the surgery. There's no rush to decide, as it seems unlikely to happen this year, but part of me is wondering what the flying f**k am I thinking!? I am adamant that I don't want to remain uni-boobed (rather large, and I am very mistrustful that rightie won't develop cancer too, if it's not there already!), but is it ridiculous to put myself through this huge a surgery, especially if there is a significant risk of failure? I think I could live with being flat if I had to.

Sorry for the long post. I just wondered if anyone out there has had flap surgery after a history of blood clotting?? 

Thanks tlbradyful, for your reply, and Nihahi for bumping me

I've been searching and searching, and although it seems many articles indicate hypercoagulative history or disorders to be a contraindication, or at least a relative contraindication to microvascular surgery, there seems to be no real basis to this except, as my PS stated, it "being reasonable to assume a greater risk of failure". And doctors are reluctant to take that risk in this litigious age, I guess, particularly in North America!

I cannot find any clear evidence that this is the case, although I shall continue to enquire, and to consult fully with my health professionals, possibly seeking other opinions. One paper I did find, however concluded the following:

Conclusion: Pre-operatively diagnosed inherited or acquired hematological disorders are not a contraindication for microsurgery. Peri-operative medical management in close consultation with haematological specialists and meticulous surgical technique allows this patient population to undergo successful microvascular surgery.

http://aahs.asrm.aspn.confex.com/oasys_new/2009/te...

I think I'll go with this at the present time, as it pleases me, and go do something to change the subject for now. I have about four new songs to learn!!

Thanks MartyJ,

I would expect that .... at the very least in my case