Whether the top surgery that you will be undergoing is female-to-male (FTM), female-to-nonbinary (FTN) or male-to-female (MTF), you are hoping that your results will be exactly what you want.
And, it goes without saying: you also want your surgery to be done as safely as possible, minimizing the risk of complications.
Obviously!
Numerous factors can play a role in the likelihood of experiencing surgical and anesthetic complications. Exploring every one of these in detail is not the purpose here. The one that will be reviewed here relates to medications.
It is well established that various medications can increase the risks for complications during the postoperative period as well as during general anesthesia or sedation.
The following will present the more common medication classes that need to be addressed prior to surgery. It is not all inclusive. Other medications, like insulin and steroids, need to be specifically addressed on an individualized basis.
A caveat to the information below is that it should not be taken as gospel. There may be variations in time frames, whether for before or before and after surgery, that still may end up generally with similar rates of complications. There also will be disagreements regarding certain specific medications or even their dosages. Ultimately, you should follow the guidelines of your plastic surgeon.
Blood Thinning Medications
What is a blood thinning medication?
In essence, it is a medication that affects the body’s ability to form a clot normally in response to an injury or surgery. Consequently, taking such a medication can lead to problematic postoperative bleeding as well as extensive bruising that could require another trip back to the operating room in order to address.
For example, when you cut yourself shaving, the bleeding typically stops quickly due to your body forming a clot in response to the injury. If you were taking a blood thinner and cut yourself shaving, it can take several minutes or longer for the bleeding to finally stop.
As you can imagine, taking blood thinners and undergoing surgery is NOT a good combination. You can have excessive bleeding during surgery – not a desired occurrence. After surgery, this can lead to the development of what is called a hematoma – the accumulation of blood in the tissues. This often leads to the need for surgical evacuation – another procedure.
The most common blood thinning medications are aspirin and aspirin containing formulations and the NSAIDs. Examples of the latter include ibuprofen, Motrin, Advil, Aleve, Naproxen and Naprosyn. Presently, there are over 90 medications that fall into this category.
Though there are various recommendations as when to restrict these medications, the general consensus is to stop them 10 – 14 days before surgery until at least 10 – 14 days after surgery.
However, if you are on blood thinners for a major medical reason, this will need to be addressed on an individualized basis. This can also include determining whether or not you are an appropriate candidate for surgery. Fortunately, this issue is one that is virtually never faced by those individuals seeking top surgery.
GLP-1 Agonists (Medications for Diabetes and Weight Loss)
This class of medications was originally used in the treatment of Type 2 diabetes. It is now far more commonly (and popularly) used in the treatment for weight loss. It includes medicines such as Ozempic, Wegovy and Trulicity.
Though all medications have side effects and risks, this class of pharmaceuticals can place a patient at substantial risk who is undergoing a procedure under general anesthesia or sedation. Without going into great detail, these medications exert their therapeutic effect by delaying the emptying of the contents of the stomach. That means that even with the appropriate fasting prior to undergoing a general anesthetic, there is an increased risk for aspiration – meaning that the contents of the stomach can get into the lung. This can result in pneumonia and even death.
Consequently, this medication must be stopped at least one week prior to surgery that will be performed either under general anesthesia or with sedation (twilight anesthesia).
Medication for High Blood Pressure
Certain classes of medication used to treat high blood pressure (hypertension) can increase risks for patients having either general anesthesia or sedation. These include the Ace inhibitors, Angiotensin II receptor blockers and diuretics.
If you are taking medication for high blood pressure you may or may not know any of this information.
Don’t worry, though. You are not expected to know it.
Just know what medications that you are taking.
A few examples of these medications include Losartan, Valsartan, Lisinopril, Vasotec and hydrochlorothiazide.
If you are on any of these agents, they should not be taken on the day of surgery.
That’s it.
The important thing for you to do is to inform your plastic surgeon that you are taking medication for high blood pressure and what it (they) is (are). You should then be instructed as to whether or not the medication should not be taken the day of your surgery.
Testosterone and Estrogen
In the not too distant past, it was a somewhat common practice to stop testosterone prior to surgery for those individuals undergoing either FTM or FTN top surgery. The same was true regarding estrogen for those individuals undergoing MTF breast augmentation.
Though some plastic surgeons may still do this, at least to some extent, generally there is no medical evidence supporting the need to stop either testosterone or estrogen prior to surgery for the overwhelming majority of patients undergoing top surgery.
If you have any questions about this, ask your plastic surgeon.
List of Medications to Avoid for Your Top Surgery
We provide all our patients with a thorough list of medications to avoid – either before or before AND after – their top surgery. The specifics are clearly listed.
If you have any questions whatsoever, you are encouraged to ask.
Taking a medication that should not be taken during the specified time period CAN result in cancellation of your surgery.
This is very important.
Your safety is very important to use and we take it quite seriously.
Contacting Us
If you have any questions or want to schedule your top surgery consultation with me, please contact the Arizona Center for Aesthetic Plastic Surgery by either calling (480) 451-3000 or by email.
Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona
