A sad case. A 39 year old woman had extensive plastic surgical procedures — a mommy makeover. This included breast lift, tummy tuck, and other procedures. She died two days later from what the coroner labeled a pulmonary embolism.

Now the lawsuit. The family’s plaintiff attorney alleged the patient was taking oral contraceptives. She was cleared for surgery by her internist.  Both her internist and plastic surgeon were aware of the oral contraceptives.

“The combination of birth control pills with a major surgery of four hours or more is a deadly combination,” Pajcic (the plaintiff’s attorney) said.

Paraphrasing –  that’s common knowledge in the medical field, and if doctors had taken Brooke off her birth control, she’d be alive today.

“It’s shocking to me,” Pajcic said.

We can all agree this is a sad case with a bad outcome. And oral contraceptives do increase the risk of venous thromboembolism.

But, the report is silent on whether the doctor utilized any prophylactic methods against venous thromboembolism – such as compression hose, intermittent pneumatic compression device,  Lovenox, etc.

Furthermore, is it realistic to stop oral contraceptives before any activity that might increase the likelihood of thrombosis? Let’s take air travel. It is recognized that the risk of venous thromboembolism increases on flights greater than 8 hours – (prolonged sitting doesn’t help). There’s an increased relative risk – but the absolute incidence is still quite low. So, are primary care doctors – who learn their patients will be going to Europe – under an obligation to advise stopping the pill. While in Europe, stick to abstinence or condoms. Really?

Maybe the patient in the lawsuit had other risk factors – and perhaps she was a suboptimal candidate for any type of surgery. This will come out in discovery.

For now, the dogma that oral contraceptives should be stopped before a plastic surgery procedure will come as news to most doctors. And that dogma is what will be shocking.