Diabetes and Plastic Surgery

Making Plastic Surgery Safe for People With Diabetes

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Plastic surgeons commonly see people who have diabetes. Diabetes is a disorder in which the body cannot properly use sugar, specifically glucose, which is consumed when eating. Complications from the disease can warrant reconstructive surgery.

What is Diabetes

This occurs either because a person does not produce insulin, as is the case with people who have type 1 diabetes. On the other hand, when a person’s inability to handle glucose occurs because the cells of his or her body do not respond to the insulin that she or he produces is, this is known as type 2 diabetes. With either type of diabetes, the blood sugar or blood glucose levels are higher than normal. A constantly high blood glucose level can lead to many problems. Problems with touch or feeling in the hands or feet (also known as neuropathy), blindness, kidney problems, heart problems, and wound healing issues can result from poorly controlled blood glucose levels.

Diabetics and Wound Recovery

In terms of the reconstructive branch of plastic surgery, plastic surgeons are often called upon to monitor and treat slow-healing or non-healing wounds in diabetic patients. Additionally, some people with diabetes also look to have cosmetic plastic surgery to enhance their appearance. This presents a unique problem to the plastic surgeon.

All types of surgery create a wound or incision. Any time an incision is made on the skin, no matter how small it is, a scar will be created. This is the body’s normal response, known as healing. Plastic surgeons, for better or worse, have acquired a reputation for “scarless” surgery. This reputation has come about not because there are no scars that occur at the hands of plastic surgeons, but because plastic surgeons have more opportunity to hide scars in inconspicuous places on the body. These inconspicuous places include skin creases and areas that are covered by underwear or a two-piece swimsuit. Plastic surgeons are concerned about how their incisions heal in all of their patients. Because complications can arise in a totally healthy patient without any medical conditions, extra care must be taken in patients with diabetes as they may be more prone to wound healing problems.

Can Diabetics Have Plastic Surgery

A person with diabetes can undergo cosmetic plastic surgery if they have tight control of their blood glucose levels. How is good control of blood glucose levels determined? Along with the usual battery of blood work that comes before having surgery, a vigilant plastic surgeon will ask for another specific blood test in their diabetic patients.

This test is known as a glycosylated hemoglobin level, also known as hemoglobin A1c test. A blood sugar level taken at a random moment in the day can come back normal, even in patients that have poor control of their blood glucose levels. A hemoglobin A1c test cannot be “fudged.” This test helps to assess the long-term control of blood glucose levels, specifically how well the blood glucose levels have been controlled in the prior two to three months. This level should be less than 7%. If it is higher than 7%, this is an indicator that over the past two to three months, the blood glucose levels have been too high and the person needs an adjustment in their insulin management.

Additionally, because surgery can affect how the body responds to insulin, it is prudent for a plastic surgeon to work with the doctor managing their patient’s diabetes. Diabetes medications may have to be adjusted in the immediate period after surgery.

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