Coverlipedema is committed to helping women make informed decisions about the surgeons who will perform their lipedema reduction surgeries. We have prepared some questions that go beyond the basics that should be answered by a surgeon before you decide who will perform your lipedema removal surgery.
Are you board-certified in plastic surgery? If not, in what area are you board-certified?
For the best and safest results, we recommend that your surgeon be a board-certified plastic surgeon. While surgeons who are not board-certified in plastic surgery have treated lipedema patients, these physicians are not typically trained to perform skin excisions after liposuction or perform panniculectomies to address lipedema in the abdomen.
Do you perform surgery in a hospital or a state-licensed setting?
Lipedema reduction surgery can been performed in facilities ranging from a hospital to a surgery center to an office-based setting. Hospitals have the highest standards of care and are generally in-network with most insurance plans. A surgery center that is not state-licensed is usually accredited by an agency with lower oversight standards for infection control, monitoring, and post-operative care. However, surgery centers, which are often owned by surgeons, might not be in-network, and you will be expected to pay upfront. Reimbursement by your insurance might be much less than you paid, but the surgeon will make much more money, raising potenital conflict of interest issues.
Can you admit lipedema patients to a hospital if there is a problem during or after surgery?
Ideally, your surgeon should have hospital staff privileges as a plastic surgeon. Hospitals allow physicians on staff to admit patients only within their specialty. If your surgeon is board-certified in dermatology or vascular surgery, they can only admit those patients, not lipedema patients. Even plastic surgeons might not have staff privileges with a hospital. If you have a complication during or after surgery, your surgeon will not be able to admit you directly. You will have to go to the emergency room first. Of course, in the best of situations, this means delays and exposure to illness. But with COVID restrictions, you could face even greater delays and exposure. Additionally, your surgeon will not be able to continue your care without staff privileges.
Will an anesthesiologist monitor my surgery?
Any type of anesthesia carries risk and should be done in the safest location possible. For large volume liposuction, you might prefer anesthesia be administered by a physician anesthesiologist. Some office-based surgeons use local or twilight anesthesia that they administer themselves without an anesthesiologist present. You should ask to see where the surgery will be performed and ask about monitoring and emergency capabilities. If the surgeon is using an anesthesiologist, you should check their state licensure and ask to speak with them before your procedure about any complications you have had with anesthesia or other health issues. While a nurse anesthetist (CRNA) may be appropriate for many situations, you are more likely to have a physician anesthesiologist in a hospital setting. If you have issues with general anesthesia talk with your surgeon who even in a hospital setting will use other types of anesthesia still under the supervision of a physican anesthesiologist.
How many liters are you removing, and does that warrant 24-hour monitoring?
The American Society of Plastic Surgery Guidelines on liposuction state that regardless of the anesthetic route, large volume liposuction (greater than 5,000 cc or five liters total aspirate) should be performed in an acute-care hospital or in a facility that is either accredited or licensed. Vital signs and urinary output should be monitored overnight in an appropriate facility by qualified staff familiar with the post-operative care of liposuction patients.
Many women with lipedema also have Ehlers Danlos Syndrome (EDS). Standard EDS recommendations for anesthesia and post-operative monitoring recommend that all EDS patients should be monitored for at least 24 hours following surgery. EDS can cause issues with anesthesia (over or under sedation), blood pressure, and bleeding. If you have a risk of bleeding or blood pressure/heart issues, consult with the appropriate specialist before surgery and have any necessary testing.
What type of post-operative monitoring do you recommend?
Post-operative monitoring can range from an overnight stay in a hospital which is best for monitoring and addressing post-operative issues as there are registered nurses, extensive diagnostic equipment and access to physician specialists. In Germany now, lipedema patients typically are monitored in a facility for multiple nights. If you would go to an aftercare center ask and then verify if the center itself is licensed or accredited and whether it’s in network with your insurance. Many insurers will not reimburse well or at all for aftercare while hospitals are usually in-network and bill insurance directly. Ask about whether are are licensed registered nurses or just lower-level nurses on site. Ask whether there is a physician medical director avaialbe 24/7 and what provisions they have for emergencies. Ask how far the emergency room is and whether they have a transfer agreement with an ambulance company or just call 911. Your surgeon should provide his cell phone number and permission to call any time if you are not staying in a hospital under a doctor’s care.
How can I reach you after my surgery?
You, and any caretaker, should be able to communicate with your surgeon anytime after surgery. You may have questions or concerns that should be addressed quickly. Several surgeons provide their direct mobile phone numbers to their patients. If you are in a hospital, the nursing staff should be able to reach the surgeon via pager or mobile phone.
Knowledge is power, and knowing the answers to these questions will help ensure that you have a safe and effective lipedema surgery.