Reducing Breast Implant Revisions, Reducing Patient Choices

breast revisionThere is a movement in plastic surgery to reduce the frequency of breast augmentation revisions. This is a laudable goal, as revision within the first two years of surgery can be as high as 30 percent. It is especially a problem when a common reason for the revision is that the patient is unhappy with their breast size after surgery. Doing more pre-operatively to "get it right" and avoid revisions prevents unnecessary surgery, limits risk, and reduces costs for the patient. Unfortunately, what can be sacrificed in this process is the woman's chance to select her outcome.

In the past, plastic surgeons would decide in the operating room what they thought was the best implant size for the patient.  This was extremely problematic, especially when the plastic surgeon thought everyone should be proportioned like Barbie. Even in the best cases, the surgeon's tastes might not match those of the patient. This resulted in somewhat of a backlash, where patients began telling their surgeons what size breast implants they should have. These outcomes were also frequently unsatisfactory, as the patient did not have the knowledge, training, or experience to make such a decision.

To reduce the amount of revisional surgeries being performed, plastic surgeons have sought to develop a full-proof system for identifying the proper implant size for a patient pre-operatively.  Several measurements of the patient are made, and then the patient is told what implant size is appropriate for her.  As part of the consent process, the patient agrees to accept a specific size implant.  The end result is that revisions are less common, first because the patient participated in the process, and second, because she agreed to the implant size.  Realistically, it is hard for a patient to demand a revision of a breast implant she helped select and agreed to having placed.

This advance in implant selection has been tremendously beneficial in reducing revision surgery.  However, it has its drawbacks.  First of all, many patients want a certain look after their surgery.  Since implant size is determined by a formula, patients may or may not achieve their desired look. They may be unhappy, but are stuck with the implant they chose.  Second, while participation in implant selection is important, many patients really do not understand what they are agreeing to when they sign a consent for a "300 cc implant."  How many patients know that 30 cc roughly equals one liquid ounce?

Plastic surgery, like any science, moves forward slowly.  One imperfect process is replaced by a better, but still imperfect process. For a patient, the point is to not be so preoccupied with the process of selecting an implant that the ultimate goal of looking the way you want is compromised.  Formulas and systems can improve the implant selection process, but they may generate recommendations that are nothing like the patient wants. While patients need to trust their plastic surgeon's judgement, if they want to be happy with their results, patients need to make sure their desires are heard so their goals can be met.