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7 Things You Should Know When You Are Considering Breast Augmentation

Sep 1, 2007
Many of the patients that I see in consultation have small breasts that they want enlarged. They also may have a problem with sagging of what little breast tissue they have. This is more common in women who have had children and in women who had had significant fluctuations in weight.

Evaluation of these patients includes looking at the texture of their skin, to see if there are stretch marks, noting significant underlying damage to the skin's ability to tighten . In addition, it's important to look at the shape of the breast, the areolar size, the asymmetry of the breasts, and the age of the patient.

1. The truth about implants. Contrary to what you may think, the majority of plastic surgeons would choose silicone over saline for patients. This prevailing opinion is agreed upon by 9 out of 10 plastic surgeons.

Currently, the implant manufacturers are using gel that is even thicker. They call it "cohesive gel" because it is designed not to leak out in case of a disruption in the outer shell.

As the size of the implant increases, it becomes more difficult to disguise it. Women are selecting larger implants than ever before and they need to know that their body can only camouflage a certain size implant before it becomes obviously "un-real". My consultation with every patient includes a discussion that specifically compares their body and breast type with the implant size that they choose.

2. "What happens to my breasts with age?" Breast tissues age just like other tissues of the body. The skin stretches out, the fibers that hold the internal tissues together weaken, the milk-producing gland tissue enlarges and shrinks with each menstrual cycle and pregnancy, and the fatty tissue varies with weight changes.

Insertion of a small or moderate breast implant behind these tissues will be accommodated well and will improve the shape of the breast in most cases; however, larger implants are also heavier, and they will produce a greater degree of stretch to the tissue, thereby causing it to weaken over time.

Brassiere sizing is not constant. Although the brassiere manufacturers set up a standard sizing system, they do not adhere to it. A 34C bra bought from Victoria's Secret is much smaller than a 34C bought from Target. We are, however, accustomed to describing breast size in terms of bra size.

It is better to discuss your desires with a surgeon based on the look that you want rather than the bra size. Bring in photographs of topless models, ask to place sample implants inside a bra that gives you the look that you are hoping for, or visit websites that show examples of patients that have undergone breast augmentation.

3. "Is the surgeon peer reviewed?" Peer reviewed means that the surgeon has privileges to do breast augmentation at a hospital or surgical center where other surgeons also operate at. To obtain those privileges, the surgeon must submit an application that is reviewed by other qualified surgeons. These other surgeons have been selected to give privileges only to new surgeons that perform skilled surgery.

A board certified plastic surgeon can only be certified in America by the American Board of Plastic Surgery. Other boards exist that certify dermatologists, facial plastic surgeons, cosmetic surgeons, gynecologists etc. They are not truly plastic surgeons although they may perform plastic surgical procedures and may call themselves plastic surgeons.

"Should a non-plastic surgeon do my surgery?" If you decide to work with a non plastic surgeon, you should check up on the surgeon's qualifications.

How many years has the surgeon been in practice? It is always reassuring to know that the surgeon has been practicing for some time, and that he performs a considerable amount of surgery. How many cases does the surgeon do per year? If the surgeon is using his own operating room, you must ask if it is certified by one of the accepted certifying agencies. These organizations maintain standards that ensure safety, quality and experience.

4. "Who puts me to sleep?" There are several methods used for administering anesthesia. If an anesthetist is supervised by an anesthesiologist (M.D.) on the premises, you have nothing to worry about. If the anesthetist is supervised by the surgeon or by an anesthesiologist that is not physically present, you should think twice about surgery performed in that location.

You want your surgeon to focus on your surgery and not to be distracted by the responsibility of the anesthesia. Some rural hospitals allow anesthetists to provide anesthesia without supervision. Personally, I would not allow an unsupervised anesthetist to give me anesthesia, unless it was a dire emergency.

Anesthesia is a drug induced mental state that allows surgeons to work without you experiencing pain. These drugs can and often have other effects. Some drugs may cause postoperative nausea and vomiting. Usually this will resolve in a day or two, although occasionally patients say that they remain mildly affected for up to two weeks after surgery.

Newer drugs and techniques are developed every year, usually because they do the job better and with fewer side effects. It is the sole job of the anesthesiologist to keep up with these drugs and techniques, so that your anesthesia goes as smoothly as possible.

5. "Why do prices vary?" The cost of the surgery is a combination of three charges. The first of the charges is the surgeon's fee. The surgeon's fee will include the operation and all of the office appointments. Do not underestimate the office appointments.

Most surgeons will allow you to return annually at no charge to check up on your implants and to examine your breast tissue. Take advantage of this benefit. If you go out of town for your surgery, you are giving up that benefit. The surgeon's fee will also include the price of the implants. Some surgeons include medications while others ask you to fill a prescription. This can amount to $100-200.

The second charge is the operating room fee. Surgeons that use a surgical center or a hospital will tell you that fee, and you will usually pay it directly to the facility. Surgeons that use their office for the surgery will not usually describe this fee specifically; it will be part of the "inclusive fee".

Food for thought: Surgeons that run their own operating room have been tempted to cut corners to save expenses. Again, be sure that the operating room has been certified.

The third charge is the anesthesia fee. Usually the same billing methods apply as for the operating room.

Why is the cheapest quote definitely not the best? There are some things that add cost to the surgery, which are well worth the extra expense. Yes, you can have a breast augmentation surgery without these things, but you will be sacrificing something. The sacrifice may be a safety feature or it may be a less optimal appearance of your breasts.

Allow me to give some examples. There are many types of implants. Silicone implants cost more than saline implants. Some implants have a separate saline and silicone compartment. Implants are shaped differently. These are for special situations. They are more expensive to produce and therefore they sell for a higher price.

Your surgeon should tell you about these special implants if he feels that they will be a better choice for your particular situation. Your surgeon should also tell you if your breasts will require additional work, such as a breast lift, to obtain the optimal result. This additional work will add more time to the surgical procedure and therefore the cost of the surgery will increase.

An anesthetist is not as costly as an anesthesiologist. Some surgeons cut costs in their own operating room by using anesthetists. Always consider the "what ifs", because surgery is not without risk. Be comfortable that your surgeon is well trained and strives to have as few complications as possible. Complications do occur and will often lead to additional expenses.

If you go out of town for your surgery, you will have to travel again to treat a complication should it develop. Or you will have to go to another surgeon closer to home to treat the complication. It is the best policy to choose your surgeon wisely. Try to avoid shopping for the lowest price surgeon.

6. "Do I want to buy the extended warranty?" Did you know that all of the implant manufacturers have a warranty for their implants and that they sell an extended warranty for an additional fee? As I have said above, no medical devices including breast implants last forever. Breast implant manufacturers offer a very generous warranty.

They realize that their product is chosen as a lifestyle luxury. You will not see this type of warranty from any other type of medical device manufacturer. The breast implant manufacturers will replace the implants, if anything goes wrong with them, for your entire lifetime.

In addition, for several years after implantation they will also reimburse some of your expenses for the other costs of the second surgery. The extended warranty that can be purchased increases the amount of reimbursement and lengthens the period of time that the reimbursement is available to you. So how do you decide if it is worthwhile to buy the extended warranty?

Most consumer advocates will agree that extended warranties are generally not worth the expense, and merely serve to make greater profit for the seller. However, there are always certain situations that can make it worthwhile. I will tell you my personal opinion regarding the extended warranty for breast implants.

Most plastic surgeons want to have happy patients that will return to them in the future. If one of our patients has an implant problem, such as a leaky implant, also called a deflation, we will usually perform the second surgery, even if it is many years later, for a minimal fee. However, if another surgeon performed the first operation, the surgical fee for the second surgery can be higher than the original surgery.

Therefore, if you think that you may not be able to return to your original surgeon in the future, e.g. you have plans to move elsewhere, it may be prudent to purchase the extended warranty. Conversely, if you traveled a distance to an outside surgeon, you may want to consider purchasing the extended warranty.

Remember the warranty only applies if there is a problem with the implant. If in the future, you wish to change implants for a larger size, you will have to pay for the new implants.

7. "Do I like the surgeon?" Answer this question immediately after your consultation. You may have gone to the consultation because of a recommendation by a friend. Do not let that influence you. You should feel comfortable with the surgeon. You need to be able to openly discuss exactly what you want. You need to feel that you can ask as many questions as you desire. You should not feel as if you are on an assembly line or that the surgeon is too busy to give you adequate time and consideration.

Many surgeons are busy and often run late with their patient appointments. However, if the surgeon gives you all of the time that you want when you are in the initial consultation, you should be reassured that you will not be shortchanged at your following appointments.

If the surgeon treats all of the patients equally well, there will be other patients that need more time or have more questions for him than his schedule has allowed for. If he is running late because of spending extra time with another patient, you can be assured that he will give you extra time when you need it.

Do I like the surgeon's staff? Many of your interactions will be with the other members of the staff. Be sure that they are friendly, knowledgeable and sincerely want to help you. The type of staff in a medical office also speaks volumes about the personality of the surgeon.

If you have made it this far, you must truly be interested in having a breast augmentation. Doing your homework will bring you to the day of surgery with a comforting feeling that the surgery will give you a new figure that will last you a lifetime.
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