On occasion patients desire "touch-up" surgery to improve the results of prior surgery. Usually for my good clients I discount this surgery. If patients come to the table without being nasty, they tend to get this pretty inexpensively. When they are indignant (fortunately for me this is very rare,) I show them the door. Be nice and it will likely all work out.
The bottom line is that this is a matter of policy and there is not an absolutely right or wrong way for a surgeon to handle it.
Patients desiring augmentation and lift after major weight loss (over 75 pounds) present challenges to the most experienced surgeon. The reason for this is primarily skin tone and breast tissue thinning associated with the weight loss. Sometimes, patients look fabulous on the table, and within a number of months, they start sagging again. For this reason, many surgeons, including myself, offer such patients two stages when necessary. In the first stage, a breast lift is done. The advantage of this is that a very significant amount of excess skin can be removed and the breast lifted with a tight, perky look. After a short period of healing, an implant can be placed. Although I perform most of my lifts in a single stage, for the special patient, a two stage approach works better. You doctor should counsel you on the plan, realistic expectations, and be reasonable if a touch-up needs to be done.
A breast lift and augmentation is a complex procedure ESPECIALLY in a massive weight loss patient where the skin laxity is unpredictable. Some surgeons recommend performing this in TWO procedures. So right now you may need two. Generally speaking if this was discussed preoperatively, you may be responsible for all fees. If however, it was implied that only one surgery would accomplish your goal, then patients are commonly asked to cover operatory, anesthesia and implant fees. ALSO PLEASE REMEMBER IMPLANTS ARE NOT FOREVER and you will be responsble for revision surgery in future.
Revision policy varies quite a bit. It is difficult to predict how poor quality skin tissue will respond to surgery and therefore, in a case like this I would request the patient to cover the facility cost to revise the result
It is best to know what a plastic surgeon's revision policy is prior to having surgery. There are fixed costs such as anesthesia, supply, implant and facility fees that would need to be covered. I would look over your paperwork and most certainly visit your plastic surgeon to discuss your feelings. Take care.
As a surgeon I attempt to produce beautiful results and happy patients. However I often tell patients that surgery is imperfect. Trying to lift and reduce the difference in size or appearance between two breasts is more challenging than routine breast augmentation.
My office provides all patients with a quote during their preop consultation that spells out our policies about redo surgery and which items the surgeon will discount, and which items the patient would be responsible for. Patients know this before agreeing to initial surgery.
In general, surgery does not come with a warranty of patient satisfaction or guarantee of a specific result. You should not expect another surgery "for free." Of course as a surgeon I would want my patient to have the best final outcome with the least risk and expense. Talk with your surgeon about your concerns and his or her policies.