Should Fixing the Bottoming out of my 3 Month Old Implants Be Covered Under the Original Fees?

My left breast implant is bottoming out. When I raise my arms the nipple is almost all the way at the top of the implant. The doctor has me scheduled to fix this by using non-disolvable stitches to stitch the pec muscle to the rib muscle. I feel that this procedure should be covered by their practice since my implants are only 3 months old. I am getting quoted over $2200 to fix what I feel is their mistake. This is quite upseting to me. Is this procedure normally charged as an additional fee?

Doctor Answers (11)

Revision covered under original fee

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Every office and facility will have their own revision policies.  In my practice, I only charge supplies and anesthesia, if needed, within the first year after surgery.  Depending on your surgeon's situation, for instance whether he operates in his/her office or that hospital, he/she may have no control over certain fees.  While I have my own ACHA surgery center attached to my practice, I still have to pay the anesthetist their fee regardless of whether it's a revision or first time procedure.


Orlando Plastic Surgeon
4.5 out of 5 stars 39 reviews

Who Pays for Revisions

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A few things to consider:

1. Did you review the doctor's revision policy before surgery?

2. Not all problems after surgery can be predicted and bottoming out does not imply the surgeon is at fault or that a mistake occurred.

3. The fee you quote sounds like the cost for the facility and anesthesia only, not the surgeon's fee. This seems like a reasonable solution to your problem.

Karol A. Gutowski, MD, FACS
Ohio Plastic Surgeon
5.0 out of 5 stars 17 reviews

The standard Practice of Cosmetic Surgery

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IS:  for revision work to be free of charge from the surgeon,  but the facility and anesthesia fees are the responsibility of the patient.  If this was not clearly stated before the surgery, it is the standard of care in most regions.  As many of my colleagues have stated above,  your focus might be to concentrate on your surgeon's plan and the likelihood of a sucessful outcome.  Best Regards,

 

Dr Del vecchio

bostonbreastcenter

Daniel Del Vecchio, MD
Boston Plastic Surgeon
4.5 out of 5 stars 42 reviews

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Revision Policy

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Basically, what you are asking about is your surgeon's revision policy. Every office has a revision policy and it should be explained to you before your surgery. In my office, the revision policy is clearly detailed in the financial agreements that every patient reviews and signs weeks before any surgery.  It sounds as if your surgeon is charging you for the facility and anesthesia fees only. These are fees that the surgeon has no control over. It seems as if he is waiving his surgical fees.  You should discuss this issue specifically with your surgeon as we cannot really make a comment about another doctors personal policies.

Matthew Schulman, MD
New York Plastic Surgeon
5.0 out of 5 stars 163 reviews

The Costs Of Revisional Breast Augmentation

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Like all business transactions in which the results can not be guaranteed, the issue of the economics of revisional surgery should be known before you ever have the original surgery. No plastic surgeon can assure every patient that their result will be ideal and the need for revisional surgery for many plastic surgery procedures, particularly breast augmentation, is not rare.The only issue the plastic surgeon controls is the cost of his/her time, not operating room and anesthesia fees. It sounds like you are only being charged the fixed costs of the revsional procedure, which is both common practice and fair. 

Barry L. Eppley, MD, DMD
Indianapolis Plastic Surgeon
5.0 out of 5 stars 26 reviews

Fees after bottoming out

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The fee quoted sounds like it is aa fee for the facility.  A surgeon's fee to revise this would be much more.  Every surgeon's office policy is a bit different and you should ask yours to review it with you.

Steven Wallach, MD
Manhattan Plastic Surgeon
4.5 out of 5 stars 17 reviews

Revision Fees Are Not Unusual

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Dear Fed,

There are differing policies regarding revsion breast surgery.  From the fee that you quoted, $2200, it sounds as if you are only being charged for the operating room materials and anesthesia.  It is not unusual to charge these fees and wave the surgeon's fees if an early revision is needed.  God luck!

Kenneth R. Francis, MD
Manhattan Plastic Surgeon
4.5 out of 5 stars 31 reviews

Fee for breast augment revision

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Bottoming out is a known risk of breast augmentation, an elective procedure you desired and underwent. It's regrettable that you developed this complication but that does not make your surgeon a guarantor of the outcome. Based on the fee, it would appear to cover anesthesia and facility which is the norm for revision shortly after surgery. My financial policies are made clear to patients prior to surgery so that there will be no later misunderstandings. Hope your revision goes well.

Robert L. Kraft, MD
New York Plastic Surgeon
5.0 out of 5 stars 9 reviews

Did you discuss this with your surgeon

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There are different policies to deal with revsision. Most surgeons will do the revision for free and only charge for the anesthesia and operating room fees. The surgeon is offering his/her time and patient paying for the other cost. Your bottoming out can be due to anatomical variation,transaxillary approach or too big implant. I always discuss the revision policy before surgery to avoid this kind of situations.

Kamran Khoobehi, MD
New Orleans Plastic Surgeon
5.0 out of 5 stars 54 reviews

Unfortunately, Aesthetic Surgery Cannot come with a Guarantee of Outcome

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Hi there-

Essentially what you are asking is why your surgery did not come with a "satisfaction guaranteed" clause...

The truth is that aesthetic surgery is an art and a science, and that working with patient's skin and tissues is different every time (although obviously similarities allow us to learn as we go- hence the term "practicing" medicine).

Therefore, and in even in the very best of hands, occasionally there will be an unpredictable and undesirable complication or outcome which requires intervention. This, in fact, is the reason you were asked to sign informed consent documents acknowledging your understanding that these events do sometimes occur.

This does not mean that your surgeon necessarily made a "mistake", as you say- just that you didn't get exactly what you wanted.

Unfortunately, in many cases like yours, another operation is required to achieve the patient's goals, and this operation will necessarily generate costs which cannot be avoided. The instruments and sterile products used, the medications administered, the anesthesia professional, and the surgeon's time all have a dollar value associated with them that cannot be denied.

To your surgeon's credit, it sounds like he/she is willing to perform this procedure at a significantly reduced fee, probably representing only the anesthesia fee and the OR fee, although this will vary among surgeons.

If this is the case, rather than feel cheated and accusatory, you really ought to be grateful that your surgeon wants you to be happy and is willing to do this in order to more closely approximate your goals- because he doesn't have to.

One of the greatest mistakes I see patients make (on this site and others) is to forget that their safety and happiness with their aesthetic surgery is critically dependent on the relationship they have with their surgeon. If you begin to treat your surgeon like a clerk at Mcdonald's who screwed up your order at the drive through window, nothing good will happen.

Remember that as with any other relationship in your life that should be important to you, it is important to approach this one with mutual respect and open communication.

Explain, don't demand. Talk, don't threaten.

Your surgeon wants you to be happy- I promise you. But if they start to feel like they aren't going to be able to make you happy, or that you are going to be abusive and ugly no matter what they do, they may retract their offer to lower the fees of improving your outcome. Then you'll have to find another surgeon to perform the surgery, who won't be willing to lower or waive fees, and who (because they don't have a clear understanding of what was done at your initial procedure) will have a lower chance of succeeding.

The simple facts are that your surgeon probably didn't do anything wrong, you just didn't get exactly what you wanted (a known risk of this surgery), he is being very gracious offering to donate his valuable time to help maximize your outcome, and your best chance of achieving success and happiness is to graciously accept his offer and tell your friends how helpful and interested in your happiness he was when you developed a problem and it needed management.

Armando Soto, MD, FACS
Orlando Plastic Surgeon
5.0 out of 5 stars 98 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.