one of the replys from a doctor on this site. "This is a standard of care issue! The questions are : Why were no measurements taken? Is your doctor a "true" PS, board certified? How can the determination to size be done without measurements? These are my concerns as there are yours"
From Reading the Replies on Measurement, The Standard of Care is the Plastic Surgeon Should Take Pre-opt Measurements?
Doctor Answers (14)
Breast augmentation with breast implants
Breast augmentation has come a long way since it was first introduced in the 60's. As with any surgery, the patient needs an appropriate history and physical exam to first determine if the procedure is indicated. If so, preoperative photographs are essential in order to document the starting point. Without these it is impossible to evaluate the ultimate result. Although it is still an art, preoperative measurements allow the surgeon to gain valuable information in planning the procedure and be more precise in implant selection, positioning and predicting the final result. In this fashion the patient is involved in the decision making process, learns much about the surgery beforehand and, hopefully, be happier with the result. The ultimate goal is patient satisfaction.
Standard of care issues
I concur with Dr. Pousti's statements with regard to possibly influencing legal proceedings or issues based on conjectural online answers. With regard to board certification in plastic surgery, this is something that prospective plastic surgery patients should consider and ask about when seeking a plastic surgeon for care.
Modern Day Breast Augmentation
Modern day breast surgery, including augmentation and revision breast augmentation, has several types of implants styles and sizes available that were not available 10 or 15 years ago. With these new styles comes the ability to tailor the implant size and shape more closely with the patients goals. In order to fully utilize each implant style and allow for the best implant style to be chosen in order to meet the patients desire and goals, breast measurements are necessary. While it is true that experience is a valuable tool that plastic surgeons utilize for great aesthetic results, breast measurements supplement this experience. I routinely take numerous measurements at the time of a breast consultation and will repeat these measurements during a preop visit in order to assure both myself and the patient that we have all of the data needed to allow for a successful and aesthetically pleasing surgical result.
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Preoperative Breast Measurements
One of the most important factors when determining and recommending breast implant size is to obtain preoperative measurements. While experience can generally dictate what can be accommodated by the breast, measurements and photographs are the only objective factors that can be documented in your medical record. The measurements are used as a guide to what size implants can be safely selected. Going beyond these limitations can lead to an increased risk of problems with your skin and the implants in future. You may still choose go larger based on your goals and desired look, however, your surgeon should be counseling you on what the risks are. If your surgeon is not taking measurements and having this conversation with you, I would be concerned.
Measurements for breast augmentation
I take preoperative measurements on my patients prior to breast augmentation as do many other plastic surgeons. Some surgeons use pre-manufactured templates that show the base width of the various implants. It is the ultimate result that matters.
I use breast measurements as a guide and not a final determination of the exact implants that I am going to use. I imagine some do not use measurements.
Use of Pre-op Measurements
Most physicians mark the patient prior to surgery. Pre-operative measurements tend to limit the size that a patient can go. The new high profile and high, high profile implants are narrower, allowing a more projecting implant to fit in a smaller space.
Are breast measurements standard of care?
I take measurements of the breast and use them routinely to counsel patients about implant size. However, it is not standard of care to do so. There are many excellent surgeons who routinely get good surgical results and do not use measurements obtained during the consultation. Talk to your doctor; it's the best way to clear up any concerns.
Standard of care for breast augmentation
Pre-op measurements can be useful for some surgeons but are not a "standard of care" issue. The standard of care involves providing enough information to allow patients to make good choices.
Having your surgeon review with you pre- and post-op pictures from his or her portfolio will give you an excellent idea of the surgeon's concepts of balanced breast augmentation. Chose someone Board Certified by the American Board of Plastic Surgery and make sure you get to see a representative series of pictures.
My approach is to bring to the OR a complete set of implants and then I use temporary sizers in surgery to see which sizes and shapes yield the best results. I then know exactly which implants to place.
The most important concept is balance:
Balance L vs R;
balance top to bottom for overall figure proportionality;
balance skin vs. volume for breast aesthetics.
Photographs mandatory, preop. breast measurements optional
Virtually all plastic surgeons take before and after photos. There are some measurement systems available. However, they tend to produce small implant volumes. I personally do not find them useful. I use my experience and patient input to determine implant size, not preoperative measurements. It has never been shown that preop. measurements improve the surgeon's ability to give the patient the implant size they desire, or reduce complications. The most common surgeon error is to use implants that are too small. This does the patient no favors, because she will need to come back to have them replaced with a larger size, at considerable additional expense. Best to get the size right the first time. So, no, preop measurements are not part of the standard of care.
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.