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Is the Number of Revisions a Surgeon Does on Their Own Breast Implant Surgeries a Concern?

When choosing a doctor, how relevant is it to know if a surgeon needs to do revisions on breast augmentation they performed? Is it equally important to know the situation in which these revisions were needed? I want a doctor that has experience. If they did a lot of revisions of their own work, I want to know why. Maybe some of those cases were outside of their control or outside factors were the issue. How available is this information to prospective patients?

Doctor Answers (9)

Choosing a Surgeon for Breast Surgery

+1

Hi there-

I'm not sure that whether or not a surgeon performs revisions of his own work (or the frequency with which he does so) is that relevant at all...

All good surgeons will perform a revision from time to time...

I think that the factors you SHOULD consider (in order of diminishing importance) are:

  1. The surgeon's Board Certification Status (The one you want is The American Board of Plastic Surgery)
  2. The surgeon's prior OUTCOMES. Before hiring an artist you would want to know they had a long history of producing beautiful works of art, right?
  3. The surgeon's education and training (there's gotta be a reason we all want to get into the best schools, right?)
  4. Their experience
  5. Their personality and reviews written by other patients

For more on this topic, read this:


Orlando Plastic Surgeon
5.0 out of 5 stars 102 reviews

Choosing your plastic surgeon: revisions for breast surgery

+1
  1. all doctors do revisions
  2. implants have a revisions rate 5-15%
  3. capsules occur 8-15% but not all require revisions
  4. check doctors certification, years in practice
  5. ask when and why they may do revisions
  6.  what are the costs

Jed H. Horowitz, MD, FACS
Orange County Plastic Surgeon
5.0 out of 5 stars 18 reviews

Breast Augmentation and the Risk of Revisional Surgery

+1

Every operation is associated with a risk and some percentage of the need for revisional surgery. This is particularly so for any operation in which a synthetic implant is responsible for the result and breast augmentation is most certainly a device-dependent procedure. Most patients would be surprised to find out that the three year risk of revisional surgery in breast augmentation, for any reason whatsoever from infection, asymmetry or dissatisfaction with implant size, is near 33%! This is the actual statistics from the manufacturers in the product inserts that come in the breast implant packaging. The bottom line is...every plastic surgeon does revisions of their own breast augmentations. It is neither rare nor a sign of their level of competence. It is the nature of breast augmentation surgery and the use of a large medical implant. 

Barry L. Eppley, MD, DMD
Indianapolis Plastic Surgeon
5.0 out of 5 stars 27 reviews

Breast Implant Corrective Surgery

+1

  There are always a certain % of surgical cases that will need some secondary revision.  These numbers are known and for breast implants 2 to 3 % of patients may need a revision surgery.   Yes, if a surgeon is revising  a huge number , this would be a concern and peer review session where doctors review doctors help  solve this problem.   Peer review sessions are designed to help patients and doctors.  When you consult with a plastic surgeon, it is fair to ask the revision rate.  Most are quite low and will be honest with you.  Equally important is if revisions occur, who pays.   Generally surgeons never charge surgical fees for revisions but may require the patient to pay for the operating room and the anesthesia.  Things happen in a biological system, and the patient and surgeon can do all correct and capsule contractions can occur as well as infection and bleeding.   There is a shared risk in any surgery.    Then at times, a surgeons willingness to revise a breast just indicates the trait of perfection seeking in that surgeon.   Surgeons with high complication rates and endless revisions do not last too long in communities that are well reviewed by peer groups.   Hope this helps answer your question.   Best Dr George Commons

George Commons, MD
Palo Alto Plastic Surgeon
5.0 out of 5 stars 26 reviews

Breast augmentation and revisions

+1

I think that every surgeon performs a certain percentage of revisions. Certainly the longer you are in practice, the more patients come back to you for either additional work or revisionary work.  It is a testament to their satisfaction that they trust you to do their surgery again.

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

Number of Revisions in Breast Augmentation

+1

Dr Tholen may have summed it up best about the 3 types of surgeons who don't have to do revisions. Instead of trying to measure your surgeon by the number of revisions, look at the before and after pictures, office revision policy, evaluations from other patients and your own interactions with the surgeon. The longer a surgeon is in practice, the more patients return asking for touch-ups, revisions and implant replacements. Some skilled and experienced surgeons are known for taking on hard and challenging cases and therefore may have more revisions.

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

Plastic surgery and re-do operations . . . the fewer, the better!

+1

There are only 3 surgeons who don't have re-do surgeries:

     1)  The dead surgeon.

     2)  The retired surgeon.

     3)  and the liar.

The best surgeons (those who have the fewest complications or re-do operations) are those who obtain excellent training, obtain board certification by real (not bogus) boards, keep up their continuing education, do a lot of the kind of surgery you are contemplating, and have a humble nature that allows them to admit their failings and learn from their mistakes or less-than-ideal outcomes. Educators, whether in academic or private practices, who like to teach other doctors are generally more up-to date, and those who provide charitable surgery for people in less fortunate circumstances tend to be better at their craft, and constantly striving for improvement regardless of their years of experience.

Unfortunately, some surgeons who are on a salary may have less incentive to do better than those whose income depend on their patients' satisfaction and ongoing referrals, but the latter may also be more prone to puffery and self-promotion.

Very few of the hundreds of surgeries I perform each year request (or require) any sort of re-do or touch-up surgery, but I have also found that the more I perform an operation well with happy patients and great results, the more they tell and show their friends, who may have not had as good an experience elsewhere. So then I get more re-do surgeries (from other doctors), tougher problems for their first surgery, and basically more of the "harder cases" and tough problems--each with a higher-than-average potential for more surgery being necessary for the best result. And of course, that is affected by the degree of "perfectionism" I tend to have! Still, anyone can do the "easy" ones!

If all a surgeon operates on are the "easy cases," then there should be a very low revision rate. If a surgeon is skilled and experienced, then "harder cases" may have a naturally-expected somewhat higher revision rate. As you can see, comparing the type of patients, the severity of their cosmetic concerns, and the difficulty of the actual surgery is virtually impossible, as is comparing re-do rates, and what is appropriate or what might be "too much!" One way of comparing surgeons objectively is to consult with the state medical board and ask about numbers of complaints, and what investigations showed. Checking into lawsuits is another basic method of seeing who has had malpractice judgements against them, how many, and what type. Do not confuse poor results with malpractice or negligence. Truly "botched surgery" should be a rarity!

Those "botched surgeries" that I have seen recently: a breast augmentation that was attempted under local anesthesia by a Dermatologist (who called himself a cosmetic surgeon) and only one implant was able to be placed because of patient pain so severe he had to stop halfway through the operation. He tried again the next day (also under local, since he had no hospital privileges and was doing this in an exam room in his clinic) and failed again. Ten days later, the patient still had severe pain in the implanted breast, scars on both sides but an implant missing on one side, and I took the patient to surgery (under general anesthesia)  to remove the one implant that he did get in--I found bleeding and possible early infection. Lawsuit pending. Case two: a facelift, forehad lift, eyelid surgery patient from Singapore whose surgery was not done improperly or "botched" at all, just didn't give her the improvement she (reasonably) wished for. Compared to her pre-op photos, there was really NO improvement, so I include this in the "botched" category. I redid everything, so her overseas cost "savings" really was a huge unnecessary expense and additional risk (she was lucky there were no complications other than a poor result).

Even properly-trained, board-certified plastic surgeons have complications or poor results; those with less training have more bad outcomes, or may be more successful at selecting patients who are "easy" cases, or less well informed as to what constitutes a good outcome. Foreign plastic surgeons can be superb surgeons, but there is a higher proportion of substandard training or practices in some foreign countries. You may be lucky enough to choose the best surgeon in a distant locale, but what happens if there IS a problem or complication?

Breast augmentation is the most commonly-requested cosmetic operation in the United States (ASPS and ASAPS data 2010), so almost all plastic surgeons do this operation. Only a few do over 100 per year, so there are lots of well-trained plastic surgeons (and a few others) who do a few dozen a year. The sad thing is that unless you really do a lot of breast surgery and see your results year after year for many years, you really don't do enough to get better by seeing how your work holds up over the long haul! If your surgeon simply takes your money, does the surgery, and "off you go" with very little follow-up, that surgeon will never get better, and his or her patients will never understand how much better things could have been with an experienced breast surgeon who does several hundred breast augmentations per year, year after year. With that kind of experience comes a certain amount of skill enhancement. Practice really does make "perfect."

If you are just concerned, good for you for asking these questions! If your gut is telling you to be concerned about who you are seeing, get a second or third opinion! Remember, the bitterness of poor quality remains long after the sweetness of low price is forgotten.

 

Richard H. Tholen, MD, FACS
Minneapolis Plastic Surgeon
5.0 out of 5 stars 123 reviews

Breast Surgery Revisions

+1

No honest surgeon will ever tell you he never has to do a revision. And if a surgeon's techniques are such that he has to do a larger than average number of revisions, he may not admit that to you. Talk with friends, nurses, mammographers and hair care professionals and I bet pretty soon one or two names will come to the top on your list as to who has the talent you want.

Ronald V. DeMars, MD
Portland Plastic Surgeon
5.0 out of 5 stars 13 reviews

Surgeons and their Revision Rates

+1

Thank you for the question.

It is important to understand that no surgeon is perfect and that every surgeon will have to re-operate and improve upon his/her surgical results. As you say, sometimes the “complication” is preventable, sometimes not.  If the surgeon has a significantly  higher rate ( than average)  of complications such as hematoma or infections than this  would be very concerning. In my opinion, this would point to a potential problem with attention to detail.

Information regarding specific complication rates for specific surgeons will likely be very difficult to come by. However, by doing your due diligence you will come to learn which surgeons in your community have higher complication rates than others.

In my practice, I encourage prospective patients to meet with (or talk to) as many previous patients as possible.  This communication is helpful in educating the new patient about the procedure and recovery process. It also helps  the prospective patient to develop  confidence in that myself  and my office staff will take care of the patient.

After a period of time, through research online and talking to members of your community you will develop a sense of which plastic surgeons do the best “quality work”. When you meet with those surgeons you should see as many examples of their work  (whether in pictures or in person);  plastic surgery is a visual discipline and you will be able to note  good quality results when you see them.

You should also ask your prospective plastic surgeon how he/she handles complications.  Ask to see examples of patients who've had deflation  of implants,  encapsulation,  implant malposition  etc. Obviously, the most experienced surgeons will be able to show you lots of examples of good quality work and successful correction of poorer  quality work.

Unfortunately, there is no shortcut in this process but I hope this helps.

 

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 722 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.