Unmet expectations: Life after breast implants

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As a surgeon who specializes in elective surgery, I am eager to please.  Occasionally there is a discrepancy between post-op results and patient expectations; discord results.  Over the past 3 years, I have acquired considerable experience working with breast explant patients, who I feel are among the most informed and studied consumers.  Listening to their stories, I have learned to counsel prospective breast implants that they may eventually remove their breast implants and that decision should not be undertaken in a trivial manner.  It seems logical to divest 'opt out' of a cosmetic procedure, if quality of life measures are not well served.  That being said, there are multiple factors, influencing explantation outcomes and these may roughly broken down to patient factors, surgeon experience and wound healing.   Consider a "simple" case: young individual whose preop breast was attractive (equal volume, aligned nipples, elastic skin envelope), where the motivation is volume reduction. The shrinkage is dramatic and their recovery relatively short.  "Moderately difficult" might include the need for capsular procedures.  "Complex" require multiple procedures (capsulectomy +/- mastopexy) to reconfigure an acceptable breast. I have heard the term "en bloc" resection misapplied to removal of the capsule in continuity with the breast implant.  Strictly speaking, "en bloc" is a term appropriated from the breast cancer literature and not a mandatory techique guaranteed to reverse every ailment.  In fact the caspulectomy and subsequent need for drains may create a necessary and sufficient condition where the breast flap adheres to the chest wall in an unfavorable manner.  Monday, I was reminded of my human shortcomings, receiving a Request for Records for a dissatisfied explant patient, whose remaining breast volume and form was not acceptable to her. The psychological distress cannot be underappreciated for breasts are a cardinal feature of women.  I ran late and missed the opportunity to meet a new explant consultation, who left without being seen. Everyone has the right to change their minds, after all  but "hardwired" as I am to meet and exceed expectations, I regret having inconvenienced her and hope she would reconsider rescheduling a time to meet. She may not decide to proceed, however I'd like to learn from  her case. 

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Orange County Plastic Surgeon