Christopher Newman, DO (in memoriam)

Takeria17,

One of two scenarios are at play here.  One, your plastic surgeon is charging additional for something that is not approved by insurance.  This is legitimate but should be discussed with you.  This practice can be deceptive if the patient is not told up front that this is going on.  Second, the plastic surgeon may be charging above what the contracted rate is which is usually a violation of contract agreement.  You are right by asking the question, because you obviously were not told about this up front.  If we surgeons agree to participate with a particular insurance and go through the motion of submitting for authorization, then we are obligated to abide by the contracted rate.  Otherwise, we shouldn't request approval from the insurance company in the first place.  Notify the insurance company that this is happening.  Bottom line, you should have a trusting relationship with your surgeon.  Ask the surgeon why you are being asked to pay more.  If you find that there is reason not to trust, choose a different surgeon.  

Assessment of breast 3 weeks after surgery can be stressful as each side may heal and progress at a different rate.  I can see why you would be concerned based on the limited photos you provided, but one should not be overly concerned at 3 weeks.  You still should have post operative swelling that may resolve at different rates.  Physical examination by an experienced surgeon should be able to tell more than the photos do.  My recommendation is to see your plastic surgeon and express your concerns.  

Breast surgery should never be limited by the age of a patient.  A surgeon placing that limit is not comfortable for some reason and, as such, probably should not be your surgeon.  What does matter is your health and fitness.  Plus, measures can be taken to reduce your risk of undergoing breast surgery by adjusting the medications used during anesthesia.  Your plastic surgeon should collaborate with the anesthesia provider to reduce risk.  

Liposuction and tummy tuck treat 2 different problems.  Liposuction is done to remove fat from beneath this skin. Tummy tuck is to remove excess skin. Some patients benefit from both. Your pictures show excess skin as your main issue therefore a tummy tuck is the better choice for you. A thorough physical exam would determine if you would also benefit from liposuction. 

Fat grafting to the breast should be reserved for refinement and touch-ups in my opinion.  Even with perfectly identical implants, patients are sometimes troubled by mild asymmetries of their breasts after augmentation simply because anatomy is sometimes asymmetrical and presents additional challenges.  Fat grafting is much less perfect and predictable than identical implants.  More fat may survive on one side than the other.  Fat may not remain in the location you put it, especially in larger volume transfers.  Finally, if you are thin and have very little fat to transfer, that's the ultimate determining factor.  If you are thin, you cannot expect an appreciable improvement in volume in the breasts.  Good luck.  Hope this helps.