Is it a red flag to watch out for if a PS does not have any pics of explant without replacement? That's the procedure I need

Question

I went for a pre op appt today with the surgeon I had chosen for explant silicone unders that are 29 yrs old. At consultation I was told I did not need a lift and would have nice results. However, today at pre op appt I was ask to pay my balance. I was absolutely ready to do so. But I asked to see before and after pics of explant with no replacement before I shelled out any money. The RN said the doc had none. Only revision pics with replacment. Not even one of explant with capsulectomy

Orna Fisher, MD · Answer

Removal of breast implants is not generally considered an aesthetic procedure and I personally do not showcase pictures of implant removal on my website. The results are almost 100% patient factor dependent, so do not really feature my skill or artistry. There are also limits to how many before and after pictures we show on our websites, so these take away from pictures that do feature  more truly surgeon-dependent outcomes. 
That being said, if a patient would like to see pictures of an explantation, we can certainly show them in the office. However, you need to know that when it comes to explantation, another patient's photos won't give you much information regarding your own potential results. Again, this is because the outcome of implant removal is almost entirely dependent on patient factors such as age, skin quality, tissue thickness, under/over the muscle, presence/absence of some degree of capsular contracture, size of implants, etc. Lastly, showing patient photos requires consent. Patients having explantation procedures are far less likely to want their photos shared compared to those who have had augmentation procedures.
While I wouldn't necessarily judge your plastic surgeon for not showing you any pictures, you do need to have confidence that he/she is has the experience to know that your personal "patient factors" will allow for a good outcome.

Nelson Castillo, MD · Answer

Thank you for sharing your question and best wishes on your upcoming surgery.  If you feel uncomfortable with your surgeon's ability to perform the procedure I would advocate seeking out second opinions.  I would also reach out to the surgeon directly to address your concerns as his RN may not have fully known what you were asking for or where she may find images.  Hope this helps.

Camille Cash, MD · Answer

This is not a red flag per se, but it is important that you are comfortable and confident in your surgeon and surgical plan as you prepare for your procedure.  I encourage you to speak to your surgeon about your concerns.

Pravin Reddy, MD · Answer

Thank you for addressing the issue of B/A photographs.
You should select your surgeon based on his professional credentials and how comfortable you are with his consultation and advice.  In addition, your surgeon should only perform surgery at an accredited surgical facility with hospital admitting privileges.  If the physician satisfied the above criteria, I would feel comfortable proceeding with surgery.
B/A photographs are a useful tool in illustrating what a surgical result may look like.  Showing B/A photographs requires the patient consent to the use of their photographs and not all clients agree to the use of their pictures.  Patient privacy matters are protected by HIPPA -- a Federal Law.  This is one of many reasons your surgeon may not be able to show B/As.   
In our practice, we consider it a distinct privilege to be able to use patient photographs and we only show a very limited number of photographs.  Keep in mind, B/As do not guarantee results and most practices have an active disclaimer to this effect.

Johnny Chung, MD, FACS · Answer

Thank you for your question. Not having photos of explanted implants is not uncommon. The reason is that most explant patients had a different implant surgeon.  The surgeon removing the implant cannot guarantee your post operative size or shape due to the fact that he/she has no idea what your starting breast size or shape was.  If you have any concerns, I recommend speaking with your plastic surgeon. If you are still uncomfortable I recommend a second opinion. But not having photos should not deter you if you are comfortable with your surgeons ability. Best of luck with your surgery.

Steven Wallach, MD · Answer

There are many procedures that I have performed and do perform that I do not post photos of or have photos to show.    It should not disqualify your surgeon from performing the procedure for you. Best of luck.

Gaurav Bharti, MD, FACS · Answer

Choosing your surgeon is very important and you need to feel comfortable.  Don't be afraid to discuss your concerns with your surgeon.  At the end of the day you get to decide who takes care of you.  Good luck.

Genevieve MacDonald, MD (retired) · Answer

Some patients do not want their pictures shown. Your results depend on your skin, amount of breast tissue  and your healing process.I prefer to go through the inframammary fold in case there is any indentation. The upper pole fullness is less.

Is it a red flag to watch out for if a PS does not have any pics of explant without replacement? That's the procedure I need

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