Surgery, Symmetry, Warranties
As a surgeon I attempt to produce beautiful results and happy patients. However I often tell patients that surgery is imperfect. Trying to reduce the difference in size or appearance between two breasts is more challenging than routine breast augmentation.
My office provides all patients with a quote during their preop consultation that spells out our policies about redo surgery and which items the surgeon will discount, and which items the patient would be responsible for. Patients know this before agreeing to initial surgery.
In general surgery does not come with a warranty of patient satisfaction or guarantee of a specific result. You should not expect another surgery "for free." Of course as a surgeon I would want my patient to have the best final outcome with the least risk and expense.
Size discrepancy after Breast Augmentation
Every surgeon's policy varies and although you may be upset with the result, the surgeon may feel that they got the best possible result given the circumstances.
There may be many logical reasons for why your breasts remain uneven.
Going in to correct your problem is an opportunity to improve on the outcome but it also is an opportunity to make it worse. Every operation has a new risk of infection, scarring, etc. How badly does it bother you? Only you know. Given your desire to re-operate, I can surmise that it remains a significant concern but you need to be willing to undertake the risk of this new surgery. I am assuming that because the surgeon is charging you, they do not feel that it is worth the risk. In my opinion, I would have to agree that a 30cc difference is relatively minor and not advise a patient to seek correction.
Every office operates differently in terms of redoing a breast augmentation. Talk to your doctor's office again and see what they can do for you.
Breast augmentation redo payment depends upon doctor's office policy
If a correction seems like it would work out, I usually do them for actual "hard" costs (surgery center, anesthesia, new implants) if they are done soon after the original surgery. Each practice has its own philosophy on this issue however.
Be nice to your surgeon and he should be nice to you. I really don't offer any kind of discount to rude patients. Fortunately, I don't have many of these and these problems are not common.
What does the surgeon's office policy state?
First thing to do is to look at what his written office policy is on payment for re-do'. If you don't have it in writing before hand, you are at the mercy of the doctor afterwords.
I prefer to use the same size implant because it is generally easier to correct asymmetry. This is because the implant diameter gets larger with implant size, and I have had problems where the larger implant looks like it is sitting higher.
You may ask the doctor to re-do it for free, but you may be disappointed. You may also seed a second evaluation too.
I am so sorry that you are disappointed and frustrated, and I hope that things work out for you.
Revision pricing is complex
First of all, with your asymmetry preop, yours is a more difficult starting point and the result may never be quite what you want because your body won't allow it to be perfect. Secondly, your initial price was relatively low by national standards.
If your surgeon feels that your result is as good as he / she can get given your body, then the revision is something you are driving and asking you to pay facility, anesthesia, and equipment fees is reasonable. If, on the other hand, your surgeon feels that he / she expected the result to be better than it turned out to be, then they should do the whole thing for free.
Depends on your agreement with your doctor
When you enter into the informed consent for a procedure and sign the consent it IS a contract between you and your surgeon. I am sure there is something in writing stating revisional procdures will entail additional costs to you. There is most likely wording about the lack of warranty and the possibility of the need for additional procedures. These clauses in the consent would make it legal and ethical for your surgeon to ask for a fee. I personally would not chrge a fee in this situation, but there still would be facility and anesthesia fees. This is well known to my patients prior to surgery!
Correction of asymmetry is challenging and a "homerun" may not be hit on the first attempt.An implant change in this situation is not uncommon. I suggest you discuss this issue with your surgeon to see if he would waive or reduce his fee. Keep in mind, if the consent you signed has what I listed above, he legally does NOT have to. Good Luck!
Is any further surgery even necessary?
Nearly all women have some asymmetry. There are more obvious ones like in your situation and therefore correcting them is beneficial in overall happiness with the outcome of the surgery. However, no asymmetry can be corrected to perfection. You always trade one asymmetry for another. For example, now your implants are asymmetrical which leads to a fuller breast on one side. With all asymmetries you try to compromise to get the best overall results. If you are within 30cc, that is very difficult to see with a human eye. I believe expectation and preop discussion may be the issue here. I would suggest going over your before and after photos with your surgeon to see how much improvement you have gotten with the surgery. Since surgery is not an exact science and is very much dependent of human genetics, there is no warranty on the surgery. The implants are a medical device and have a warranty if they break - and only for the implant. The fee that you paid is a pretty good one - rather inexpensive actually. Remember that revision surgeries have risks such as capsular contracture. Make sure you review your photos and all options before jumping into another surgery. Cost should rank last in the decision making process.
It is fair for you to pay only for the actual costs.
Hi! My personal policy is that if a patient needs a revision within a year of the original surgery, then we don't charge a surgical fee at all. However, the patient does pay for actual out of pocket expenses (running the operating room, the anesthesiologist, the cost of new implants).
Each surgeon is entitled to his own policy. My goal is to always make sure the patient feels she is treated more than fairly and to make sure the patient is happy.
Surgery is and Art and a Science
One thing we all have to keep in mind is that surgery is an Art and a Science. It is impossible to predict with 100% certainty how a surgery will turn out. With that said, if something was done differently that what you discussed preoperatively then you may have cause for concern. From you question you say that one side had 300 cc and the other 380 cc. If you and your doctor estimated a 100 cc difference, then there would only be a 20 cc difference now. Studies have shown that the eye cannot perceive a 30 cc difference between breasts, so you are within the margin of error. If you provide before and after pictures, then we may be able to give you better advice. As for the money, in most cases if there is a true technical error by the surgeon, then they should waive their surgical fee for any correction. You would still be responsible for any operating room or anesthesia fees. If you only paid $5000 for your initial surgery (I am assuming this does not include the price of the implants) you got a very good deal to start with. Third, why are you having saline implants placed? If you are going back for surgery, then you may want to consider having them switched to silicone. Good luck.