Who Should Pay for Capsular Contracture Repair?

Question

If a person gets a capsular contracture and done everything possible, how can a doctor expect a patient to pay to replace implants. Shouldn't the fee fall on both parties?

Michael S. Beckenstein, MD · Answer

Capsule formation is a known side effect of implant placement and the developement of a contracture is unpredictable! The surgeon has no real effect on whether this (contracture) happens or not. He/she, therefore, should not be held responsible. This should be clearly presented to you during the consultation process AND in the consent you sign for surgery!

Larry S. Nichter, MD, MS, FACS · Answer

In all surgical specialties and procedures you are paying for the surgeon's best surgical efforts and care. There are never any direct or implies guarantees of success and this is especially true of Plastic Surgery which is both an Art form and Inexact Science. For example if you rejected a kidney after it was transplanted you would not expect your money back. If you looked over the consent paperwork you signed, I am sure you will find this explained as it is standard for all surgeons.

	Capsular contracture can not be predicted and is our bodies particular reaction to the implant.Your surgeon did not do anything wrong which is the reason for and necessity for to be responsible financially for additional procedures.

David Shafer, MD, FACS · Answer

Capsular contracture is not the doctor's fault. Capsular contracture is a rare, but known possible sequelae from breast augmentation. It is impossible to predict who it will occur in. However, it is most likely due to genetic and environmental factors, beyond the control of the doctor. It would be unreasonable to expect the doctor to pay for such an occurrence. Cosmetic surgery is different than all other medical care, in that it is not viewed as "medically necessary" and it is not covered by insurance. When a patient undergoes cosmetic surgery, they need to understand the risks and benefits of the surgery, including financial responsibility. Good luck with your procedure.

Steven Wallach, MD · Answer

Unfortunaetely, a capsular contracture can happen to any patient for unknown reasons. If this develops on the earlier side, I usually work something out with the patients. In other words, my fee is lowered for the patient, but the patient pays for the surgery and the facility, and implants.

Marcus L. Peterson, MD · Answer

Most of the time the surgical fee is shared with the patient because the surgeon wants to get the best result possible.  This will generally happen only with the surgeon that placed the implants.  When I say "share" the fee I mean it is reduced to a very cheap rate. The other costs of going to surgery are outside of the surgeon's influence and would be covered by the patient.
Most of the time the implant will not need to be replaced unless it is old or you want to make a change in size.  The surgery may be as easy as making an opening in the capsule to allow the implant to go lower in the pocket.  If the capsule is very thick and tight it may require complete removal.
Unfortunately, no one has complete control of how a person will heal with implants.  If the surgeon had complete control then the surgeon would warranty such work but I do not know any reputable plastic surgeon that makes such guarantees.

Robin T.W. Yuan, MD · Answer

Capsular contracture is a known and accepted risk of the procedure. In general, it is not a surgical error that causes it although bleeding and infection can increase this risk. Most are unpreventable and unpredictable and we know statistically that a certain number of patient will get it despite doing everything right. When you undergo breast augmentation, you need to know and accept that there are possible problems and maintenance costs. However, many surgeons will either reduce the cost for their own patients (as opposed to a new patient with the problem) and you can discuss this with your surgeon. In addition, some insurance companies will cover a portion of the cost to treat capsular contracture.

William B. Rosenblatt, MD · Answer

When you signed up for an augmentation, it was known that a capsule could form. If so, it was not the surgeons fault. Therefore, you are responsible for the surgery. I will usually discount my surgical fee, but the patient is still responsible for the OR, anesthesia and any fee for new implants.
In a perfect world, the surgery would be free, but this is not the case.

George J. Beraka, MD (retired) · Answer

Hi.
Payment policies should have been explained to you before your breast implants.  In New York City, our policy is that for one year after surgery, we do not charge a surgical fee for revisions, but you do have to pay for the operating room, the anesthesiologist, and any new implants.

Bruce K. Barach, MD (retired) · Answer

I hope your surgeon did discuss this possible complication with you before surgery. It is not anyone's fault that it happens every so often. It is one of the risks you assume when you consent to implant surgery. Hope the revisional surgery goes well, but unfortunately you will probably have to assume the financial responsibility for it.

Richard P. Rand, MD, FACS (retired) · Answer

A capsular contracture is made by your body, not by the doctor. As such it is your responsibility to cover costs for revision, not the doctor. Personally, I do these "at cost" for the patient, but in no way should the surgeon have to take a loss on this.

Who Should Pay for Capsular Contracture Repair?

Answers (10)

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