Implants Were Not What I Chose, Is It Normal Practice That I Must Pay For The Revision?

Why do PS make you pay for new implants when they are the ones who put in the wrong size. I tried on implants that are not close to what I have. I was told he filled them as high as he could for my frame. I did not go high profile, because he told me my breast stuck out far enough. I was specific-DD or larger. I have maybe a D now, from a C. Why do I have to pay for new implants? 

Doctor Answers 2

Avoiding and Handling Dissatisfaction with Breast Augmentation

Hi there-

First of all, I'm very sorry that you are not pleased with the results of your surgery. The unfortunate reality is that unhappy patients are bad for all of us and our specialty. It is therefore very important to me that I help you be happier and more at peace if I can...

Secondly, please understand that I want only to help you (and all other patients in your position) become happier and achieve a better experience and outcome if possible. I have nothing to gain by what I am going to share with you, other than hopefully educating more people about how to best go about the process before and after surgery in a way that is best for you and for your relationship with your surgeon. Just as bad outcomes are bad for us all, a better educated patient population is good for us all.

Some of what I am going to say may not apply directly to your exact situation, but hopefully is generally helpful. Also, some of what I tell you may be uncomfortable for you, but again, I think you and all patients are better off with a truthful understanding than with a sugar-coated answer to your questions...

So- let's go over this...

It sounds like the process in your chosen surgeon's office involved you trying on implants and selecting the implants you want prior to surgery. In my opinion, this is a large part of the reason you are now unhappy...

It is very important to understand that the way an implant looks under a bra outside of your body, or on a computer simulator, is NOT the way it is going to look after it is placed under your skin, breast tissue, and muscle (no matter which computer simulator is used).

The simple fact is that women's skin, breast tissue, and muscles have very different levels of elasticity and thickness- and these variables are the absolute most important in determining how any particular implant will look inside any particular woman's body. Trying to determine how and how much these variables will affect the implant's appearance before surgery (and therefore before getting a CLEAR understanding of these variables) is a GUESS at best- even with a computer simulator.

There are many reasons why patients and surgeons sometimes prefer this approach- it makes the patient feel like they are involved in the decision, giving them the feeling of being in control of their outcome and procedure, and allaying some of the anxiety it is normal to feel when you are about to have aesthetic surgery.

It also gives the surgeon the improved selling position (it may make it more likely for you to get more business) of telling prospective patients- "I'm going to give you control and let you pick your implants"... To many women this is very attractive. This process also encourages patients to believe that whatever they want is possible (again, good for the surgeon) while the truth is that some women's bodies simply don't allow the goals they have. Furthermore, it allows the surgeon to, in a manner of speaking, wash his hands of the outcome, because you chose the implants.

In cases like yours, where the patient chose an implant before surgery, and without an understanding of how her tissues would affect the possibility of achieving the appearance she thinks she wants, and then does not get that implant because her tissues would not allow it, she is understandably upset, and the surgeon in a difficult position.

So for all the reasons I have outlined, it is my strong opinion that for a patient or surgeon to firmly commit to an implant before surgery is a mistake.

Please understand I am not necessarily saying that your particular surgeon was disingenuous with you or that he did something outside the standard of care... Just that I don't agree with his approach. But there are a great many surgeons who do it the same way.

It is infinitely more useful, and in my opinion a more honest approach, to center all preoperative discussions on what my patient wants to look like when we're done.

But now that you're in this position, I would not advise you to take an adversarial position with your surgeon. In the final analysis, your easiest and most economical path to a goal you're happier with, with the least amount of stress, is to maintain a positive and healthy relationship with your surgeon. 

Remember that you have responsibilities here too. You entered into a relationship with a surgeon that you hopefully chose because you respected his abilities and skills- you agreed to his process and gave consent to the procedure and all of its risks- including the risk of being unhappy with the result. 

As a result of the heavy and sometimes cheap media coverage plastic surgery has been receiving for several years now, many patients unfortunately view the plastic surgery experience too much like the drive through food experience, in which they believe they can drive up to the window, tell the person what they want, pay their money, and get exactly what they wanted. And that they have the right to be very angry if they don't get EXACTLY what they asked for. 

The truth is that plastic surgery involves a lot of science, a lot of art, a lot of skill, experience, and (hopefully) some talent as well. There are no absolutes and guarantees cannot be given. These are the reasons it is always in every patient's best interests to find the very best, most talented surgeon they can, and why shopping for a low price is almost always a mistake.

It is the patient's responsibility to be open and honest about her goals, understand and accept the limitations placed on the procedure and its outcome by her anatomy, carefully follow all instructions, and remember that her safety and happiness will depend on her choosing her surgeon carefully and for the right reasons, and then committing to the relationship.

And it is a relationship- if you want to get the most out of your plastic surgery, it is important to approach every interaction with your surgeon the same way you would any other relationship in your life that is important and can have such great implications for you- ant not like the drive through window at McDonald's.

It is the surgeon's responsibility to listen carefully to the patient's goals, openly and fully educate them about their options (after a careful examination) and the limitations, as well as the pros and cons of each alternative, the possibility (if present) that their particular goals may not be realistic and what approximation of those goals might be achieved. It is also the surgeon's responsibility to explain the anticipated recovery and the risks involved with the surgery being considered- including the risk that you will not be happy or get the exact result you desired.

When patients are unhappy after surgery, it only makes it harder to achieve what they want (a closer approximation of their goals with minimal expenditure) if they take the angry-person-at-the-drive-through-window approach and belligerently accuse their surgeon of not giving them what they asked for and demanding refunds or free surgery. Destroying your relationship is not going to help you get what you want.

The truth is that you chose your surgeon, understood the risk of being unhappy, and you agreed to it. While I don't agree with the process your surgeon uses for choosing implants, you did. Therefore you have some responsibility for the outcome you have now.

The best thing to do is to realize this, accept it, and move forward in a positive manner by openly, honestly, and respectfully engaging your surgeon in a discussion of how things could be made to more closely approximate your goals (if possible) and what costs you might (fairly) be expected to incur.

The one thing I am confident of (if your surgeon is a Board Certified Plastic Surgeon) is that he wants you to be happy- 

Talk to him about what might be possible. Accept your responsibility in the process and the outcome. Discuss a plan and fees, and move positively towards your eventual goal.

The alternative is to abandon ship and see another surgeon who will not have the benefit of an understanding of your first procedure, and will charge you a lot more money. This will have the net effect of making the whole experience even more negative for you in the long run, and may even compromise your safety or ability to achieve what you wanted in the first place.

I hope that with reflection, you are able to move forward and be happier with your plastic surgery and experience. Good luck.


Orlando Plastic Surgeon
4.8 out of 5 stars 157 reviews

Implants and revision

Being that I was not involved in your care, I can only hyopothesize what went on. Obviously there was  a communication error between you asn the surgeon.  As for the fees, that is something that you should discuss directly with the doctor and his office.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 28 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.