My doctor put in smaller implants than we agreed upon. My bras do not fit and I now have loose skin. What can I do?

Question

I recently decided to take my savings and get my implants exchanged for the same size/maybe a touch bigger newer implants as mine were 21 years old. Apparently he removed 450 cc oval and put in 400cc round. I really loved my old implants,I do many photo shoots in swimsuits and sports bras and I am judged on my appearance on the stage as part of my professional career. This took all of my money and now I am left with loose skin and bras/ competition suits that do not fit. Who is responsible?

Richard H. Tholen, MD, FACS · Answer

To answer this, one must first be aware of both sides of any discussion, and without having been present during consultation, no one here can agree or disagree that your surgeon "bears responsibility." I know you were asleep during surgery, but you weren't during the consultation, or the markings pre-op, or when you signed the consent form.

Of course, what your question really relates to isn't responsibility--it's about cost. Who pays for what? This should always be discussed BEFORE surgery, especially with revision surgery.

Just as an aside: who bears responsibility for choosing the surgeon who operated on you?

They did not "take all of your money." You chose elective surgery, and willingly paid for the operation. If a specific size of implant was chosen and agreed upon, was this specified in the consent form? Or did the consent agree to the surgeon utilizing his best judgement? Would you really want your chosen expert to utilize anything other than his most thoughtful decision-making in the performance of your surgery? Do you really believe that your surgeon openly disregarded your requests or went against agreed-upon plans?

Intentionally making patients unhappy is not a good business plan! Please understand that when a patient is unhappy, their surgeon is probably unhappy as well, and both will have to bear some part of responsibility for the present state of affairs. So, respectfully, lose the attitude, unless you want your surgeon to react defensively rather than charitably.

A confrontational attitude causes lawsuits, most of which have little or no merit and even though the aggrieved patient is often upset enough to force the issue (and lawyers greedy enough to "fan the flames" of discontent), these cases are almost always losers for everyone. And the patient ends up paying full price elsewhere for more surgery when the most recent surgeon would happily put in larger implants for implant costs and minimal OR/anesthesia fees with limited or no surgeon's fee--all in a effort to convert you to a happy patient. Sure, you want it for "free," but this isn't an overdone steak, and re-do surgery costs should always have been discussed in advance, even if exact implant sizes were not.

That being said, 50cc is 3 tablespoons and 1 teaspoon, and such a minimal amount that this difference is truly scarcely visible--it takes 200-250cc to equal one bra cup size, and I'm pretty sure I don't know what "a touch bigger" is in cc. Is it more than a "tad?" And lots more than "a skosh?" This certainly required more than your summary of what must have been an important and significant amount of discussion.

Frankly, this whole issue is likely about more than 50-100cc too-small implants. Sure, your suits don't fit like they used to, but if 50cc (or 100cc) will revive your competition wins and magically "fill" that  loose breast skin, then understand your surgeon has a "cost" involved in re-do surgery as well as you do (he could be doing a "paying" patient rather than one simply covering costs), so make nice and stop looking for someone to "blame." It's truly better than the alternative. Best wishes! Dr. Tholen

Thomas Trevisani, MD · Answer

Without the benefit of physical exam- reading the operative report, and knowing more details - it's difficult to comment accurately. Usually, patients sign pre-operatively consent forms outlining a mutually agreed upon surgical plan, including the implant sizes. I suggest you review it all with you Operating Surgeon, as well as review your before and after photos.

Martin Jugenburg, MD · Answer

I am sorry to hear about your post-operative results. Your surgeon must have taken consent from you with regards to the implant size and shape decisions. If not, then your surgeon is responsible for the decision and outcome.I believe an honest, and open discussion is important to avoid miscommunication and conflicts. Let them know how you feel, and let them know that you expect your breasts to optimally fill your breasts. If the matter is that your breasts are filled adequately, but your competition suits are not fitting, then there may be a different problem.If you had your surgery recently, then you may have to wait for at least 6 months depending on your surgeon's preference.Hope this helps.

Curtis Wong, MD · Answer

it does create an uncomfortable situation.  It really comes down to whether there was an implied contract with agreeing to an implant size and not getting it.  Your surgeon knows if he/she is culpable and if you can prove there was an agreement of a specific size, its your surgeon's responsibility to fix this.  If there was no agreement to size and it was entirely left up to the discretion of your surgeon, then you have to live with your results.  So best to sit down with your surgeon, review the written records (recall alone won't cut it here - its what is on paper) and see what can be done... and hopefully this will work out for you.

Tom J. Pousti, MD · Answer

I am sorry to hear about your concerns after revisionary breast augmentation surgery. Obviously, online consultants will not be of much help to you when it comes to specific assessment (without photographs). Some general thoughts may be helpful to you.

In cases where an unfavorable outcomes are present it is best for patients to discuss their concerns in a calm/constructive fashion; most plastic surgeons very much want their patients to be pleased and will do everything they can to improve outcomes.  On the other hand, an accusatory stance taken by a patient does not end up working out well for anybody involved.  For example, I would suggest avoiding using inflammatory term such as "botched"... Overall, staying emotionally even keel tends to be helpful in these cases.

When it comes to revisionary surgery costs, policies will vary: charges such as facility and/or anesthesia fees are quite customary in most practices.  Often, surgeons will reduce or waive fees.  I can tell you personally that I am much more likely to waive fees for patients who demonstrate an understanding of the circumstances as opposed to patients who expect "perfection" and approach the complication in an accusatory or faultfinding fashion.

Again,  communicate your concerns in a calm/constructive fashion. Working together you will likely come up with a plan to achieve an outcome that you will be happier with. Best wishes for an outcome that you are pleased with long-term.

Keith Denkler, MD · Answer

A discussion with your surgeon is appropriate.And best to review all that you signed before the surgery in order to show your agreement.

Douglas J. Raskin, MD (retired) · Answer

Greetings,From your note, it appears as if your expectations have not been met by your recent surgery. When this happens, you must consider revisiting your plastic surgeon for a candid discussion. You both can consider options based upon your outcome, appearance and objectives.Best Regards,

My doctor put in smaller implants than we agreed upon. My bras do not fit and I now have loose skin. What can I do?

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