My Doctor Never Had Me Sign off to Any Specific Size Implant Before Surgery.. is That Legal?

I am 400cc's I told my doctor I didn't want to be any bigger than 350cc's. (I know many Doc's say 50cc's isn't drastic, but one of my boobs is a 1/2 to full size bigger already yet both boobs received the same size implant of 400cc. Unevenness is drastically noticeable. I was a sml to med B Cup & I already had something to start with. I kept saying the smallest implant would suffice. I signed off my paperwork, but no where on there was there a spot declaring my desired size. I'm so unhappy.. :(

Doctor Answers 9

Concerns after Breast Augmentation?

I think that Dr. Tholen has done a better job than I could in answering your question for you.

 Best wishes.

San Diego Plastic Surgeon
5.0 out of 5 stars 1,498 reviews

Is it legal for your surgeon to use too large (or too small) implants?

Perhaps another way of stating what I think you're asking is to ask "Is it practicing medicine without a license when patients make surgical decisions?" Ouch; that's harsh isn't it?

The real issue here isn't about proper consent or implant choice being "approved" prior to surgery (or the supposed "illegality" if it is not done), it's about the fact that you have visible asymmetry as well as feeling too big with implants that you believe are 50cc too large.

If your breasts were the same size pre-operatively, then adding the same size implants to each side means you must have blood, fluid, (or more likely just swelling) more on one side than the other. So this should not be an issue as you heal, settle, soften, and swelling diminishes.

You are absolutely correct in stating that 50cc isn't "drastic;" in fact, it is exactly 3 tablespoons and 1 teaspoon. Over a whole breast, I doubt that very few patients and even many surgeons would be able to "see" this difference.

So let the swelling go down, your tissues soften, stretch, and heal, and your implants settle to their final position (lower). Over several months (if you don't over-react and have a premature re-operation), I suspect you will find out your surgeon made a good choice for you. S/he wants you to be happy, and used best judgement in the operating room, based on years of surgical training, board certification tests, and years of experience, and likely hundreds if not thousands of other breast augmentation patients.

Please don't be so quick to be thinking about malpractice or lack of informed consent. I know of no plastic surgeon who expects his/her patient to "sign off" on a specific size implant pre-operatively, even those who order implants in advance because they don't stock all sizes and profiles of implants (as I do in my practice). Even these surgeons will order several pairs so that there is at least some chance of making the "best" selection once the pocket is created surgically, and the muscle tone, thickness, and ribcage assessed.

BTW, you don't need to have a law degree to be told that "poor result" or "undesired outcome" is not malpractice or negligence, so don't waste your time or angst going down that path! Be constructive and talk with your surgeon, who will hopefully be explanatory and not defensive (and that depends on your attitude in questioning!) in answering you. It might be wise to ask about revisionary surgery policies/costs/responsibilities if these were not discussed BEFORE surgery as they should have been.

Hang in there! My prediction: you'll be just fine and look great as time goes by. Best wishes! Dr. Tholen

Richard H. Tholen, MD, FACS
Minneapolis Plastic Surgeon
4.9 out of 5 stars 255 reviews

Implant choice

Discussing the final volume is often done before surgery in my practice.  However the exact volume I discuss with patients will always be determined during surgery because many factors go in to getting it "just right."

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 29 reviews

Legal questions about breast augmentation not suitable for this form.

Only an attorney familiar with the law can advise you about the legality of the documents you signed your plastic surgeon.

Vincent N. Zubowicz, MD
Atlanta Plastic Surgeon
4.8 out of 5 stars 36 reviews

Implant size questions

Implant size can be a touchy issue.  Because a patient can not actively participate in the operation it becomes the patients job to be sure that she is on the same page as the plastic surgeon.  The Vectra 3 D imaging system has virtually eliminated size problems since the patient is able to visualize their after appearance before the operation.  This is a tremendous educational tool allowing active communication between all parties involved.  The ultimate goal is meeting expectations, when this occurs everyone is happy. If you have persistent asymmetry and size issues then discuss this with your plastic surgeon.  We all work to serve our patients and try to use our best judgement in each and every case.  

Jeffrey Zwiren, MD
Atlanta Plastic Surgeon
4.5 out of 5 stars 19 reviews

Unhappy that doctor went bigger than agreed to

Some doctors do make choices for their patients and from their experience, it works for them.  If your results truly show a marked asymmetry, you certainly can discuss your concerns with your surgeon but 350 cc's implants would have produced the same asymmetry since the implant volume is identical in both breasts.  Yes, 50 cc's is not a terrible difference in implants.  And if you allow yourself to heal, the asymmetry may even resolve adequately to where there is no appreciable difference.  So try not to fret and complete the healing and keep your doctor informed of your concerns.  We don't like to be surprised when we thing everything is fine.

Curtis Wong, MD
Redding Plastic Surgeon
4.8 out of 5 stars 33 reviews

Breast implant size

I'm not aware of anyone who routinely has a patient sign a document stating what size implants  used. Furthermore, most plastic surgeons will use an implant slightly larger than the one chosen because once you place the implant it will look smaller so you have to add to the volume. Therefore if you chose a 350 CC  a 400 mL implant for surgery would be an appropriate increase

John Paletta, MD
Savannah Plastic Surgeon
5.0 out of 5 stars 21 reviews

My Doctor Never Had Me Sign off to Any Specific Size Implant Before Surgery.. is That Legal?

Although there are a handful of plastic surgeons who earned law degrees, I, and the overwhelming majority of participants in this site have not, so this would not be an appropriate forum for legal questions or advice. 

The sort of problem you are discussing can usually be managed one on one with your surgeon. Without photos, none of us will be able to make medical comments that might help you in any decisions you will consider. It is common that similar amounts of size differences are considerably more noticeable in larger breasts. I can't tell from your question if using different sized implants was discussed before surgery. 

I would recommend making an appointment with your surgeon to discuss the areas of dissatisfaction. All the best. 

Jourdan Gottlieb, MD
Seattle Plastic Surgeon
4.6 out of 5 stars 45 reviews

My Doctor Never Had Me Sign off to Any Specific Size Implant Before Surgery.. is That Legal?

Dear Betty,

Thank you for your question.  There is no legal issues to having a patient sign a form saying exactly what implant they want.  However, I'm sure your plastic surgeon is trying to please you to the best of his ability.  If there was a size difference before surgery, and still a size difference, then maybe a revision with placing more saline into the smaller size saline implant or placing a larger silicone implant may be necessary.  Ask your PS why he chose the implants he chose, and I'm sure there is a good reason.  Sometimes if using silicone implants, the next size up is too much in the opposite direction for making the implants even, and the same implant is as close as can be obtained with silicone implants as they only come in limited sizes.  Discuss your concerns with him and give it time.  I know its probably not what you want to hear right now, but the most common complaint in breast augmentation surgery is that the patient wishes they had gone a little bit bigger.  In 6 months, you may think that it is the perfect size.

Best Wishes,

Pablo Prichard, MD

Pablo Prichard, MD
Phoenix Plastic Surgeon
5.0 out of 5 stars 48 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.