What Rights Do I Have? PS Changed the Operating Procedure As I Lay on the Table Hooked Up to IV and Ready to Go.

I am 115 lbs. 5'7". A-C. We agreed to go with a high profile, smooth, round, saline submuscular implant. Surgery in August. PS talked to me, marked where the incisions would go, then waited until the OR was available. Laying on the Operating table, PS informs me that he thinks we should go Subglandular because of my shape. I question the wrinkling due to be so skinny. He felt we would be okay. Trusted him. Now, I am wrinkling and there is a lump. What are my $rights w/ his unprofessionalism?

Doctor Answers 8

Miscommunication between Patient and Plastic Surgeon

For a Cosmetic Surgery to be successful the surgeon must educate the patient on all her options, on the potential risks a prudent person would require to make a decision and the patient must have realistic expectation. The process is known as the INFORMED CONSENT process. It cannot be done with the patient under the influence of mind altering drugs or otherwise incapacitated. While surgeons may be called upon to make life saving decisions in the OR, this is rarely the case with Cosmetic Surgery, in which the plan is agreed upon before surgery and except for rare exceptions need not be changed without consulting the patient. Dr. Peter Aldea

Memphis Plastic Surgeon
4.9 out of 5 stars 108 reviews

Changing the surgical plan....

Cosmetic surgery procedures should be thoroughly discussed  by the patient and physician, and a detailed surgical plan laid out. The risks and benefits of the procedure and options for alternative procedures should be also  discussed.

If for whatever reason the plan has to change, the same process should happen. Ideally Not on the operating table.If you signed an informed consent for a submuscular augmentation, a new consent should have been provided (assuming no drugs were given to you prior to signing the new consent.) .

Being very thin is yet another reason for going submuscular

In my opinion the suglandular placement is an outdated technique fraught with increased complications.

Good luck

Jose M. Soler-Baillo, MD
Miami Plastic Surgeon
4.7 out of 5 stars 92 reviews

Make sure to tell your surgeon about all your issues

Your question is really more of a legal one than a medical one, so the physicians on RealSelf may not really be able to answer what your "rights" are.  I would recommend to you and any patient who has any issues or concerns after any plastic surgery, to discuss them with your surgeon.  When you are at your appointment, don't be afraid to speak your mind if there is something that you do not like.  Your surgeon would be the best person to answer any questions you have about the specifics of your surgery.  After that, you can seek out a second opinion from another plastic surgeon in your area to see if there are any other ideas that they may have.  Beyond that if you are still unhappy with the way you are being treated by your surgeon, then you certainly can explore other avenues, but, especially in the early post-operative period, try to make sure you express your concerns directly to your surgeon or patient care coordinator to see what they can offer.

Jason Brett Lichten, MD
Columbus Plastic Surgeon
5.0 out of 5 stars 18 reviews

Meeting expectations in plastic surgery

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 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

Patients' Rights Regarding Canceling Surgery

You have every right to get up and go home at any time.  Even if you just feel nervous and "get cold feet" about your surgery, you can cancel anything you want at any time.

Sure, it is inconvenient for all concerned, but this is all about YOU, not anyone else. 

The decision of going over or under the muscle is particularly critical to the outcome in breast augmentation. 

I personally am very selective in the patients and procedures that I do.  Communication and agreement on every detail of any operation avoids this type of problem.  I never proceed with any operation if there is any doubt on the patient's part.

Gregory Diehl, MD, FACS
Long Island Plastic Surgeon
5.0 out of 5 stars 14 reviews

Placement Of Breast Implants - Who Makes That Decision And When?

Breast augmentation, more so than any of the other cosmetic procedures I perform, requires both patient and surgeon buy-in and agreement for almost every step along the way.  In my practice, the patient determines which manufacturer of implants they want, what type of filler they want, what covering and shape, the route of entry for the implant as well as positioning, cup size and cc range. 

This being an elective surgery, if the patient wants something the surgeon disagrees with, the surgeon can refuse to do the surgery.  If the surgeon wants something the patient hasn't bought into, the patient can choose another surgeon.  Making last minute decisions about whether the implant should be above or below the muscle may be necessary intra operatively based on anatomical findings.  If the surgeon changes his or her mind as to location of the implant pre operatively while the patient is laying on the operating table with or without premeds on board, that decision bypasses the informed consent and strips away patient's rights. 

Unfortunately, the rippling may or may not have been present even in the submuscular position, but in my opinion, there is a greater chance of the rippling with the saline implant in the subglandular position. 

I believe this is a case where the patient should speak frankly and directly to her plastic surgeon, and the patient and the plastic surgeon should come to an amicable agreement as to the next step. 


Plastic surgeon changed operative plan on the table.

I would first address the issues with the surgeon and ask him/her about the options for resolution. Other than this, your options are to discuss it with the hospital or facility at which he/she works or with an attorney.

Otto Joseph Placik, MD
Chicago Plastic Surgeon
4.9 out of 5 stars 81 reviews

Confusion about surgery

This is a tough question ot answer. I spend alot of time with my patients preoperatively to discuss ths issues that you are concerned about to avoid confusion.  You should go over this with your doctor.

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.