Breast Surgery: 10 Questions

Remember that it is legal for anyone with a medical license to perform this type of surgery. To become a physician who is certified by the American Board of Plastic Surgery, the individual will have completed training in an approved residency program. This training lasts anywhere from five to eight years after the completion of medical school. The individual will also have been examined over several years in a rigorous series of oral and written examinations. The advantages of choosing a physician with these credentials should be obvious. Almost all board-certified plastic surgeons are members of the American Society of Plastic Surgeons. Plastic surgeons with a particular interest in aesthetic plastic surgery are selected for membership in the American Society for Aesthetic Plastic Surgery.

When evaluating a person’s credentials, you need to look at the entire educational path that individual has followed. Take a look at the medical school and residency programs. Are these leading institutions? How about their undergraduate years? My point is simply that if there is a consistent path of educational excellence, this might give you an idea about how seriously this particular doctor takes his or her work.

Of course, there should be other criteria than mere surgical volume for selecting a physician. That said, there is probably an advantage in seeking the services of someone who has extensive experience with breast augmentation surgery. I would also suggest that this experience should extend beyond routine operations. There may be nuances of anatomy in your particular breasts that require more unusual or advanced techniques in order to obtain the best possible outcome. I also feel that there is an advantage in selecting a surgeon who has experience with reconstructive breast surgery, as the challenging circumstances that he or she will have encountered will work to your advantage.

Breast augmentation surgery is very much about visual aesthetics. It is very important that the patient and her surgeon establish clear communication about their mutual goals. If, for example, you desire a natural result while the surgeon is for some reason attracted to an “overdone” look, there will probably be a mismatch.

As a general rule, we stand a much better chance to achieve our goals if we are able to articulate them clearly. I would suggest you select a surgeon who can clearly express to you the specific goals he or she is attempting to achieve in your breast. There are many nuances in this surgery. It is not enough just to make them “bigger.” In my opinion, a big, unnatural looking breast is a decided step down from a smaller, natural-appearing breast.

With breast augmentation surgery, there are a number of choices that you and your doctor will make. These include the access incision to the breast, the location of the implant (under the muscle or just under the breast), and the type of implant that is used. At the very least, the doctor should be able to explain to you why he or she has made this selection for you.

Whether your surgery is in a hospital, an outpatient surgery center, or a doctor’s office, you should carefully check the accreditation of that facility. In general, the higher the level of accreditation, the better.

There are many possibilities. These include MD graduates from approved residency training programs, nurse anesthetists who perform anesthesia under MD supervision, and a whole host of other less-qualified individuals. All I can tell you is to do your homework carefully here, as you may be surprised to find out who is giving your anesthesia. I also think it is important that you meet the person who will be giving your anesthesia prior to the surgery. This usually occurs the morning of surgery. The anesthesiologist or nurse anesthetist should take the appropriate time to ask questions about your medical history and make certain that this will be a safe experience for you.

This is a good question to help you discriminate between the breast implant assembly lines versus a physician who is truly going to approach you in an individualized manner. In my opinion, if a doctor says to you that he or she just does breast augmentations one way and they all look good, you are not buying the services of someone who is serious in their work. Whether an individual performs five, 50, 500, or 5,000 operations, each patient should be approached in an individualized manner.

If you have lived in a community for a while, you probably have a fairly good idea of what the leading hospitals are. If not, ask a friend who has lived in the community for a number of years. As a general rule, the leading hospitals are far more selective as to who they will allow onto their medical staffs. This is just one more way of helping you to sort through the confusing lists of doctors that you encounter. Even though the surgery will probably not be performed in a hospital environment, the hospital affiliation remains a useful gauge for selecting a physician, in my opinion. Remember, too, that in the extremely unlikely event of a serious complication, your doctor will probably draw upon the resources of the physicians at his hospital. You would certainly want a first-rate team working on your behalf. Often, but not always, leading physicians in a geographical area are affiliated with major teaching hospitals. If you are interviewing a physician who is not affiliated with a major teaching hospital, another indication of their level of commitment to their field might be whether they have offered any teaching courses or delivered any lectures at national meetings.

If you just get a blank stare in response to this question, then you may be dealing with an individual who has not given much consideration to the long-term consequences of surgery. In my opinion, the single most common source of a long-term result that is artistically disappointing is a lack of respect for the natural architecture of the breast. You can easily recognize the natural base architecture of your breast as you stand in front of the mirror and support your breast with the opposite hand. You will be able to see a visual transition point where the breast border exists. The thinner you are, the more you will regret if someone selects for you an implant that violates this natural architectural border. In my opinion, this is not too different from putting an addition on a house that extends past the natural foundation line. There can be valid and appropriate reasons to change the fundamental breast architecture. For example, a patient with an element of congenital breast abnormality will, by definition, need an intelligent restructuring of the basal architecture of the breast. If, on the other hand, you have relatively normal breast anatomy, I would strongly suggest that you try to preserve your natural architecture. At the very least, it is important that the physician who examines you measures and notes the key architectural dimensions of your breast and is able to formulate an intelligent plan for you that takes these issues into account. If this does not happen during your examination, then you may want to seek a higher level of sophistication.

Safety in medicine comes from attention to detail. If you have a consultation, pay attention to the questions that are asked with regard to your medical history. As a bare minimum, they should have obtained information about allergies, current medications, whether you are a smoker, whether you have had any surgeries, how you have healed from any previous surgeries, and whether you have any active medical conditions that might influence the safety of the operation. Remember that it is not just enough that you have entered this information on a form. Did the doctor review the medical history with you? If not, I think there might be others who are more concerned for your well being. Did the doctor take any time to get to know you as a person? This does much more than just make the experience warm and fuzzy. With breast surgery in particular, information regarding the type of work a person does, the type of exercise she enjoys, whether or not she has young children, and plans for future pregnancy can have a significant bearing on the specific recommendations we make.