The Surgeon Minute

Breast Expectations: Surgery Planning for the Short & Long Term

Breast Expectations: Surgery Planning for the Short & Long Term

The majority of women who walk into a plastic surgeon’s office for a breast augmentation consultation have already made up their mind to have the surgery, and may have expectations before they even speak to their physicians. “This is a procedure where patients pretty much want it now, or close to now,” says Dr. Mark Epstein, a board certified plastic surgeon in New York. This decision is the easiest, while the rest will ultimately decide the quality of the results. Finding the right surgeon to guide each patient through the decision making process is key.

Breast augmentation is different from many body contouring surgeries in that it doesn’t invole lengthy surgeries and extended downtime for recovery.“The way we perform it, there’s really very little disruption of the patient’s lifestyle,” says Epstein.

While surgery recovery is speedy, surgery planning is not rushed. Expert breast surgeons invest a lot of time listening to their patient’s desires and then educating them about their best options to achieve those desires. “A breast augmentation is a process, it’s not just an operation,” Epstein stresses. “It’s a process that goes on as a team between the patient and surgeon so that we can work together to create a surgical plan that will most fulfill patient goals.”

Dreams & Reality

Most patient desires are surgically possible. They aren’t, however, always in the best interest of the patient for the long term.

When a patient with a small A cup and a very tight envelope of skin wants a large implant, Epstein will educate her on the possible complications that may arise when an implant that is too large for the breast pocket is chosen. These complications include:

  • increased postoperative pain
  • internal tissue damage
  • implant malpositioning down the road
  • unpredictable tissue stretching

“I have to reorient them as to what I feel should be done,” says Epstein.Not to say that you can’t achieve what they want, but if it’s a really bad idea, I’m going to counsel them about that.” A great way to tell if your surgeon has your best interests in mind is when they hesitate on extreme desires and tell you why going huge probably will not turn out well. With a healthy, objective discussion, patients walk out of the consultation with confidence in the surgery plan and an understanding that their surgeon has their best interests at heart.


The Great Unknown

Breasts continue to age with the patient long after surgery. Many who undergo augmentation are but in their twenties or thirties and their breasts will change a great deal if they experience pregnancy and breast feeding.

A major part of the consultation stage is to consider these factors and the patient’s future while planning for the immediate outcome. “While I can’t tell a patient how their breasts are going to evolve with time, I try to counsel them to get the best breast possible for the here and now, and for the long term,” describes Epstein. 


Keys to Success

When asked how the best results are achieved during the procedure, Epstein lists 5 things for his OR: 

  1. Fit the implant to the breast
  2. Don’t overstretch the breast
  3. Handle the tissues as atraumatically as possible
  4.  Just filling the soft tissue envelope, without over-distending it
  5. Selecting the right implant

Breast augmentation is the most chosen plastic surgery procedure for a reason. It has been meticulously researched and studied with decades of experience for surgeons, which has brought down recovery time while consistently delivering great results. While the procedure itself and recovery is short, the consultation may be the most important aspect and takes time and thought. Trusting an experienced surgeon to deliver a thoughtful consultation is the difference between good results and spectacular ones.

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