Breast surgery that utilizes breast implants is very common and includes surgery for both cosmetic and reconstructive diagnoses. As in all procedures, informed consent is a very important component in preparing the patient for surgery. Lack of sufficient informed consent before a procedure that uses breast implants can reach the level of malpractice.
A patient consulted with her Plastic Surgeon about having a breast augmentation. As a 4’ 11” person who weighed 96 lbs., she told the doctor that she currently wore a 32 a bra and wanted to be augmented so she could wear a 36 D bra. She was very concerned about the possibility of implant rupture; she did not want to face the extra expense this would cost her. Her doctor assured her that he could surgically place implants that would give her the size she wanted and told her that, although he had never seen a patient with ruptured implants, if the implants did rupture, her insurance company would cover those costs. She had the surgery performed but was very unhappy because her bra size was only 34B, much smaller than her desired size. Also, 5 years later one of the implants ruptured, requiring removal and replacement. Her insurance company did not cover the costs of that surgery and she had to pay for this surgery out of pocket.
The issues in this hypothetical case revolve around lack of informed consent: A patient should be informed regarding what the surgery can achieve and the possible risks and complications.
In this case, the Plastic Surgeon informed a very petite patient that he could place implants to give her the size she requested. No plastic surgeon can guarantee an ultimate bra size in a breast augmentation, especially in a petite patient; the skin and soft tissue under which the implant is placed have a limit on how far they can stretch and therefore how big an implant can be placed. A reasonably well trained plastic surgeon would inform any patient about this.
All breast implants can rupture, requiring further surgery, and a patient must be informed of this possibility prior to surgery. A reasonably well trained plastic surgeon would know about this and inform his patient about this.
Telling a patient that her insurance company will cover surgical expenses and giving her the wrong breast size is not quite malpractice, but it reaches the level of malpractice. Not giving an honest and informed consent and giving patient unrealistic expectations, and depending on the circumstances and what or was not said, not only can be unethical but potentially below the standard of care and medical malpractice.
The Plastic Surgeon who prepared this article is a Board Certified Plastic Surgeon who has been in private practice for over 25 years and has both a cosmetic and reconstructive surgical practice.
This Plastic Surgeon graduated from the University of Notre Dame, earning membership in the prestigious Phi Beta Kappa society. After graduating from Northwestern University’s Feinberg School of Medicine and being asked to join the Alpha Omega Alpha honorary society. This expert completed a plastic surgery residency at Northwestern Memorial Hospital in Chicago, Illinois, as well as went on to complete a fellowship in pediatric plastic surgery at Children’s Memorial Hospital, also in Chicago.
This Plastic Surgeon specializes in breast reconstruction after mastectomy, breast augmentation and reduction, treatment for traumatic injuries, eyelid surgery, wound care, skin grafting and burn treatment, skin cancer biopsies and repair, abdominoplasty, rhinoplasty, facelift, non-invasive skin care, and liposuction.