Whenever possible, I recommend that an individual consult with the plastic surgeon that performed their initial surgery if they wish to have a revision of previous breast surgery, whether it be because of weight change, pregnancy or just the passage of time. I recognize that this is not always possible and so I am willing to perform revisions when I think I can make a meaningful improvement.
I apply the same criteria to patients who have had their surgery elsewhere as I do to my own patients. I am typically reluctant to re-operate on a breast augmentation patient for minor issues, because each time one undergoes revision, many of the risks of surgery tend to be multiplied. This is why I spend a great deal of time discussing size preferences and the likely outcome of surgery with my patients pre-operatively. It is said frequently that the most common reason for re-operation of the breasts in women who have had breast augmentation surgery is that they wish to “go bigger.” Ultimately, I feel that this is a poor reason to undergo repeated surgical procedures that can only result in more scar tissue, which is unpredictable, and thinning of the native tissues, which are necessary to cover the implant and provide a natural looking result. I encourage patients to think carefully about the risks of revision in cases where there is not a major problem.
Of course, if the issue at hand is appropriate for revision surgery, I always try to offer the best option possible. It is very important for me to be very honest with patients in these situations. If I feel that I can help you, I will offer you surgery. If I feel that the likely result from revision surgery does not outweigh the risks, I will decline to operate. As I frequently state, I do this because in the end, I must feel that I have acted in every individual’s best interest and that I have upheld the principles of non-maleficence.