The December 06 supplemental of Plastics and Reconstructive Surgery devoted a large portion to the issue of re-operations in breast augmentation. A panel discussion by experts is rounded off with two illustrative articles of complications of these secondary surgeries: wound necrosis, lost nipples, that sort of thing. Now why is this suddenly an issue? A recent study has suggested that 15-20% in patients who have underwent breast augmentation had their breasts went under the knife a second time within 3 years. This could not have come at a worse time for this procedure, as the FDA is just about to lift the ban on silicon breast implants put in place since the 1990's.
Now let us put aside the safety issue of silicon implants, as the same statistics apply to both silicon and saline, and instead ask a seemly absurd question: Is this a big deal? How bad is it to have one in five of your patients come back to your office in one to three years, angrily opens her blouse and says "Doc you have to do something about this."?
Some would argue that the re-op rate is justified as the expectation of plastics surgery is much higher than in other surgical fields. They invoke the analogy of redecorating one's apartment, be it an appropriate analogy or not. When you pay premium, you want things to be just right. If it means returning to Home Depo ten times to get the right faucet to go with the curtain, so be it. The public's sentiment seems to echo this. They already know what's involved from the last go-around, and they extrapolate what will happen in the re-op from previous experiences, as humans naturally do. If things ended too low the first time around, we'll just get it higher this time. And if in another five years, it sags again. We'll go at it a third-time. No big deal.
So here we are, an eager, positive, solution oriented woman teaming up with a surgeon who's seen it all and fixed it all. Before you know it, we are wheeling into that OR for the sixth time. Just a little touch up. No big deal.
But as all surgeons know, the second time around is never the same as the first. And the third, fourth, and those that follow are anyone's guess. There is more scarring, more bleeding. One is more likely to get lost, as the anatomy has been distorted. Some the vessels have been divided in the first surgery, so the healing will be slower. An otherwise viable flap dies. Therefore we have complications. Therefore we enter the spiral.
Surgeons strive to get things right the first time around. We measure just one extra time before we cut. We replace that last suture because it "just didn't look right." I do not care how extra-ordinarily demanding the patients are, in any field, twenty percent re-op rate is a HUGE problem. It cannot be justified by the personalitiy profiles of the patients. Expect this to become more publicized in the press in 07. Patients will still come, though. But we must re-think our approach if we were to stem this man-made epidemic.
