Caveat emptor, part three

Photo courtesy of Graeme Weatherston

Seriously, how many times can we talk about this?

In today's Style section of the New York Times, there is a very interesting article discussing a very disturbing trend in cosmetic surgery: the awake breast augmentation. As the article points out, most of the practitioners of this procedure aren't plastic surgeons (or even surgeons) and aren't performing the surgery in an accredited facility.

The supposed benefits to doing a major surgery while the patient is awake? It's cheaper, for one (you don't have to pay for the anesthesiologist); and the practitioners claim that it allows the patient to have "of the moment" input into their bust size.

Maybe I'm a very conservative plastic surgeon, but those reasons seem pretty weak. I like having an anesthesiologist with me during surgery. Breast augmentation is a serious and delicate operation. Since I trained for years to learn all the details of how to perform surgery, I like to focus on what I'm good at and leave the anesthesiology part to the guys and gals who spent their years learning all the ins and outs of anesthesia. Makes sense, not just for my comfort, but especially for my patient's comfort.

As for the patient input claim? I'm definitely a patient advocate in this matter - I do my utmost to communicate openly and often with my patients about what their hopes and expectations are in terms of breast size, shape, and feel - and this should be done well before the operation. By the time the surgery starts, we're all on the same page, and my patients trust me to use my surgical skill and judgment to deliver the look they want. I personally think it's problematic if you don't have that sense of trust before going under the knife and you have to rely on last minute input from your "awake" patient who is actually fairly altered from the narcotics and barbiturates given for the procedure. If you can't drive a car or sign a legal document while on those kinds of meds, you certainly can't give an informed opinion on how big you want your boobs to be.

But that's just what this cranky female plastic surgeon thinks (although, from the comments in the article, it's what other well-known and respected plastic surgeons are saying too...).