Safety First

Cosmetic surgery, like any surgery, involves risk. There are no guarantees in medicine or in surgery.

But like any activity, there are measures we can take to reduce risk. As a plastic surgeon doing elective, cosmetic surgery, I operate on patients when surgery is not necessary, unlike my surgery colleagues doing appendix removal, cancer surgery, or hip replacements, to give a few examples.

So, the responsibility to bring you, the patient, back to your pre-surgery health (and in better physical form) is very substantial.

Sometimes reducing risk involves making a surgery plan which doesn’t push things beyond reasonable limits. A frequent example is a patient requesting larger breast implants than what I think are safe. This is especially a problem when a breast lift is being done at the same time. The breast and the breast skin circulation, its nourishment can be reduced so it becomes insufficient to heal the incisions or to maintain the vitality of the nipple, and major skin loss, death of the nipple, or extrusion/exposure of the implant leading to the need to remove the implant can be the result.

I tell my patients who are making (what I consider) unreasonable requests for size this compares to speeding at higher and higher rates. We can feel comfortable in our safety if we travel under normal road conditions at about the speed limit. The risk of an accident becomes greater if we are speeding in a 100km/hr zone at 130, but with a good vehicle and skilled driver, the risk is only moderately higher.  At high speeds, a serious crash becomes almost a certainty.

The same is likely true when we start to use bigger and bigger implants, and at a certain point, I simply refuse.

This discussion about implant size and the risk of complications has nothing to do with issues of esthetics. Big implants also increase the risk of what I call Esthetic failure.  By this I mean a variety of problems which mar the outcome without being a complication of surgery in the usual sense. This includes malposition of the implants such as dropped out or bottomed out implants, lateralization, and excess upper pole fullness, on one or both sides. When the implant comprises the vast majority of implant/natural breast together there is a much higher chance the implant will be visible or palpable (able to be felt.

Most experienced plastic surgeons are reluctant to use big implants, for good reason. We have no difficulty using devices which are generous enough to make you feel “Super – natural” but not beyond. We have had to deal with the consequences of too much, and we want the best for you.

Dr. Gelfant’s Living Beautifully Blog

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