Preparing for Surgery
What Should You Do?
“You are ultimately responsible for thorough planning that assures optimally safe surroundings and the most pleasant experience.”
Now that you’ve selected your surgeon, it’s time to prepare for surgery. Preparations begin with money: what are the costs, which are justified, and where does the money come from? Next, you’ll need to check into the surgery facility to be sure that you’re not having surgery in someone’s back room (Don’t laugh; it happens every day in bargain basement situations.) Finally, it’s important to clearly understand the scheduling policies and procedures of your surgeon and make all necessary arrangements in an organized manner. A lot of arrangements are required. Preparation and organization prevent glitches that can interfere with your surgery.
Part of preparation is paying for your surgery. During your visits with surgeons, you collected a specific breakdown of costs from each surgeon. You’ve probably noticed that we didn’t go into detail about analyzing costs while choosing a surgeon. The reasons?
If you want the best result, cost should not be the primary determining factor in choosing your surgeon. Choose based on qualifications, and then address the costs.
You can’t pay enough later to undo problems from “bargain” surgery, but you will pay to correct them
Are we saying that costs don’t matter? No. Costs certainly do matter. But you’re not going shopping for a dress. You’re asking someone to permanently make changes in your body. If costs seem unreasonable or totally out of line with other quotes, investigate. Way too high or way too low is worth looking into. Ask questions! Why the high cost?
Or how can you get such a bargain? Look carefully at the breakdown list of costs we provided. Don’t just accept a “package deal” if it seems out of line.
Is there such a thing as “bargain surgery”? Undoubtedly, you can find low-cost plastic surgery. But a bargain? A bargain is value at a lower than expected price. The key word in this definition is value. If, in fact, you get top-quality surgery at a lower-than-expected price, then you’re getting a real value. But it’s not often that you get a steal when buying surgery. When bargain surgery seems attractive, ask yourself:
Am I getting top-quality surgery for this bargain price? How do you know? What might you be giving up?
How is the bargain surgeon able to offer such a good price?
Cheaper implants? “back room” surgery, instead of an accredited surgical facility? Not many cases scheduled? Less qualified? Who pays for costs of reoperations if problems occur?
How many professionals (or anyone, for that matter) do you know who do more work for less money—at the same quality level?
Most of the better surgeons we know charge similar surgical fees. We don’t know any top-quality surgeons who offer bargain basement prices. In fact, we don’t even know any above-average surgeons who offer extremely low prices. If you encounter prices that are substantially lower than other surgeons you consult, beware. You may find some surgeons who do equivalent quality surgery at a lower price than other surgeons, but how do you really know until they’ve already operated on you? Once they’ve operated on you, you’ll definitely have to live with the “bargain.”
Our favorite answer when asked about surgeons and prices is:
If there is anyone who knows what a surgeon is really worth, it’s the surgeon.
How Much Difference Is There, Really?
After all, this is just a breast augmentation, and breast augmentations are simple. Believe it or not, I’ve heard more than a few patients and surgeons make this statement. My response?
Anything seems simple if you don’t know enough to understand why it’s not simple.
If augmentations were really simple, all results would be outstanding, and you’d see very few reoperations.
If it’s so simple, why the drains, bandages, special bras, pain pumps, narcotic pain medications, bruising, excessive pain, and prolonged recovery following surgery? Remember, with optimally performed surgery, there is a greater than 90 percent chance that you can return to full, normal activities within 24 hours of your surgery using techniques we have published in the most respected professional journal in plastic surgery1 with no drains, bandages, special bras, straps, no bruising, and no narcotic pain medications!
Your best chance for a good result is at the first surgery.
After that, everything gets more difficult and risky, with more trade-offs and more costs.
Few patients appreciate the importance of getting a good result at the first operation. We can’t overemphasize this important point. If you require a reoperation, even the best surgeon is working with previously operated tissues. Things are always more difficult, and every aspect of a reoperation is less predictable. Every reoperation involves even more factors that a surgeon cannot control. All augmentations and all surgeons are not the same. Reoperation and complication rates can vary significantly from one surgeon to another. In FDA studies where augmentations were performed by many surgeon investigators, an average of 17 percent of patients had a reoperation in just three years following their augmentation.2,3 Using processes and techniques that we described in peer-reviewed and published journals, in 1,664 reported cases with up to seven-year follow-up, instead of a 17 percent reoperation rate, we documented a 3 percent reoperation rate1.4,5 In a more recent study, we documented a zero percent reoperation rate in a 50-consecutive-case series supervised by an independent review organization in an FDA study.
Substantial differences in outcomes and reoperation rates can occur from one surgeon to another.
Many of the same techniques that speed recovery, combined with optimal decision processes, reduce complications and reoperations.
Costs by Category—The Details
It’s easy to eliminate or reduce costs by eliminating tests and procedures prior to surgery. The key question is how much of your safety you may be sacrificing when you eliminate more thorough testing even if it seems to be overkill. What might an additional test or two be worth if it potentially prevented your having a cardiac arrest or other It’s easy to eliminate or reduce costs by eliminating tests and procedures prior to surgery. The key question is how much of your safety you may be sacrificing when you eliminate more thorough testing even if it seems to be overkill. What might an additional test or two be worth if it potentially prevented your having a cardiac arrest or other problem during or after surgery? If you didn’t do the test and had a major problem during or after surgery, there’s a good chance you’d question why you weren’t as thorough as possible prior to your medically unnecessary operation!
Fees for all cosmetic surgery are paid prior to surgery. We’re not aware of a single quality cosmetic surgeon who does not follow this policy. To fully understand costs of your surgery, look at the breakdown of costs associated with first-time (primary) breast augmentation surgery:
Surgeon fees—These fees vary with the qualifications and experience of the surgeon. Cost range: $2,500–$5,500; average $3,500.
Laboratory fees (for lab work prior to surgery)—Some basic lab tests are usually required even if you’re perfectly healthy. A routine blood count (to assure that you’re not anemic and do not have an undiagnosed infection or other problem) and routine blood chemistry (to check factors that could affect how you react to sedative drugs or anesthesia) are common. Some surgeons require HIV testing. Some surgeons don’t feel that any lab tests are necessary in a healthy individual. We disagree. To make this surgery as completely safe as possible, leave no stones unturned. Check everything. It’s not worth risking a problem. Costs of lab tests? Range: $150–$300; average $200.
Electrocardiogram fees (if needed)—If you are over 40 years old or have any history of any type of heart problem, your surgeon may require an electrocardiogram. Cost range: $150–$300 (including interpretation by a cardiologist); average $200.
Mammogram fees (if your surgeon requires mammogram)—Many surgeons require routine mammograms before a breast augmentation regardless of your age or family history of breast cancer. Some surgeons do not feel that routine mammograms are necessary. It’s true that breast cancer is exceedingly rare in women below the age of 30-35 years, but it happens. We require mammograms on every patient over the age of 30 because operating in the area of an undiagnosed breast cancer may have significant effects on whether that cancer can be cured. We want to take no unnecessary risks with a totally elective operation even if a mammogram increases the costs. Have your mammogram at a breast center where they are familiar with breast augmentation patients. Cost range: $100–$350; average $150.
Surgery facility fees—This fee is the fee that a hospital or outpatient surgery facility charges for the costs of the facility and supplies required to do your surgery. If a surgeon operates in an office facility, this fee may be lumped with other fees. If this fee is excessively low, beware! The only way to substantially lower this fee is to use fewer or cheaper supplies, have fewer or less qualified personnel, or to have less equipment or cheaper equipment in the facility. Fully accreditied facilities with adequate, qualified staff and equipment must charge fees that allow them to remain in business. Cost range: $1,200–$2,000; average $1,500.
Costs of implants—Implant costs vary widely. In chapter 4, we discussed many of the factors affecting implant costs. Cheaper implants are usually cheaper. Enough said! If an implant fails sooner because it was cheaper with respect to quality, you didn’t get a bargain. What you got was another operation with substantial costs and risks. Check carefully into implant costs and manufacturer before you implant this device. Cost range: $600–$1,600 per pair; average $1,200. Silicone-gel-filled implants, especially form-stable silicone-gel implants, cost more compared to saline-filled implants. These costs can vary widely, so check costs with your surgeon.
Anesthesia fees—Fees for anesthesia vary according to the type of anesthesia (general versus local) and increase with the level of person giving the anesthesia. Most state-of-the-art facilities require that CRNAs (certified registered nurse anesthetists) or anesthesiologists administer anesthesia—particularly general anesthesia. Cost range: $250–$750; average $350.
Medications fees or costs (for before and after surgery)—Costs of medications that are required before and after surgery vary significantly from surgeon to surgeon. The more medications a surgeon requires you to take, the more you’ll spend! The most common medications required for breast augmentation surgery are antibiotics and pain medications. Other medications are optional, and the necessity varies with the surgeon. The less trauma a surgeon causes, the less medication you will need. Cost range: $15–$200; average, less than $40.
Any other fees—Always ask if there are any other fees. If other fees are charged, they are unusual, and you should carefully investigate the value of those charges. Special circumstances exist, but always check out any unusual fees.
Adding individual costs listed above, you’ll find that an augmentation at today’s prices will cost between $4,965 and $11,000 with an average of $6,500. What a range! In our opinion, if you pay more than $8,000 for a top-quality augmentation, you are paying too much. If you pay less than $5,000 today, beware!
Financing for Cosmetic Surgery
Financing options are available for patients desiring breast augmentation who cannot or don’t wish to pay with cash or check. Common options include credit cards, bank financing, and finance companies specializing in cosmetic surgery. Let’s examine these options.
To continue reading this chapter and the remainder of this book, please ORDER NOW
1 Tebbetts, J. B. Achieving a predictable 24-hour return to normal activities after breast augmentation, part II: Patient preparation, refined surgical techniques and instrumentation. Plast. Reconstr. Surg. 109: 293-305, 2002.
2 U. S. Food and Drug Administration. General and Plastic Surgery Devices Panel Meeting Transcript. http://www.fda.gov/ohrms/dockets/ ac/03/transcripts/3989T1.htm. Accessed January 13, 2004.
3 U. S. Food and Drug Administration. General and Plastic Surgery Devices Panel Meeting Transcript. Washington, DC. 1992 Feb 18.
4 Tebbetts, J. B. Patient acceptance of adequately filled breast implants. Plast. Reconstr. Surg. 106(1): 139-147, 2000.
5 Tebbetts, J. B. Dual plane (DP) breast augmentation: Opti1. Tebbetts, J. B. Achieving a predictable 24-hour return to normal activities after breast augmentation, part II: Patient preparation, refined surgical techniques and instrumentation. Plast. Reconstr. Surg. 109: 293-305, 2002.