Questions about revision surgery

[greatlakes]

I am going in for a "modest" revision on my right side shortly to achieve a more balanced look. I did alot of questioning myself whether I should go in for a revision but my gut says I should do it.  I am sticking with my doctor, because he said he would revise if I was not satisfied, he is reputable, and I brought some special challenges that he had to deal with.

I hear some of you perform revisions on other doctors work - but my two questions are more when you have done revisions on your OWN work (assuming occasionally this happens to even the best experts like you docs). So.....

1) When you do perform revisions, who is usually behind the request - you  - the patient -  or some mutual agreement together, that a revision would yield improvements.

2) What is the level of satisfaction of you and your patients for the second time you work on them? Healing, complications, and final results?

[Dr. Elliot Jacobs]

My revision policy is stated on my website.  I essence, I do not perform a revision merely at the request or demand of a patient. (Some patients simply are unrealistic as to possible results -- or they are seeking perfection, which cannot be guaranteed given the vagaries of individual healing).  On the other hand, if feel that additional surgery would be beneficial, then I will discuss with the patient and we mutually decide to do it.  No revision is ever done prior to six months from surgery.  I revise maybe 1% of my cases. In all cases so far, the healing has gone well with no complications, and the patient has been satisfied.

Dr Jacobs

[greatlakes]

Thanks Dr. Jacobs for responding.

I am glad to hear that in the small percentage (1%) of patients you do mutually agree to revise - they are happy with results and healing goes well.

There was little uncertainty on my part the first time, that it was needed. Going in for revision was more difficult as I questioned whether I am being a perfectionist. My left side is nearly perfect (sculpted) in my view. My right is better but continues to bug me and is unbalanced. You can see it clearly with my shirt off, and with a tight tshirt as well The doctor has agreed he can improve the right, but cautioned me he can't guarantee it will look like the left side - just that he can get more out of the right side for me. A second doctor (my endocrinologist) has said my chest looks improved and very good after the surgery, he complimented my surgeon - but agreed with me the right side has some remaining tissue that the left does not.

I am hoping my healing will be quicker and easier than the first time as it is just a touch up on the right.  I can almost live with the right now, and a little extra out, would do it.

Thanks again.

[Litlriki]

I discuss revision with all of my patients prior to their first surgery, and I explain my revision policy.  If a patient is unhappy with the outcome and a revision will improve it, it's a mutual decision.  I have had a rare patient who requests a revision, in whom I think further intervention could have more downsides than upsides--really this has been the case for only one of my own patients that I can think of.  I finally gave in on one side, and he was satisfied with what we did on that side.  Now he wants me to do the same thing on the other side, which he had previously been happy with--and I can't really ever see what he complains about.  It's hard to operate on something that I can't see. 

My personal revision rate is very low--I'm not sure it's 1%, but maybe 2 - 3%  Of course, some "revisions" are anticipated, such as in the occasional patient with borderline large areola, in whom we decide to do a peri-areolar reduction under local in the office at a later time, rather than at the time of the primary procedure. 

I won't do a revision before 6 months, and I often encourage waiting a longer period of time.

Other than the one patient I mentioned--who is basically satisfied, but perhaps being a little obsessive--my patients have been pleased with their final outcome.  Otherwise, it's not their final outcome!

RS

[greatlakes]

Thanks Dr. Silverman for your reply. Interesting story on the flip flop patient. That wont be me my left side is DONE for good and I am very happy with it.

[DrPensler]

Any surgeon who performs a large number of surgeries has some revisions on his patients.If a surgeon tells you differently run!
Each patient and therefore each revision is unique. There are a myriad of possibilities, and in fact in some patients we discuss the significant likelihood of the need for revisions prior to the first procedure.Other patients may have a very small issue that would benefit from more work.I basically have a couple of requirements for a revision
1)I need to be able to see what we are talking about,if I cannot see or feel the problem I will not operate.
2)I need to think there is a significant possibility that a revision will improve the situation. For instance a patient with  barely visible scar that is well healed and I cannot improve would not be a candidate for more surgery.
3)The patient wants to have the revision .I tend to be pickier  than the patients so if something bothers me but not the patient we will not do anything.
4)The time course needs to be appropriate. It is impossible to evaluate a number of issues very early in the course of recovery and in fact most issues resolve with tincture of time.
5)Revision is in no way a failure its an opportunity to improve things. Its like taking a 9.5 and going to 9.9 on a scale of 1 to 10 for gymnastics routine for instance.