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Plastic Surgery/Breast reduction

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Question
QUESTION: Hello Dr. Engler,
My 18 year old daughter had a breast reduction almost 8 weeks ago. She wore a 34E/F. She is a petite 110#.  She repeatedly requested to be "as small as possible." There could not have been a misunderstanding.  The plastic surgeon  only took off 250 gm and 270 gms.  He said he took off as much as he could to preserve her nipples. Well, she is pretty much able to fit in all her old bras and is devastated! She was hoping to have a new found freedom shopping for bras and bathing suits. Can you please tell me if anything more can be done? I am so sad that she went through the surgery and you can hardly tell a difference!
Thank you for your time.

ANSWER: from Dr. Alan Engler
www.bodysculpture.com

Hi Jill,

I am obviously very sorry for your disappointment at the results of the surgery.

It can be challenging to make sure that the patient and the doctor are "on the same page" and it is important to try to do so before the surgery.

But I'm surprised to hear that if she was a 34 E/F, only 250/270 grams was taken off.  Was the bra size correct?  Was there something unusual about your daughter's breast shape that made it difficult or dangerous to take off more?  These and other questions can only be answered by comparing before and after photos and, even better, by being able to examine your daughter in person (preferably before and after).

At this point, though, you - at the very least - have a problem that is much more easily rectified than if too much tissue were taken off.  While upsetting to think that she went through this and didn't get the result she wants, if she still wants more tissue removed (setting aside the issue of whether or not an appropriate amount was removed at her first surgery) she can consider a revision.  As with any other procedure (such as lipo) it is obviously better to need/want to take out more tissue, than to try to put some back.

So I would suggest the following.  Try to stay calm about this and meet with your surgeon.  Explain what you (and your daughter) thought the understanding was and see what your surgeon says.  It's possible that he can re-examine his position, and will agree to revise the procedure, and take out more tissue.  (This may or may not be straight-forward, and the costs will undoubtedly be a concern, but that is difficult to address via this forum).  I would also suggest consultations with at least 2 additional board-certified plastic surgeons so that you can compare opinions.

If you're not comfortable continuing to work with your current plastic surgeon, then you can go straight to other surgeons and, at the very least, see what they have to say.

Again, I'm very sorry for the disappointment and distress.  It is, fortunately, a more resolvable problem than many others might be.

I hope that this helps and good luck,

Dr. Alan Engler
Member of #RealSelf100
@RealSelf

---------- FOLLOW-UP ----------

QUESTION: Hi Dr. Engler,
Thank you so much for your very timely and helpful reply! The PS was aware that my daughter wanted to be as small as possible. Before the procedure, he said there were limits to the amount he could take off and was estimating he could make her a big B/small C, which would have been great!
Her bra size, if anything, was too small, as she was popping out of a 34E.
The PS is aware of our feelings and he has said that he distinctly remembers her wishes and surgery and he whittled down as far as he could go. he said even if I was in the OR with him telling him what to do, he couldn't take off more.  He also said that his first job is to do no harm, second is to do what my daughter asked. He admitted he may have been on the conservative side, but women go to him to be fixed after botched surgeries! He said she'll just have to live with her current size! He is a very well known PS who is board certified and considered one of he best in our state. The worst part is, he doesn't take any insurance and we paid 100% of his fee. i paid him $4500 for my daughter to be able to fit in her old bras!! My gut was wrong! The hospital billed and luckily, a huge chunk was covered. I'm hoping that he didn't rush her surgery, as he had another BR immediately following. I already have an appointment set up in January, with the PS I should have used, which will be 6 months post op. I will be bringing the operative report to that appointment. I go to sleep thinking about this and wake up thinking about this. I see your point that it's a better problem than taking too much off, but I wish it could have been done right the first time! I think she is too glandular for lipo.  Would she have to have the whole surgery again, or is there a way to do a revision and not open up all the scars?  She had the anchor procedure. Thank you again for your time!

Answer
It's hard to answer that without seeing at least pre and post op photos but also being able to examine her in person.

In general, though, if there's that much of a discrepancy it may well involve, more or less, redoing the entire procedure.  Sometimes a reduction can be performed of just some parts of the breasts - let's say, the sides - to improve the shape and size.  But the greater the amount of the reduction requested at the second procedure, the greater the likelihood that more extensive surgery will be required.

Good luck,

Dr. E

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Alan M. Engler, MD, FACS

Expertise

Dr. Engler has answered over 6400 questions on social media sites, including over 3500 on AllExperts alone. His expertise includes breast surgery (breast enlargement with implants, breast reduction, breast lifts), liposuction, eyelid surgery, tummy tucks, facelifts, lipomas, skin cancers, cysts, etc. Dr. Engler has been listed as one New York`s Top Doctors, and as "One of the World's Most Famous Aesthetic Surgeons" (Aesthetic Surgery, TASCHEN Books, Angelika Taschen, Editor). He is the author of 4 books, including "BodySculpture" (a best-selling plastic surgery book on breast surgery, liposuction and tummy tucks), "EyeScapes" (Plastic Surgery of the Eyelids), "Restylane," and "The Slim Book of Liposuction." Dr. Engler has two US Patents for surgical instruments that he's designed, and has appeared on numerous television shows, including The Tyra Banks Show, The Ricki Lake Show (four times), the Dr. Keith Ablow Show and Jerseylicious. Videos of his appearances are available on YouTube (search for "DR. ENGLER"), and his discussion of breast implants, also on YouTube is "How to Choose a Breast Implant." His website is www.bodysculpture.com. Follow Dr. Engler: @AlanEnglerMD

Experience

Dr. Alan Engler is a board-certified plastic surgeon in New York and the author of BodySculpture - Plastic Surgery of the Body for Men and Women (ISBN 0966382749) one of the top-selling plastic surgery books on amazon.com, barnesandnoble.com, as well as EyeScapes - Plastic Surgery of the Eyelids.

Education/Credentials
Dr. Engler graduated from Yale University (BA, Russian Studies) and the Columbia University College of Physicians and Surgeons (MD). He did his residency training in General Surgery and, after that, Plastic Surgery, at the Montefiore Medical Center in New York. He is on the faculty of the Albert Einstein College of Medicine in New York in the Departments of both Surgery (Plastic Surgery) and Medicine (Dermatology), and is a Special Lecturer in the Department of Dermatology at Columbia University in New York. He has admitting privileges at Beth Israel Medical Center and Montefiore Medical Center, both in New York.

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