Friday, June 24, 2011

The "Hidden Costs" of Procedures

This week I have been struck by the growing number of patients who seek my services because of poor surgical results achieved elsewhere. With each passing year, I see a growing number of patients referred to me for revisionary surgery, and the single largest revision procedure requested is breast surgery...augmentations, lifts and reductions. When the need for revision is continued aging of the breast, weight fluctuation, device malfunction, or the patient changed her mind...I understand these as valid reasons for revision...but, when the reason is a poorly planned or executed initial surgical procedure...I fail to understand so well. There was a recent FDA report in Medscape that cited the all-too-true 20 % revision rate seen with breast implant procedures.

Now, let's think about that a moment. There is absolutely no way to prevent the need for SOME breast implant revisions...those revisions due to continued aging of the patient's breasts (these may require reshaping, resizing, or re-lifting), those revisions due to device failures (they are man-made devices), those revisions due to the changing desires of the female patient, those revisions due to the small, unexpected chance of infection or bleeding, and those revisions due to newer, better breast implants that may become available after initial implantation. I get all of those reasons for revision. What I don't get, is the fact that those revisions probably account for less than 5% of all breast implant revisions. The remainder seem to be revisions necessitated due to poor planning of the originating breast implant procedure, poor execution of the surgery, or poor communication with the female patient regarding the intended result. These latter reasons for revision of the original result are to me, the preventable, avoidable reasons for revision, and therefore represent, the "hidden costs" of surgery.

In each and every visit my staff and I have with a future breast implant patient, we touch on the reasons that some patients will have to have their breast surgery revised. In my practice, the revision rate for preventable complications (actually, allcomers) is less than 5%. Yes, we are very proud of that statistic, but it is heartbreaking for us to continue to meet more new patients each year who have NEVER achieved their intended or wished for result after their first breast implant surgery. The costs of the revision surgery plus the original surgery far exceed the cost of a nicely performed single breast augmentation that allows the appropriate time for control of surgical factors that, if performed, reduce the need for future revisions. (See a previous blog entry on the "No-Touch Technique of Breast Augmentation")

I have been in a successful breast, face and body contouring practice for 16 years now, and with a strong reputation in this community, I expect to see a certain percentage of revisionary surgical procedures, but the number of revisionary procedures I am now asked to perform has exceeded 30%. This is an astounding statistic to me. I very much enjoy a challenging case, and the results delivered to a patient who feels so appreciative at the conclusion is a great thing to participate in certainly, but it does sadden me when I feel that it wasn't done right to begin with, and that the patient and I should have been able to meet under better cirumstances (perhaps a second plastic surgical cosmetic procedure sought because the first one was so enjoyable!).

My message to any patient seeking a cosmetic procedure - not even just a breast procedure - is do your homework and don't settle for merely the cheapest might actually get what you pay for. A common denominator then, among many of the revision procedures I do is, the patient chose the surgeon based on lowest price, believing all surgical techniques are largely the same. There are so many differences in the way surgeons perform all surgical procedures that I couldn't possible enumerate even some of them here, but with respect to breast augmentation specifically, there are several that bear mentioning. (Again, these are more completely summarized in the blog mentioned above, the "no touch technique" of breast augmentation, which reduce revision rates, but also importantly, reduce recovery times after breast implant surgery). Here are just a few of the most commonly seen errors: implants that are too large for the patient; pockets for the implants that are poorly made; poor choice of device; sloppy, hastily made breast implant pockets; poor attention to sterile technique or control of oozing; poorly chosen surgical facilities that don't lend themselves to a sterile environment, which is so important when placing a prosthetic device; poor communication between surgeon and patient, so that intended results are inadequately discussed and agreed upon; poor attention to detail in the early post-operative period; infrequent patient follow-up, which is necessary to recognize early, fixable problems or asymmetries...and many more.

And it's not just breast augmentation that lends itself to unnecessary's also the $9.00/unit Botox, and the steeply discounted fillers and laser procedures. We do occasionally reward our loyal customers in my practice with periodic discounts, but we do so specifically because we recognize that this a tough economy, and we want to make it easier to remain loyal to this practice, and we refuse to sacrifice the quality of the procedure when we discount things. Remember, the only way a practitioner can make up these drastically discounted profits when they are constantly being offered, is via increasing volumes...and when that is the primary reason for ongoing, less periodic, discount rewards, then there can be only less time spent concentrating on the quality measures that reduce revision rates. Hence, the poor result.

Bottom a wise consumer...insist on quality of care...and when you find an office committed to the highest quality that also cosistently exceeds the patient's expectations...STAY THERE!

Have a great summer!

1 comment:

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