The most grandiose myths about breast augmentation

John Tebbetts.

1. The bigger is the better.

If we consider the issue from the point of view of the state of tissues over time and discard “social desirability”, then a large breast does not mean the best. Breast plastic surgery (endoprosthetics) is not required if the overlying breast tissue constantly maintains the weight of the breast over time. If the breasts are able to “outsmart” genetics, gravity, pregnancy and aging, then the price for a larger size may not be so high, and the spectacular, beautiful breasts of size D of an eighteen-year-old girl will not become terribly sagging and empty at the age of thirty in the upper pole. The covering tissues of the “middle” chest are so arranged that they can support weight within certain limits. If, as a result of genetic, hormonal influences, pregnancy, lactation, weight gain, installation of implants, breast weight goes beyond these boundaries, then we can naturally expect undesirable consequences. The consequences of installing excessively large implants include: ptosis, tissue stretching, tissue thinning, insufficient tissue coating of the implant, visible edges of the implant, “ripples” when the breast is displaced, atrophy of the parenchyma and subcutaneous fat, potential perforation of the implant and a high probability of repeated operations, which entails additional costs and risks. In fact, all of these problems can be avoided by limiting the size of the implant. What does “too large an implant” mean? For some patients and surgeons, these simply do not exist. There is always an excuse that “the patient wants this,” plus a number of psychological, physiological, or financial arguments in favor of the operation. With a successful combination of circumstances, the patient can get on the spread of the magazine or on the cover, and the surgeon will put the picture in a frame and hang on the wall in the office as an advertisement. And nothing that the patient throughout her life will most likely have to face significant negative consequences and potential reoperations, the reason for which is excessively large implants. When the volume of the implant exceeds 350 cc, even if such a volume is necessary to adequately fill already stretched tissues, over time, the dynamics of the “implant – soft tissue” will naturally negatively affect the breast tissue. If patients ask for or require implants of 350 cc or more, even for reconstruction, they need to explain in detail the weight of the risks, and they must consciously take the risks listed in the “informed agreement” document. Whether the patient will like the result immediately after the operation is less important than minimizing the negative consequences that may occur throughout her life. Will she want such large implants if she is honestly informed about what she can expect over time? The excuse that “she will go to another place where she will do it anyway” testifies to the principles of the surgeon.

2. Patients do not deserve the right to choose, because they do not know what is the best. The surgeon knows best what is best.

The patient’s choice is limited only by how much the surgeon is ready to carry out explanatory work with her, as well as how much the surgeon himself is interested in professional growth. There is no single “best” solution for breast augmentation. Good, similar in quality, results can be obtained in different ways, each of which is equally acceptable, and has its own advantages and disadvantages. The Informed Consent Act requires the surgeon to provide the patient with information on all existing alternatives. If the surgeon’s professional skills and his worldview are limited to one option, then this option will be the best that this surgeon can offer.

3. There is only one best option for prosthesis, surgical pocket and location of surgical access.

This statement is true only if this “best” option is the only way the surgeon can do breast augmentation. If the “best” option really existed, we would probably all have used it. Nevertheless, plastic surgeons can observe a unique tendency to discuss the obvious, maintaining the status quo, but not see the possible. Obviously, the best thing is that the surgeon knows and owns what. The only factor limiting the surgeon’s professional abilities is his / her unwillingness to learn and improve. The location of the scar will not cause questions after the operation, if the chest turned out to be magnificent. Any location of the scar has its drawbacks, but the flaws should not be considered as a determining factor when choosing a particular location for the incision. Assuming that the surgeon is able to work with more than one option for surgical access, the choice of the incision site is determined by the following criteria: For each specific type of breast and implant, what access will allow the surgeon to better control the situation? At which surgical approach are tissues less injured? At what access are the blood supply and innervation structures at the least risk? What access does an informed patient prefer? This criterion is applied provided that the surgeon has examined the first three criteria, explained everything to the patient, and can get equally good results using more than one option of surgical access. Choosing the type and size of the implant key to achieving optimal long-term results, and what can be heard in the consultation? “Take a container of rice or water, or an implant, put it in your bra and tell me what size you like”, “bring me a photo what would you like to look like”, “what size of a bra do you want?”. And although each of these methods can provide useful information, none of them is related to the most important issues of breast augmentation:

What are the characteristics of the tissues of a particular patient (volume and elasticity of the covering tissues, breast parameters, volume and distribution of the parenchyma, how much does the existing parenchyma fill the maximum stretched volume of the breast)?
Given the above, what volume will be required for optimal breast filling?
If the patient requests more volume than is required for an optimal result, is she fully aware and ready to accept responsibility for the long-term consequences?
Whether the surgeon is ready to spend enough time to explain to the patient the inevitability of some negative consequences, regardless of the type and size of the chosen implant.

The most important thing that a surgeon should do to prevent future complications and reoperations is to provide adequate coverage of the prosthesis with soft tissues both in the short and long term. It is necessary to choose such a size of the implant and such an arrangement of the cavity that the soft tissue coating is preserved for a long time. Looking at the long term, for some excessively thin (slender) patients, it would probably be better not to have breast plastic surgery (endoprosthetics), regardless of their desire and the surgeon’s financial considerations. The same criterion of “subtlety” must be applied in case of repeated operations. Regardless of the etiology, if the tissue has become so thin after surgery that soft tissue cannot be covered by any known methods, implants should be removed to avoid negative, medical or aesthetic consequences, which are much worse than the aesthetic defect in the removal of implants. Despite the difficulty of the decision to remove the implants, if they are left in the presence of an inadequate tissue coating, the risk of further deterioration of the condition of the tissues is high, which will entail persistent, deformed deformations. What is a “thin patient,” and when does subtlety become critical in making a decision? Quantitative measurements (to some extent, of course, subjective) are more accurate than completely subjective opinions. For any patient whose thickness of the fold of soft tissues above the breast is less than two centimeters (1 cm of skin and subcutaneous fat), an implant should be placed under the muscle, despite the disadvantages of such an installation. The medial fibers of the pectoralis major muscle along the sternum must be maintained in most cases, even if the patient wants a smaller inter-thoracic distance. This will allow to avoid such uncorrectable deformations as “tuberosity” of the fused edges of the pectoralis major muscle, visualization of the edges of the muscle, “ripples” when the implant is displaced when it pulls the capsule attached to the thin covering tissues. When the thickness of the soft tissue fold in the area of the inframammary fold is less than 0.4 cm, in order to provide better coverage, it is preferable not to dissect the muscle along the inframammary fold, taking a slightly increased risk of the implant moving up and forming a less predictable and accurate inframammary fold. To minimize complications, in most cases you should not choose the base width of the implant in excess of the width of the existing parenchyma.

4. For the surgeon, it is best to choose a method and an implant once and for all.

This myth is as absurd as the assumption that all patients are the same in their desires and in their tissue characteristics. Unfortunately, this myth becomes a reality if the surgeon knows only one method and is familiar with only one type of implant. Patient’s breast tissue, characteristics of parenchyma, covering tissues vary widely. Given the wide range of breast types, optimal results cannot be predicted using a single combination of implant, surgical access and pocket positioning. The stiffness of the surgeon and his unwillingness to learn and change limit the patient’s options for choosing an implant and method for breast augmentation. It is much easier to criticize alternative methods and implants than to admit lack of experience. It is easier to express an opinion without having practice than to make an effort to improve skills and gain experience. Most competent surgeons recognize that in order to achieve optimal results with breast augmentation with glandular ptosis and constrictive lower pole, an individualized method of implant selection and surgery is required. With this type of breast, the surgeon must distinguish and take into account the components of the tissue complex, the characteristics of the covering tissues of the breast and parenchyma, otherwise the results will be disastrous. In fact, tissue characteristics and the implant-soft tissue ratio need to be considered for any primary increase in order to improve long-term results. The question is how much the surgeon is configured to choose a more complex method that allows you to take into account all these factors. The “disregard” attitude to even the simplest cases of increase rarely leads to optimal results and never to the best.

5. A good surgeon in the field of breast augmentation is distinguished by the artist’s talent.

Believe it or not, the art of breast augmentation is much more than a red word from magazines and TV shows. The art is to accurately perform breast augmentation, based on a thorough examination of the patient, planning the operation and considering several options with extensive experience and knowledge of various methods. The art of breast augmentation is not just a visible result. This is how much detail has been explained to the patient regarding the increase; what range of options she was offered, how quickly and without problems she will recover, how many operations she will need in the future, how the implants will affect her tissues over time. If the surgeon is able to portray beautiful breasts and show the intended results on the screen to patients or the media, this does not guarantee stable good results for breast augmentation, quick and easy recovery, as well as “trouble-free” long-term results. An artist, being creative in nature, does not always have the discipline and intention to expand his horizons. Any open-minded surgeon who is willing to learn and not devoid of self-criticism can become an artist in breast augmentation.

6. Over the past 20 years, we have seen tangible progress in breast augmentation.

It sounds beautiful, but it’s just a myth. We have endoscopes. We can install the implant through the navel. We have a larger selection of implants than 20 years ago. But if we really “advanced” in breast augmentation, why do many patients have surgery for two or more hours? Why do most surgeons in the US use what we used 20 years ago, namely round smooth implants, blunt pocket dissection? Why does the Drug and Food Committee (FDA) “favor” surgeons and implant manufacturers who are researching silicone gel implants that are no different from those that banned the use in 1992? Why do many patients need 1-2 weeks to return to normal activity? Why do patients need postoperative drainage? Why do patients have to wear bandages, elastic bandages, and the like for days and weeks after surgery? And the most outrageous thing is that the huge number of patients (28% -44%) involved in the two large trials provided by the FDA (clinical trials preceding the launch of products by many plastic surgeons) had to undergo a second operation within three years after breast augmentation. How is this possible? And we are still surprised at the skepticism of the FDA and public opinion. Answers are unpleasant. It seems that we are not doing our job as well as we could, and as we should do breast augmentation. While we continue to discuss and uphold the status quo, we are not able to devote enough time to educational forums where we could study in more detail more advanced methods and options for increasing. The programs of our Meetings continue to fill in 7-minute presentations and 30-40-minute round tables, which at best entertain and rarely provide significant information that really affects the quality of the results. Sometimes it seems that conflict and disagreement are more important than practical benefits. Politics, ego, jealousy, and organizational and financial problems make it difficult to communicate productively. If the number of participants is still more important for the organizers, rather than providing useful practical information, the Meetings will remain culturally entertaining rather than educational. If surgeons do not require a more detailed, in fact, discussion of issues, they will not receive it. Improvements rarely occur from maintaining and maintaining the status quo. If something has worked for the past 20 years, then this does not mean that it is optimal. If we made only part of the effort to make progress from those that we spend on protecting the status quo, we would hardly use implants and methods twenty years ago. Implant manufacturers naturally produce what is in demand. If most surgeons request and use products 20 years ago, manufacturing companies will not spend financial resources on research and development and due to savings they will improve profit indicators, respectively, dividends and share prices will increase. The price war between implant manufacturers (round and smooth implants, in reality, are not much different from each other) reduces the part of the profit that could be directed to promising research and development of new products. The annual report and sales data for the two remaining breast implant manufacturers in the United States reflect this pattern. You can see what percentage of profit goes to research and development of new products. Surgeons “do not shine” with new and improved implants that can be offered to patients. The saddest thing is that now there is not a single new product in development that, having gone through all the stages, would have reached the market in the next 7-10 years. Name at least one technology-oriented business that would last two decades while maintaining the status quo. And even if he held out, how can one explain the fact that the situation of patients and surgeons, deprived of new and better products for a decade, is considered the norm? We are not just living with the FDA. Our inability to effectively counter the FDA’s poorly designed and scientifically unreasonable guidelines, given our lack of time, organizational resources, and influence, can have a painful effect on our patients and ourselves. It is high time that we stopped dealing with charges, we need to take responsibility, draw conclusions from the past and change for the better.

7. The shape of the implant does not matter.

Many discussions about the shape of the implant stem from a much more important problem, namely: how to make each specific breast augmentation better, how to guarantee the patient a quicker and easier recovery, how to minimize the risks of complications and reoperations in the long term? The problem of choosing the shape of the implant can be easily solved by “self-determining” according to the following criteria: o If you do not like the implant of a certain shape, do not use it. o If you do not want to learn how to optimally use an implant of a certain shape, do not use it. o Keep the status quo untouched if everything suits you and you do not need new methods and improved products. o Even if you have little or no experience in using any methods or products for the primary increase, freedom of speech, however, guarantees you the right to make unfounded judgments. Any experienced surgeon can make breasts of any desired shape (from natural to “Lifeguards Malibu”) using a properly selected round or contoured implant. And the question is not that the contoured implant gives the breast a more natural shape, as it is well known that with a round implant you can make an excellent, natural looking breast. For 10 years, I used only round implants and published photos with “natural” results. My interest in anatomical or contoured implants was caused by the desire to prevent the collapse of the shell of the implant, to prevent the formation of folds on the surface of the implant and at the same time to maintain optimal aesthetics. The most important questions are whether the sheath of anatomical implants is more durable due to the specifics of filling their volume, and do anatomical implants provide additional options for surgeons and patients? The shape of the implant is not very important for those surgeons who do not attach importance to the long-term dynamics of the implant – soft tissue, who are not worried about the problem of the longevity of the implant shell and the potential consequences of shell wear in the formed folds. For those who do not want to explain to patients the problem of filling the volume, who believe that the patient is not smart enough to understand and make an informed choice, for surgeons with little or no experience in using anatomical implants for primary enlargement. More than 50 factors due to the patient’s soft tissues, as well as those due to the surgeon, affect the final shape of the breast. If the surgeon does not understand and does not affect these factors, giving lectures and publications, he is unlikely to understand the problems of filling the volume and the dynamics of the complex “implant – soft tissue”, which vary for each type of breast. Lack of clinical experience with any method or implant at primary breast augmentation, the groundlessness of the surgeon’s opinion and gives rise to the so-called dimpled ballot. If we believe that the shape of the implant does not matter, we must compare this statement with the fact that surgeons around the world have already installed more than 500,000 anatomical implants and continue to use them in large quantities. The shape of the implant may be key to extending the life of the sheath, given the variety of filler types. We have not even begun to apply the latest engineering technologies to create forms of breast implants. There are no exact, reliable ways to check the wear of the folds of the shell on the example of a wide range of forms of implants. We know that the formation of folds on the implant shell is most likely the most important reason for its premature wear. At the same time, we cannot say with certainty how the shape of the shell and the filler affect the level of risk of wrinkling. It should be noted that, as many people know, I am a developer of anatomical implants, and I received a financial reward for this. But many do not know that I am also a developer of round implants, and that in my practice I use both round and anatomical implants, depending on the patient’s desire (after a detailed explanation of all possible options) and the condition of her tissues. The shape of the implant is not an end in itself for me, it can be round, anatomical, contoured or any other, provided that the implant is safe and provides optimal long-term results. Do I think that with a round and with an anatomical implant you can get good aesthetic results? Yes, no questions asked. Should I have a bias? Of course. But my bias is not what many might think. Speaking of breast implants, round or anatomical, the following four points are important to me:

Has the implant passed the necessary tests and is it guaranteed to be medically safe?
To what extent does the shape of the implant give me the ability to control my breast shape in the long run?
What is the life of the implant, and therefore the number of repeated operations for the patient?
By choosing an implant of a certain shape, do I get additional alternatives?

Of course, judging from my 21 years of experience with breast augmentation, anatomical and contoured implants offer a much wider range of possibilities for different types of breasts than round implants. Can patients always understand the difference? I dont know. Can all surgeons see the differences? I also don’t know. But I see this difference in most cases, and more importantly, I grow professionally, improve my results, and maximize the number of opportunities available to me and my patients. Most importantly, while improving aesthetic results, I do my best to ensure the maximum durability of the shell of the implants that I install for my patients. For each primary breast augmentation, both round and anatomical implants are suitable. Both those and those have their own advantages and disadvantages. The Informed consent low law requires the patient to be informed of both options. And although by law, surgeons are not required to inform the patient about their own experience in using each type of implant, from an ethical point of view, this is necessary.

Here are some common sense considerations regarding the choice of implants:

If the surgeon masters any technique or implants and intends to learn on a certain number of cases (at least 10 cases), but he does not manage to achieve optimal results during this time, maybe he should not use this method or implants. If the surgeon is not at all ready for training (which the patient, unfortunately, does not know about), it is probably better for the patient to look for another surgeon.
The most important thing is stable, without complications, predictable results. If the surgeon and his / her patients are satisfied with the results, this is one level of quality. If the surgeon expands his professional capabilities and can offer the patient more options to achieve the same result, this is a different level.
If for any reason the surgeon maintains the status quo, this is his / her prerogative. But, I would hope that this surgeon will honestly talk about his clinical experience, making any statements, and will respect those who are striving for progress in the field of breast augmentation.

8. The surgeon does not have to have clinical experience to decide which methods or implants are bad, which techniques work and which are generally possible.

It’s like asking a bus driver to explain how to control a spaceship and rely on these explanations. Professional ethics must impose on the surgeon the obligation to honestly, accurately and reliably talk about his personal clinical experience with a particular method or implant, whenever he speaks out whether it’s good or bad, about any surgical method, implant or concept of the operation in the media, in publications or in lectures. Ethically, we are obliged to publicize our financial interest in methods and products, so why not require the disclosure of surgical experience? In scientific discussions, there are logic-based judgments that are “mental constructs” or even personal preferences — so let’s distinguish what is what. When the surgeon makes responsible statements about what is possible and what is not, what is necessary and what is not, the reliability of such statements often depends on the available clinical experience. For example, in a recent scientific publication it is written that the use of an endoscope for breast augmentation through axillary access is not necessary or desirable, in another article it is written that the installation of anatomical implants through axillary access, especially retro-mammary, is difficult or impossible. In both cases, high-class and respected surgeons made rash statements due to a lack of clinical experience in this subject. We all need to be corrected in this sense. I remember how I myself spoke in the press negatively about breast enlargement through the navel when I made only two cases. My objections of a theoretical nature were acceptable. It was unacceptable that I hid the lack of my clinical experience. It would be more honest to say, “I don’t know.” It seems that the concept of “bad” methods and products mysteriously changes over time. In 1992, some surgeons spoke rather critically about the visible formation of folds on the surface of underfilled silicone implants and the level of complications with them. Even manufacturers whispered on the sidelines about the rupture of the shell of gel implants. But when the FDA completely unexpectedly decided to use old incomplete implants, almost the same ones that were banned in 1992, some of the previously “dissatisfied” surgeons, in clinical trials preceding the launch of the product on the market, they suddenly began to participate in the studies and attract patients. Manufacturers sold these products again and joyfully made a profit. Is saline implant better than silicone? Depends on what disadvantages you are ready to put up with. But you can’t “sit on two chairs.” How can we criticize with responsibility the statistics of shell rupture if everything returns to normal, when is it convenient or convenient for us?

9. Most cases of complications, reoperations and morbidity of patients are caused by breast implants and are beyond the control of the surgeon.

Breast implants blamed more for complications than all surgeon-induced problems combined. No prosthesis design compensates for poor diagnosis of the patient’s tissue condition, poor planning, or poor operation. No implant can solve clinical problems only due to its device. The surgeon introduces the inevitable “ill” by performing breast augmentation, but the degree of “unhealth”, as well as the level of complications, depends on the quality of the operation. Even capsular contracture, which is a biological reaction to the implant, and which cannot be considered a complication, is directly correlated with many factors determined by the surgeon, including dissection method, tissue injury, bleeding and contamination of the surgical cavity. Surgeons are given the opportunity to improve, the opportunities that are contained in most of the basic techniques that the surgeon applies in each case of breast augmentation. For example, can any surgeon evaluate the elasticity of the covering breast tissue by examining it? How can accuracy be achieved without objective measurements, and will there be enough three additional minutes to properly make these measurements? “Lost” can lead to not the best solutions. One and the same implant (300 cc, for example) can have completely different long-term effects on the breast in cases where the size of the breast, the volume of the parenchyma are similar, and the characteristics of the covering tissues are significantly different. Inaccurate performance measurements and poor diagnosis of the condition of the breast envelope tissue may prevent the surgeon from making the right decisions that affect long-term results. There are countless opportunities for improvement, and surgeons must implement them, not justify the status quo. The surgeon monitors the situation during the operation, and his / her choice of surgical technique can have a strong influence on the end result. Is the technique of thirty years ago – stupid dissection, still acceptable? Ask two patients, one of whom returned to normal activity after two days, and the other only after two weeks. The difference is due to the degree of tissue trauma and infection, which occurs due to tissue trauma and blood absorption by tissues. Until now, many surgeons steadfastly and persistently uphold the method of stupid dissection. Do surgical instruments matter? Do the minor details of the surgical technique matter? All of these factors matter and deserve attention and improvement. The experience of patients undergoing complications and reoperations is the basis for these improvements. Does the surgeon influence the need for additional operations through the choice of surgical methods? Is general endotracheal anesthesia worth the money and effort? Is it possible to reduce the trauma of pectoralis during dissection by applying muscle relaxants? Is intercostal anesthesia really necessary for the patient’s comfort, or, and the associated risks, time and financial costs can be abandoned by improving the surgical technique, reducing blood loss, ceasing to perform stupid dissection and injuring the periosteum and perichondrium – all that causes pain? What about drains? Do they need if there was no bleeding and serious injury. And what about postoperative bras and other implant fixation devices? Why apply something that makes the patient uncomfortable and can spoil the results when used improperly, when there are accurate methods to guarantee the planned position of the implant? If we have better alternatives to minimize the additional impact, why don’t we use them? If these drains, dressings, special bras, ties, massage and countless other influences are so necessary, why can some surgeons, without them, achieve excellent, predictable results? There are many other examples that provoke questions: “Why do not we change? Why do we continue to use the methods and technologies of twenty years ago? ” Questions are relevant here, but giving answers is not so easy. In our age of information technology, patients very quickly realize that “this should not be.” Breast augmentation can be a more predictable operation with a shorter rehabilitation period, accompanied by less complications and the risks of repeated interventions. Everything will be favorable for patients if the surgeon recognizes his role as a determinant of success, to agree that the details matter and that changes for the better require desire and effort.

10. When the surgeon opted for any method or implant, deciding that they are the best, he needs to “hold on” to this choice throughout his practice.

Rationally minded surgeons will agree that you need to do what you know, that we must offer patients proven, reliable methods and implants that provide predictable results and a minimum of complications. If we go further, high standards dictate that the good can always be the best, that the patients deserve the best, and that the surgeon who improves his professional skills is the main factor in the successful outcome of the operation. Fortunately, there are proponents of both approaches. Probably, there is some sense in maintaining the status quo until the last cleaning lady in the operating room “reaches” that there are better ways. Remember, it was mentioned above about a surgeon who “tereotized” about the unnecessary endoscope with axillary access for breast enlargement? Maybe we could theoretically do breast enlargement with a jackhammer, but today we have scalpels and tools for blunt dissection. Today we even have sophisticated electrocoagulating instruments and endoscopes! Is it really better to perform many technically important tricks in a “dumb” and “blind” way when there are more accurate and less traumatic methods? Maybe it’s the surgeon’s worldview? In order to completely “close” this question, why not make one patient dissection of the cavity using the “blunt” method, and another patient should have a dissection using the best methods, electrocoagulation and endoscope. Then see which patient will have a better condition and a faster rehabilitation period. Than listen to 7-minute presentations demonstrating selected cases, let’s compare real patients in the real world. Which patient’s condition is better and why? Give answers in favor of patients, not in favor of their own ego (surgeon). It will be good for our patients if we recognize and oppose positions such as: “I have never done this, but I know that this is bad. I get good results by doing what I do, why change anything? Why even think about change? I know better. After all, the surgeon here is me. ”

11. What is easiest is best.

The lightest is rarely the best, and judging by my experience with breast augmentation, this does not happen even when the surgeon is gaining experience. This myth can contain some truth only when a large amount of time and effort has been spent and a high level of professionalism has been achieved on the basis of extensive experience. When there is little experience working in the “limited range” using a small number of alternative methods, the myth will rarely turn out to be a reality. Progress in breast augmentation is inhibited by the fact that many patients are satisfied with the results “below average”. After mammary gland endothesis, patients feel more confident and full, and this sometimes pushes them to re-breast plasty after capsular contracture or infection, while from a medical point of view, removing implants without installing other implants would be much more preferable. This is not an easy task – explain everything to the patient in detail before the operation, examine the patient’s tissue complex, choose the right solution before the operation, constantly improve professional skills, minimize complications, and shorten the rehabilitation period. But for a patient who decided on breast plastic surgery, it will be better. Surgeons need to insist on better results than patients expect. It is necessary to help patients choose the best options, which reduce the risk of repeated operations, undesirable consequences for tissues, and increase the durability of implants. Financial considerations sometimes influence the answer “what is best”, especially if the best is more expensive and the patient has no money, and the surgeon had a decline last month. As for the welfare of the surgeon, one complication resulting from incorrect or “financially imposed” decisions can cause losses equal to the profit from three operations for the initial increase. If it came to the trial, then the financial losses of both the patient and the surgeon will be significantly greater. Sometimes it happens: patients think that they know what they want, until they see how everything turned out. And even then, they sometimes do not recognize that the lightest is not the best. Actuality. Now that we have debunked some myths, reality is before you. Breast augmentation is one of the most beneficial plastic surgeries for both the patient and the surgeon. We can do it better, we should do it better, we should do it better. It is time to move forward.

Literature

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