Deviation in the Standard of Care During Breast Augmentation (Breast Reduction, Breast Enhancement)

Evaluate breaches in the standard of care when determining Deviation in the Standard of Care During Breast Augmentation (Breast Reduction, Breast Enhancement)

Answer the following questions to find out if the standard of care was followed for your case.

  • Which of the following indications for breast augmentation were elicited? (Choose all that apply)
    Cosmetic breast enlargement
    Correction of asymmetries
    Congenital defects
    Patient had undergone mastectomy for breast cancer or cancer risk reduction
    Others
    Answer unknown
    Why is this important?
    Prosthetic breast implants are used for cosmetic breast enlargement, correction of asymmetries and congenital defects. They are also used for breast reconstruction in women who undergo mastectomy for breast cancer or for cancer risk reduction.
    (2012) 26 EIDCNA 1 111-125

  • Was a complete medical history obtained? Why is this important?
    Answer this question
    Past medical history (PMH) includes all past and current illnesses, hospitalizations, surgery, trauma, allergies and medications. The date, location, and physician/surgeon for each hospitalization and/or surgery should also be included.
    (2011) 55 EDECNA 1 15-28

  • Was a psychological evaluation obtained prior to surgery? Why is this important?
    Answer this question
    Body dysmorphic disorder (BDD) occurs in about 5% of patients seeking cosmetic surgery. Cosmetic surgery is not generally recommended for patients with BDD.
    (2003) 56 EJPRAS 6 546-551

  • Was a complete physical examination performed? Why is this important?
    Answer this question
    A complete medical history and carefully focused physical examination serve as the core of the diagnostic process. The information obtained guides the further direction of the patient's care and treatment. The deep understanding of the patient that can be obtained only through the immediacy of the history and physical examination also plays a pivotal role in treatment decisions.
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  • With which of the following risk factors for wound complications did the patient present? (Choose all that apply) Why is this important?
    Answer this question
    Several pre-operative factors are associated with increased risk of surgical site infection with all breast surgeries.
    (2012) 26 EIDCNA 1 111-125

  • Were contra-indications to breast implant reconstruction assessed? Why is this important?
    Answer this question
    Contra-indications to breast implant reconstruction include the following: younger age (patient’s who are of a younger age may need an implant replaced multiple times), the patient’s willingness to adhere to follow-up recommendations, very large breasts, very ptotic breasts, silicon allergy, implant fear, previous failed implants, and the need for adjuvant radiation therapy.
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  • Was a pre-operative breast assessment performed? Why is this important?
    Answer this question
    A complete documented medical evaluation including appropriate screening for preexisting breast disease and risk factors should precede any cosmetic breast surgery.
    (2010) 37 EOGCNA 4 533-546

  • Were pre-operative photographs obtained? Why is this important?
    Answer this question
    Documentation by photography at the consultation stage is essential, as small blemishes can potentially become magnified by prosthesis.
    (2011) 64 EJPRAS 11 1401-1409

  • Was planning for breast augmentation performed and discussed? Why is this important?
    Answer this question
    Breast Augmentation planning has developed markedly from being purely volumetric to bio-dimensional, and is today known as tissue-based planning (TBP).
    (2011) 64 EJPRAS 11 1401-1409

  • Were the details of the implant (size and type) discussed with the patient? Why is this important?
    Answer this question
    To facilitate the selection process, it is helpful to use a photographic portfolio of women of similar build, augmented with implants of various sizes.
    (2010) 37 EOGCNA 4 533-546

  • Were all the available alternatives of breast augmentation surgery explained to the patient? Why is this important?
    Answer this question
    Some women may choose not to have breast reconstruction or are poor surgical candidates for reconstruction. For these women, breast prosthesis is an option.
    (2007) 87 ESRCNA 2 453-467

  • Were the details of a full recovery and recovery time conveyed to the patient? Why is this important?
    Answer this question
    The breasts will probably be sore for a few days. Stitches are usually taken out in 7 to 10 days. The patient could be back to work in 2 weeks if it is a desk job but if it is manual labor, it may take longer.
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  • Were the additional costs that could potentially be incurred as a result of a complication and/or surgical revision explained to the patient? Why is this important?
    Answer this question
    As part of the decision-making process, women of all ages need to consider the long-term financial costs of breast implants. In addition to the initial surgery, subsequent operations to fix implant problems or remove broken implants can cost at least as much as the initial surgery, if not more.
    (2010) 18 REHEMA 35 94-102

  • Was patient education provided regarding post-surgical mammograms? Why is this important?
    Answer this question
    In addition to the risk of rupture during mammography, implants have been found to hide approximately half of the cancerous tumors that could be present in the patient.
    (2010) 18 REHEMA 35 94-102

  • Was an informed consent obtained? Why is this important?
    Answer this question
    The laws of most states require that surgeons obtain informed consent before providing treatment.
    (2011) 23 EOMSCA 3 475-484

  • Was a comprehensive medical history obtained? Why is this important?
    Answer this question
    Past medical history (PMH) includes all past and current illness, hospitalizations, surgery, trauma, allergies, and medications. The date, location, and physician/surgeon for each hospitalization and/or surgery should also be included. Particularly important issues in the identification of manifestations of systemic disease include alcoholism, cancer, cardiovascular events, diabetes, and hepatic, renal, and psychiatric reasons for admission. Particularly important medications for oral manifestations include immunosuppressives, antibiotics, cardiac medications, and psychotropics. The PMH is also important for investigating whether the chief complaint (CC) is a manifestation of a previously diagnosed disorder.
    (2011) 55 EDECNA 1 15-28

  • Was the patient advised to discontinue any medications impairing coagulation? (Choose all that apply) Why is this important?
    Answer this question
    Medications, supplements, herbs, and other substances with the capacity to impair coagulation may need to be discontinued prior to surgery to avoid unnecessary bleeding.
    (2010) 37 EOGCNA 4 533-546

  • Were the different methods of augmentation discussed? Why is this important?
    Answer this question
    There are presently five methods with which to augment the breasts in the United States: saline implants, silicone implants, autologous fat injections, external tissue expanders and tissue flaps.
    (2010) 37 EOGCNA 4 533-546

  • Which of the following methods were used for breast augmentation? (Choose all that apply) Why is this important?
    Answer this question
    There are presently five methods with which to augment the breasts in the United States: saline implants, silicone implants, autologous fat injections, external tissue expanders, and tissue flaps.
    (2010) 37 EOGCNA 4 533-546