Your Consultation

Once you have decided on a plastic surgeon, you’ll need to schedule a consultation. During your
consultation, you’ll learn whether you are, indeed, a likely candidate for breast surgery. If
you are, the surgeon you’re seeing will explain the details or having cosmetic breast surgery.
The consultation is also an opportunity for you to ask questions about the procedure, its probable
outcome and risks, as well as those about practical matters, such as cost.

Preparing for Your Consultation
Before you meet with a plastic surgeon, it’s important to make
sure that you are prepared. Some surgeons may want medical records
during the consultation; others may wait until you have actually
scheduled a surgery date before they request medical records. Because
surgeons have different preferences for when they require medical
histories, it’s best to call and ask the surgeon’s staff what information
they’d like for you to take to the consultation.

Either way, you’ll need to be prepared to give the surgeon a good
overview of your medical history. It’s important that your surgeon
understand your current physical condition. Be prepared to inform
the surgeon of any present or past medical conditions and any
surgical procedures you’ve undergone, too. Also, you’ll need to tell
the surgeon which prescription drugs you are taking currently and
why you are taking them.

What Are Your Goals?
It is essential that you communicate your wishes to the plastic
surgeon. You may want to spend some time asking yourself what
exactly you want to achieve with cosmetic surgery. What results are
you hoping for? Flip through magazines or other photos to help you
decide which breast shape, size and lift is optimal for you. You’ll need
to have a good idea of what look you want before you speak to your
surgeon. Even if you think that your surgery goal is too lofty, tell the
surgeon anyway; that way, he or she will understand your intentions.

Having an honest dialogue with your surgeon about your
expectations is essential. The surgeon can determine whether he or
she can achieve the results you seek only if you are thorough in
explaining your goals for the breast procedure.

You may wish to visit the library or go online to do some research
of your own on breast surgery so you can ask the surgeon educated
questions during your consultation. If you do a bit of self-educating,
you’ll be able to better understand what the surgery involves.

Take a List of Questions
Remember, it is your surgeon’s job to answer all of your
questions, no matter how foolish or inconsequential you may think
they are. Don’t be afraid to ask him or her to clarify anything you
don’t fully understand. This is your body and your money, so this
is not the time to just nod and agree if you don’t understand. Keep
asking until you do.

Before my breast reduction,
my posture was affected. I
was often embarrassed about
my large breasts. Now, I have
more confidence and can
move more easily. I can
actually jog around a track.
— Joan, 35

Consider preparing a list of questions to take with you so you
don’t forget anything important during your time with your surgeon.
What are you confused about regarding the procedure? If you don’t
have all of your questions down on paper, you may find yourself bombarded with too much information at once and then think of
several questions later that you wish you had remembered to ask.
This will probably happen anyway, to some degree. If you are
concerned about feeling too overwhelmed and not being able to
remember important details of your consultation, you may want to
take a friend with you to take notes as you are speaking to the surgeon.
Doing so could help alleviate some confusion later and help you
absorb all of the information you’ve been given.

If you think of additional questions after your initial consultation,
you may wish to schedule a second consultation. A second meeting
may also help you feel more comfortable committing to the surgical
process. Second consultations also offer the opportunity for you to
take a trusted friend or family member with you to help you understand
and digest any information given to you.

Do You Feel Comfortable?
Not only will you gain valuable information during your
consultation, you also will be able to sense whether you and the
surgeon have a good rapport. At no point during the consultation
should you feel any pressure from the surgeon to participate in surgery.

It’s important to choose a surgeon who conveys a sense of caring
and concern for patients. The surgeon’s attitude and responses during
the consultation are clues to your future relationship with him or her,
so be attentive. Listen to you instincts. For example, are your
questions answered respectfully and thoroughly? Do you innately
trust this individual? Does he or she seem impatient or rushed? Is the
staff caring and professional? All of these questions need to be
answered to your satisfaction before you agree that this surgeon is the
one to perform your procedure.

Your Breast Examination
In addition to providing information about you medical history,
you will also need to undergo a breast examination. Your surgeon will
visually examine your breasts first to make sure no swelling, bulging,
or skin malformations exist. The surgeon will also be evaluating several
other factors, including bra shoulder strap grooving, current nipple
sensitivity, nipple position, and the distance between different parts of
your breast. Also, your surgeon will consider your breast size, breast
symmetry, chest wall size, shape, height, and weight in order to make
appropriate recommendations.

You’ll also be asked to lie down on a table for part of the breast
exam. At this time, the surgeon will palpate, or touch, your breasts
to check for masses or lumps. He or she will use varying amounts of
pressure during this procedure to screen for lumps both near the skin’s
surface and deep within the breast. This part should feel like a
massage and should not be uncomfortable.

The surgeon will also gently squeeze your nipple to check for any
discharge; blood or pus could be a symptom of infection, mastitis, or
breast cancer. The entire procedure is then performed on your other
breast. While you are still sitting, your surgeon may feel the lymph
nodes in your armpit and around your collarbone; enlarged nodes
may be an indication of infection or breast cancer. Your entire breast
examination should be painless.

How Much Can Your Breast Size Be Reduced?
The next stage of your consultation consists of your surgeon
taking your measurements to help you choose the breast size and
shape that is right for your body. You’ll work together to determine
the amount of breast tissue that needs to be removed. If you’re receiving a breast reduction, your new breasts will need to be small enough to
alleviate your physical symptoms. It’s important not only to pick a
size and shape that you like, but also to make sure that it is right for
you. For your new look to appear natural, you’ll need a good fit for
your body.

Any amount of reduction is physically possible, but most
surgeons will explain that your "new" breasts need to match your
height, weight, and body frame in order look natural. Your surgeon
will advise you on breast size and shape to meet your individual needs.

Risks, Complications & Considerations
Some risks, complications, and considerations do exist with
breast reduction surgery procedures, just as they do with any type of
surgery. Be sure to ask your surgeon about these. He or she should be
sensitive to your concerns about the risks of breast surgery and should
take them seriously. Hopefully, your surgeon will alleviate most of
them by further educating you on the process. Most surgeries go very
smoothly and the risk of serious complications is slim. More details
on risks and complications are covered in detail in Chapter 6: Your
Surgical Procedure.

Seeing Before-and-After Photographs
Your surgeon will most likely show you before-and-after pictures
of former patients who have undergone the procedures which are
of interest to you. Usually, he or she will volunteer these photos,
but if not, ask to see them. Your surgeon should have many such
photographs. If the surgeon can produce only two or three before-andafter
shots, it could be a sign that he or she hasn’t had a lot of experience
doing the procedure under consideration.

Ichose to be very open
about telling people I’d had
breast reduction. I am so
pleased with the results that
I show a lot of people my
before/after photos.
— Marie, 28

Photographs of You
Your surgeon, most likely, also will want to take a "before"
picture of your breasts during the consultation. Most surgeons take
before and after photographs of all of their patients without exception,
no matter which procedure the patients are having performed. These
photographs then become part of your personal medical record. Your
surgeon should show your photographs to you after they are taken,
and give you a copy of them if you desire.

The "before" photograph is not only taken to demonstrate
the contrast between the old and new you, but also to serve as a
guide to help the medical staff plan for your surgery. Pre-operative
photographs are used to obtain pre-authorization from insurance
companies. The insurance companies don’t usually request the "after"
pictures; instead they rely on pathology reports to make any payment
determination.

References from Previous Patients
Your surgeon should also be able to put you in contact with former
patients who’ve had the same surgical procedure done. This way, you
have the chance to learn first hand about having the procedure. Many
surgeons do this routinely—the have names of patients who’ve agreed
to speak to new patients.

Don’t feel shy about contacting previous patients. Most people
who have had your procedure completed will be excited to share their
story with you. Usually, they enjoy telling new patients about how
having surgery enhanced their lives. And, who better than former
patients to give you the candid details of the process? Be sure to
inquire about how comfortable the woman felt with the surgeon.

Paying for Your Procedure
The best way to alleviate confusion over the total cost of your
surgery is to talk with your surgeon or a designated staff person about
it. Your consultation is a good opportunity to do this. Once you’ve
discussed your breast surgery options with your surgeon and have
chosen which procedure you want, it’s time for this conversation. In
addition to determining the fee for your procedure, you will need to
know what additional fees you will be responsible for. All surgeons’
protocols are different, but it’s fairly common for patients to cover
additional costs, such as those for anesthesia, lab tests, pathology
tests, compression vests, or prescription drugs.

Insurance
The effects of breast reduction surgery are cosmetic; however,
the procedure itself is considered reconstructive surgery, meaning it
is considered a "medical necessity." As a result, health insurance
companies often pay for the surgery if it is shown that a patient is
suffering from a variety of physical symptoms related to large breasts.
You’ll need to be able to prove that you need to have the size of your
breasts reduced to alleviate physical symptoms.

Insurance companies use a variety of criteria to determine
whether breast reduction surgery is a medical necessity. Some companies
will pay based only on the amount of breast tissue to be removed; this
usually means removal of at least 500 grams of tissue, slightly more
than one pound, from each breast. (454 grams equals 1 pound.) Other
companies use complex formulas to compare the size of the breasts
with the overall size of the body. Some companies also consider body
mass index (BMI), which assess one’s percentage of body fat, based on the ratio between one’s height and weight. And, if you are overweight,
your insurance company may require you to first lose weight.

Questions to Ask during
Your Consultation:

  • Are my surgery goals realistic?
  • What procedure or procedures
    do you recommend for me?
  • What risks, complications, and
    side effects could I experience?
  • How long will the operation
    take?
  • What kind of anesthetic will
    be used?
  • Will I have post-surgical pain?
  • Is it likely that my insurance
    will pay for my procedure?
    If not, what other payment
    options do you recommend?
  • When can my procedure be
    performed?
  • How soon can I return to work?

Your surgeon can likely tell you whether your procedure would
be covered by insurance. It may even be a good idea to call your
insurance company before you arrive for your consultation so that
you’ll know if you’ll need to explore other payment alternatives.

Self-Pay
If insurance does not cover your desired procedure or if you have no
insurance at all, you will need to consider self-pay options. The total
cost of your breast surgery will depend on the procedure and method
performed, your geographical location, and your individual surgeon.
It’s difficult to estimate the exact cost of your procedure because of
these variables.

Other Payment Arrangements
If insurance is not an option for you, your surgeon may advise you on
other payment arrangements. Many patients take out their own bank
loans through lenders who work closely with their surgeons. Your
surgeon should be able to make this kind of referral. Most surgeons
will accept credit cards as a means of payment. Some surgeons may
agree to accept monthly payments directly from you. However, most
surgeons prefer that the total cost of surgery be paid in full before they
complete your procedure.

Informed Consent
At some point prior to your surgery, you will be asked to sign an
informed consent form. Informed consent is the process by which a
patient can participate in choices about her healthcare. The intent is to ensure that the patient fully understands her health care decisions.
This should include understanding the nature of the surgery, alternatives
to the procedure, and the risks and benefits of the surgery. Part of
informed consent also includes a patient’s acceptance for the use of
intervention, if needed, to handle complications that could arise.

Table of Contents
Previous: Chapter 2. Contemplating Breast Reduction Surgery
Next: Chapter 4. Preparing for Breast Reduction Surgery

*Patient Results May Vary
Filed Under: Publications