You may visit your surgeon as many times as you wish, to have all of your questions answered. At your preoperative visit (which takes an hour or more), your final questions will be answered and you will confirm that you understood the procedure to be performed, that this material has been explained to you, that you have read and understood these information sheets, and that you accept the risks by signing the informed consent forms. You will be given prescriptions for surgical soap that will be used before surgery, as well as for pain pills and antibiotics, along with instructions for their use. Certain laboratory tests will also be required within two weeks of surgery. If you are over the age of 40, you will have to obtain a cardiogram at your doctor’s office or any licensed laboratory. You may have blood drawn by our office nurse during your final preoperative visit, or, if you prefer, at your family doctor’s office or other laboratory (e.g. Kaiser Hospital, etc.). Smoking constricts blood vessels and hinders normal healing – all smokers will be asked to stop smoking three months prior to surgery in an effort to maximize your body’s ability to heal the incisions following the operation.

It will be necessary to scrub the chest, abdomen, groin, flank regions, and thighs for ten minutes the evening prior to surgery and a final time the morning of surgery before leaving home. Washing the surgical site these two times with Hibiclens® soap will lower the possibility of an infection occurring after surgery.

Ordinarily, your anesthesiologist will call you the night before surgery to discuss the anesthetic care plan with you. But if you miss the call or your anesthesiologist does not call you, do not worry as you will be able to discuss your anesthesia and have all your questions answered in the morning, at the Surgery Center, prior to your procedure. You must make arrangements to have someone drive you to and from the Laguna Hills Surgery Center and stay with you at home for the first three or four days afterwards. Arrangements can also be made to have a registered nurse care for you for the first night or two as well, either at your home or at the Ayers Hotel adjacent to the Surgery Center.

Mastopexy or breast reduction procedures are performed in an outpatient surgery center or in a hospital setting. In most cases, a general anesthetic is employed to insure your comfort and safety.

In a breast reduction procedure, breast tissue is resected in addition to the excess skin, thus reducing the final volume of the breast, and elevating the nipple/areolar complex. Any tissue resected during a breast reduction procedure will be examined by a pathologist and you will receive separate bills from the laboratory and the pathologist for these services. Occasionally, liposuction is utilized to remove some or all of the excess breast tissue. In an uplift procedure, skin alone is resected and tissues are shifted to position the nipple/areolar complex in a more elevated location.

Following the procedure, a brassiere-like dressing will be applied and you will be sent to the recovery room where you will be kept until you are awake and ready for discharge.

Patients may choose in advance to spend the night after surgery in the Surgery Center or to have a home health aide accompany you home. Otherwise, after you have recovered to the point where you are awake and comfortable, you will be discharged home with a responsible adult. A brassiere-like dressing will be in place.

You are to leave this dressing dry and intact until your first post-operative visit to the office, which will generally be three to six days following the procedure. During these initial days, you will be requested to take an antibiotic tablet once daily and to limit your physical activity to avoid lifting or straining.

Following your first dressing change, you will be allowed to begin showering and to increase your activity as tolerated. Most patients find that within the first week they can function comfortable around a home or office setting, but that at least three to six weeks must pass before increased physical activity can be tolerated without discomfort. The best rule of thumb is to avoid any activities that cause you discomfort and to enjoy those that do not.

Every activity in life, whether driving automobiles or having surgery is associated with risk. The following inherent risks must be understood and assumed by the patient if we are to proceed with this operation. Although most patients have a very satisfactory result, complications may occur following any surgical procedure. The patient must understand that asymmetry (differences in appearance from one side to the other) is perfectly natural and that some will persist following even the most successful procedure. Likewise, visible and occasionally unsightly scars are an expected outcome of such an operation.

Possible complications include infections, bleeding, alteration in sensation of the nipple/areolar area or elsewhere over the breast mound, breast tissue loss, skin loss (including the nipple/areolar area), which may delay healing, necessitate skin grafts or other subsequent surgical procedures or, if implants are employed, implant rejections.

It is not uncommon for the incisions to pull apart along the folds beneath the breasts or around the areolae; should this occur, the open area will be treated with a moist dressing and will frequently heal without the necessity for revision surgery. Such wound separations, however, will significantly prolong the healing process. On rare occasions, revisional surgery will be required, and will result in additional expense to the patients. It is not possible to advise you of every conceivable complication. The foregoing was not intended to frighten or upset you, but to insure that your decision to have this operation is made with your awareness of the possible risks. Most patients have a very satisfactory result following such surgery and complications actually occur rarely.

All fees will be discussed freely in advance by the office staff. Your insurance company may cover at least part of the fee if an excess of 500 grams of breast tissue is to be removed. Insurance companies never pay the entire fee for breast reductions or for any other procedures that are designed solely to improve your appearance. As such, you cannot expect the insurance carrier to cover the cost of a mastopexy procedure.

You will be responsible for any portion of the fee for a breast reduction not covered by the insurance carrier.
In compliance with suggestions adopted by the American Society of Plastic Surgeons, it is customary for the patient to pay all fees for cosmetic surgery prior to the desired operation. This insures that the patient is sincere in her motivation and can afford the surgery, thus creating a better patient/physician relationship. A non-refundable deposit will be required to secure your desired surgery date. The remainder of the fees must be paid prior to the surgery, no later than the time of the preoperative visit, one week before surgery.

Additional fees are also required for laboratory tests, surgical facility fees, the anesthesiologist, and if necessary, mammography. If additional surgical procedures become necessary, additional facility, laboratory, anesthesia, implant costs and professional fees will be incurred. The surgical facility and anesthesiologist fees quoted will be based on our best faith estimate; the final fee may vary as these fees are based on surgical time, and it is not always possible to predict exactly how long a procedure will take to complete. It is important that you understand that the patient is responsible for all costs associated with all secondary surgical procedures or for the treatment of any complications that may arise as a result of this elective surgery.

Please note that if a functional component exists (very large breasts exceeding 500 grams of tissue), if requested, our office staff may be able to assist you with you insurance forms. However, payment of all fees is the patient’s responsibility. Recovery of any insurance benefits is between you and your insurance company. The surgeon’s fee does not include laboratory, pathologist, anesthesiologist or hospital/facility charges. It is important that you understand that the patient is responsible for all costs associated with secondary surgical procedures.

I, _____________________________________________certify that I have read and understand the” Reduction Mammoplasty/Mastopexy” information sheets dated May 2005, that my surgeon has answered all of my questions to my satisfaction, and that I give my informed consent for this procedure.

Witness_______________________________ Date__________________

Copyright, 11/87, Last revised 05/05
Juris Bunkis, M.D., F.A.C.S.