The media is once again spinning with stories about “Awake Breast Augmentation”. For better or worse, some surgeons in my opinion, are using the media and internet to increase their market share by pushing the limits on safety, while losing site of the long term results of breast augmentation.

There are at least two very important concerns with regard to “Awake Breast Augmentation.” The first issue is patient safety. The advertised procedures certainly sound like a bargain. One patient was quoted to have saved almost $3000. The savings most likely come from the nonattendance of a board certified Anesthesiologist, or procedures that are not performed in an accredited surgical facility. Breast augmentation is a surgical procedure. There are risks associated with bleeding, infection, and damage to surrounding structures. In addition, this procedure adds the risk of overdosage of local anesthetics, a very real potential risk if the surgery is performed while the patient is awake.

Second, at issue is the question of the long term outcomes of “Awake Breast Augmentation” and the possible prevention of avoidable complications and revision procedures. Most patients have only a vague understanding of the short and long term risks that may be a direct result of selecting an implant that is oversized. There are guidelines that have been developed with respect to implant sizing based on quantitative measurements and the characteristics of the patient’s tissues that have been demonstrated to reduce breast implant complications such as malposition, visibility and palpability of implants, and stretch deformities. Oversized breast implants are a leading driver of revision breast implant surgeries.

The thought that a patient in the Operating Room, looking in a mirror, while anxious and certainly in some discomfort, can make an educated, well informed decision with respect to size is irrational.

The real ethical debate, in my opinion, is whether a physician has a responsibility to look out for the patient’s best interest. Does the surgeon wish to avoid increased surgical risks to the patient and limit creating potentially uncorrectable deformities due to oversized breast implants, or are they merely concerned with the short term goal of attracting new patients and the media?

(These opinions are based on the authors 18 years of experience as a breast augmentation surgeon, her publications on “Patient Education in Breast Augmentation”, as well as the peer reviewed literature.)

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