By Top U.S Surgeon Robin T. W. Yuan, M.D.Excerpt from a book, Behind the Mask, Beneath the Glitter: The Deeper Truths About Safe , Smart Cosmetic Surgery, dealing with breast augmentation:
“Do what you think is best, doc. Use the best implant. Give me the best result you can. Do the best operation there is. What is the best?
The concept of “best” seems self-evident and simple. Since things are not the same, one thing should be better than another. If followed to its logical conclusion, there should be a best. In fact, there should be nothing but the best. That is the foundation of capitalism. The cream rises to the top. The weak (i.e., those who are not the best) do not survive. Evolution is competition and adaptation, creating better products and a better species. It seems one can’t have a worst without there being a best. Life is all about doing, achieving, getting, and rewarding the best: Darwinian at its best.
The problem is…there is no such thing as best. And I tell my patients exactly that…
A very common practical example is a patient who comes in seeking breast enlargement. Unfortunately, for some plastic surgeons, once a woman utters the words “breast enlargement” or “breast implants,” an operation and a specific look comes to mind: round, perky, C-cup, 320 cc’s. Within ten seconds or less, the surgeon can have the whole procedure blocked out and the patient can find herself sitting in front of a surgical consultant or “closer” (just like in baseball) being told how fabulous she will look. After all, the doctor is The Best and the patient has already told the doctor to do what he thinks is Best.So he does.
But one Best surgeon will use a high-profile implant and another Best surgeon will use a moderate-profile implant. One will use a textured implant while his colleague will use smooth. Another will opt for a shaped implant while his cross-town competitor will choose a round one. Each of them will honestly believe he has used The Best.
Often a patient will shop around and get multiple opinions. Each doctor comes with some feather in his cap or has some qualification to deserve recommendation; in twenty years of private practice, I have had only a handful of patients come to me “off the street” without a personal referral. A visit to four different Best surgeons can buy a patient five different Best opinions. One tip-off to judge if the Best surgeon believes he has a Best approach would be to ask how he or she performs a specific procedure. A definitive, unwavering response can be read as an affirmation for the “best” procedure: “I always do it this way” or “My technique is such-and-such because it gives me the best results.”
The breast augmentation procedure has about six major variables plus the irreproducible variable of technical skill and the variable of post-surgical healing with all of its many components of swelling, bruising, neurosensory re-innervation, scar contraction, soft tissue “give,” and muscular relaxation. I typically take three to four sessions over a minimum period of two to three weeks to sift through nearly a hundred different operations with the patient, finally coming up with an operation derived from the patient’s own choosing that is not necessarily The Best for everyone.”
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