INFORMED CONSENT - AUGMENTATION MAMMAPLASTY WITH SALINE-FILLED IMPLANTS

©2007 American Society of Plastic Surgeons®. Purchasers of the Patient Consultation Resource Book are given a limited license to modify documents contained herein and reproduce the modified version for use in the Purchaser's own practice only. All other rights are reserved by American Society of Plastic Surgeons®. Purchasers may not sell or allow any other party to use any version of the Patient Consultation Resource Book, any of the documents contained herein or any modified version of such documents.

INSTRUCTIONS

This is an informed-consent document that has been prepared to help inform you about augmentation mammaplasty surgery with saline-filled implants, its risks, as well as alternative treatment(s).

It is important that you read this information carefully and completely. Please initial each page, indicating that you have read the page and sign the consent for surgery as proposed by your plastic surgeon and agreed upon by you.

GENERAL INFORMATION

Saline-filled breast implant devices have been approved by the United States Food and Drug Administration (USFDA) for use in breast augmentation and reconstruction.

Augmentation mammaplasty is a surgical operation performed to enlarge the breasts for a number of reasons:

• To enhance the body contour of a woman, who for personal reasons feels that her breast size is too small.
• To correct a loss in breast volume after pregnancy.
• To balance breast size, when there exists a significant difference between the size of the breasts.
• To restore breast shape after partial or total loss of the breasts for various conditions.
• To correct or improve results of existing breast implants for cosmetic or reconstructive reasons.

Breast implant surgery is contraindicated in women with untreated breast cancer or pre-malignant breast disorders, active infection anywhere in the body, or individuals who are currently pregnant or nursing. Individuals with a weakened immune system (currently receiving chemotherapy or drugs to suppress the immune system), conditions that interfere with blood clotting or wound healing, or have reduced blood supply to the breast tissue from prior surgery or radiation therapy treatments may be at greater risk for complications and poor surgical outcome.

Saline Filled Implants Consent Form - Download