Revision Surgery, Financial Responsibility & Long-Term Expectations Policy

General Policy

Cosmetic surgery is elective. Patients should understand that maintenance procedures, revision surgery, and surgery for complications are part of the long-term financial commitment of cosmetic surgery. If funds are unavailable for potential future procedures, patients should consider delaying their initial surgery. Despite appropriate surgical care, complications or unsatisfactory results may occur because of tissue biology, aging, pregnancy, weight changes, gravity, smoking, medical conditions, medications, genetics, and other factors beyond the surgeon’s control. This does not mean that surgery was performed incorrectly or that the same outcome would not have occurred with another surgeon.

All skin relaxes to varying degrees over time based on individual skin quality, aging, and other factors; patients should not expect surgical results to remain as tight as they appear in the early postoperative period. Patients with poor skin elasticity, poor skin quality, nicotine use or a history of nicotine use, higher body mass index, prior weight fluctuations, or massive weight loss have an increased likelihood of complications, impaired healing, and the need for future revision surgery, and may experience decreased satisfaction with outcomes compared to other patients. Please refer to our separate BMI policy for additional information.

All surgical procedures produce permanent scars. Scar appearance is largely determined by genetics and skin type and cannot be fully predicted or controlled. Both light-skinned and dark-skinned patients may develop raised, thickened, widened, or discolored scars — including hypertrophic scars and keloids — despite appropriate surgical technique and wound care. In some cases, the healing process may also result in contour irregularities, depressions, or other changes in the surrounding tissue, which are considered part of the overall scarring and healing process. Any revision surgery to address scars or healing-related changes will incur a surgeon’s fee and all associated costs.

Cosmetic Surgery Complication Insurance

Cosmetic surgery complication insurance may be included in the patient’s surgical quote for eligible procedures. This coverage may help offset costs associated with complications such as hospital transfers, unplanned admissions, and other unexpected expenses. This coverage applies to medically necessary treatment of complications in the early postoperative period and does not cover elective revision surgery. Patients are responsible for confirming that coverage is in place before surgery and for understanding its benefits, exclusions, limitations, and claim requirements.

Financial Responsibility & Revision Surgery Fee Policy

Health insurance generally does not cover cosmetic surgery, cosmetic revisions, or surgery to address complications of cosmetic procedures. Patients remain financially responsible for surgeon’s fees, facility fees, anesthesia fees, implants, mesh, medications, pathology, laboratory testing, hospital care, transportation, and all other expenses related to revision surgery or complications. Patients pay three separate entities for surgery: the surgeon, the facility, and the anesthesia provider. Patients who have surgery at an outpatient surgery center should be aware that transfer to a hospital may become necessary to treat complications, and all associated fees remain the patient’s responsibility.

Cabbabe Plastic Surgery is committed to achieving the best possible outcome for every patient. The surgeon’s professional fee will be waived for urgent or emergent complications requiring unplanned, medically necessary surgery within the immediate postoperative period. All subsequent revision surgery will incur a surgeon’s fee, which may be reduced at the surgeon’s discretion. Facility fees, anesthesia fees, and all other associated costs always remain the patient’s responsibility. Breast implant surgery carries one of the highest lifetime revision rates in aesthetic plastic surgery; patients considering breast implant procedures should review the Breast Implant Surgery supplement (Page 2 of 2) for additional information.

Body Contouring Surgery

Body contouring procedures — including skin removal surgeries and liposuction procedures — are significantly influenced by tissue quality and healing. Excess skin not removed in adjacent areas of the body can affect the appearance of an operated area. A comprehensive treatment plan may involve multiple procedures, and the decision to stage or limit surgery to certain areas is made collaboratively based on safety, recovery, cost, and the patient’s goals. Liposuction is an inherently imprecise procedure; contour irregularities, asymmetry, and variations in fat removal are expected to some degree. For patients undergoing fat transfer, the percentage of transferred fat that survives is variable and cannot be precisely predicted.

Revision Surgery After Prior Surgery Elsewhere

Patients seeking revision surgery after procedures performed by another surgeon frequently have permanent scar tissue, fibrosis, and altered anatomy that make surgery more complex, less predictable, and associated with higher complication and dissatisfaction rates.

Acknowledgment

I acknowledge that I have had the opportunity to discuss my anatomy, treatment options, long-term expectations, and financial responsibilities with Cabbabe Plastic Surgery. I understand that no guarantee can be made regarding symmetry, scar formation, body contour, or the need for future revision surgery.

Patient Name: ____________________ Patient Signature: ________________ Date: ______

Witness: ________________________ Date: _________________

Breast Implant Surgery

Breast implant surgery involves placement of a permanent medical device and carries one of the highest lifetime revision rates in aesthetic plastic surgery. Future surgery may become necessary because of capsular contracture, implant malposition, bottoming out, waterfall deformity, implant rupture or deflation, infection, implant exposure, rippling, asymmetry, recurrent ptosis, stretching of the tissues, and other implant-related changes. These conditions may occur despite appropriate surgical care and do not necessarily indicate that surgery was performed incorrectly. Although surgeons strive to produce the best symmetry possible, there is no such thing as perfect symmetry, and no guarantees can be made regarding breast size, cup size, or scar tissue formation. Patients with breast implants should expect to need further surgery in their lifetime.

Capsular Contracture

Capsular contracture is unpredictable, can develop at any time, and may affect one or both breasts differently. There is a higher incidence of capsular contracture in patients who also require a breast lift; this is not an error on the part of the surgeon. Revision surgery for capsular contracture will always require a surgeon’s fee. Some implant manufacturer warranties may apply; see the Implant Manufacturer Warranties section below for details.

Implant Position & Patient-Specific Anatomy

There is no single implant position that is ideal for every patient. Placement above and below the muscle each have unique advantages, disadvantages, and potential complications — below-the-muscle placement may be associated with a higher risk of waterfall deformity, whereas above-the-muscle placement may carry a greater risk of stretching of the breast tissues. One plane may reduce certain risks while increasing others, and the recommended position is individualized after evaluating anatomy, tissue quality, lifestyle, and goals. Many patients have reduced skin elasticity, diminished tissue support, low-set breasts, a low inframammary fold, or other characteristics that influence implant position and long-term outcomes. These factors may prevent the implant from being positioned as high as the patient desires, regardless of surgical technique. These patient-specific factors will be reviewed during consultation.

Augmentation-Mastopexy/Reduction: Single-Stage vs. Staged Approach

For patients requiring a breast lift or reduction combined with breast implants, both procedures may be performed during a single operation or as two separate staged operations. Combining these procedures introduces competing surgical goals — tightening, reducing, and reshaping the breast while simultaneously expanding it with an implant — and the greater the degree of lift and reduction required, the greater the inherent risk. A single-stage approach offers one operation, one recovery, and generally lower overall cost, but carries a higher risk of wound-healing complications, infection, healing problems that may require scar revision, recurrent ptosis, implant malposition, bottoming out, waterfall deformity, and loss of lower pole support. A staged approach reduces these risks and improves predictability but requires two operations, two recoveries, increased overall cost, and a longer timeline. Neither approach eliminates the possibility of future revision surgery, and the decision is individualized based on risks, benefits, financial considerations, and the patient’s goals. Patients who have breast tissue removed as part of their procedure should understand that if they later choose to have their implants removed, they will have less natural breast volume than they had before surgery. A staged approach is always an option, even if it was not specifically discussed during the consultation; patients wishing to pursue staging should notify Dr. Cabbabe or the practice before surgery.

Mesh Reinforcement

Mesh reinforcement may be recommended to improve soft tissue support, optimize implant position, and enhance long-term stability. Mesh is designed to support the implant and its position — it does not reinforce or strengthen the breast tissue itself. The type of mesh and technique may differ depending on whether the implant is placed above or below the muscle. The mesh used in these procedures may be considered off-label for this specific application but remains a standard of care in breast implant surgery. Mesh does not guarantee correction of the underlying issue; tissues may continue to stretch, mesh may heal too tightly, or additional adjustment may be needed over time. Dr. Cabbabe will make individualized recommendations regarding mesh placement and any future adjustments.

Implant Manufacturer Warranties & Breast Implant Revision Fee Policy

Many implant manufacturers offer warranty programs that may provide limited financial assistance; however, these programs do not cover surgeon’s fees, facility fees, anesthesia fees, or the total cost of revision surgery. Any warranty compensation received from the implant manufacturer will be expected to be applied in full toward surgical costs.

Cabbabe Plastic Surgery may reduce the surgeon’s professional fee for qualifying implant-related revisions at the surgeon’s discretion. If an implant must be removed because of an implant-related infection within the immediate postoperative period — which constitutes an urgent or emergent complication requiring unplanned, medically necessary surgery — the surgeon’s professional fee for the removal procedure will be waived, consistent with the general revision surgery fee policy on Page 1. All subsequent surgery — including reinsertion of an implant, revision of the implant pocket, placement or replacement of mesh, or any other breast reconstruction — will incur a surgeon’s fee along with all associated costs.

Acknowledgment

I acknowledge that I have had the opportunity to discuss my breast implant options, implant position, the choice between a single-stage and staged approach, mesh reinforcement, long-term expectations, manufacturer warranties, and financial responsibilities with Cabbabe Plastic Surgery. I understand that breast implants are not lifetime devices, that no guarantee can be made regarding symmetry, breast size, implant longevity, scar formation, or the need for future revision surgery, and that I am financially responsible for any future procedures.

Patient Name: ____________________ Patient Signature: ________________ Date: ______

Witness: ________________________ Date: ______________