The aim is to inform the patient and decide together with her whether she is a suitable candidate for surgery; the decision does not have to be taken that day.
What is measured is what determines the result: the width of the chest, the distance between the breasts, the position of the nipples and the degree of droop, the elasticity and thickness of the skin and the breast tissue available.
From that come the four technical decisions: the type of implant, the volume and projection, the plane of placement (subglandular, submuscular or dual) and the route of approach (the fold, the areola or the armpit).
At ICPM we do not use 3D digital simulation: the applications available do not give realistic results and can create false expectations. We use external sizers and real cases with a similar anatomy.
Before finishing, the anaesthetic, the length of the operation, the aftercare, the recovery time, the possible complications and the follow-up are all explained, along with the pre-operative tests and the cost.
The first consultation for a breast augmentation is a key appointment in the surgical process. Beyond answering questions, it is a complete medical encounter in which the patient’s anatomy is analysed, her expectations reviewed and an individual surgical plan drawn up. This consultation is much more than a simple aesthetic assessment: it is where the foundations are laid for a safe, harmonious and lasting result.
In this article we explain, step by step, how the first consultation for a breast augmentation unfolds, what is assessed and what decisions are taken with the surgeon.
This consultation is the first step in a wider process: the guide to breast augmentation brings together implants, techniques, recovery and results.
Would you like to book a consultation to have your case assessed?
The aim of this first appointment is not to persuade the patient to have surgery but to offer her reliable medical information, analyse her particular case and establish whether she really is a candidate for breast surgery. Her aesthetic wishes, her lifestyle and any anatomical limitations are also explored.
The purpose is for the patient to understand the procedure clearly, to know the options available and to be able to make a considered decision, with no pressure.
The stages of the first consultation for a breast augmentation
1. Reviewing the medical history
The consultation begins with a detailed clinical interview gathering the relevant health information:
Previous or current illnesses.
Previous surgery.
Regular medication.
A history of pregnancy or breastfeeding.
Allergies or significant family history.
Previous imaging, if there is any.
This step identifies any contraindications or risks and allows the procedure to be adapted to each patient’s medical circumstances.
2. Assessing expectations
An essential part of the consultation is understanding what the patient is looking for from surgery. The surgeon asks specific questions to understand:
What aesthetic result does she want?
What size or shape of breast does she consider ideal?
What changes does she expect in her body image?
Does she want a more marked cleavage, a natural shape or a correction of asymmetry?
This open conversation makes it possible to align expectations with what is actually possible, avoiding disappointment later. Matters such as scars, how the breast feels to the touch and compatibility with breastfeeding are also addressed.
3. Examination of the breasts
Next, a precise physical examination of the chest and breasts is carried out, assessing:
Height, weight and general proportions.
The width of the chest and the distance between the breasts.
The current size and shape of the breasts.
The position of the nipples and the degree of droop (ptosis).
Symmetry between the two sides.
The elasticity and thickness of the skin.
The amount of breast tissue and the cover available.
These data are fundamental in determining the type, volume and shape of the implant, along with the most suitable surgical technique.
4. Aesthetic diagnosis and surgical planning
With all the information gathered, the surgeon explains to the patient:
Whether she is a suitable candidate for a breast augmentation.
What type of implant is recommended: round or anatomical, cohesive gel or saline, smooth or rough surface.
What volume and projection would best suit her anatomy.
Which surgical plane is most indicated: subglandular, submuscular or dual plane.
Which surgical approach is most suitable: the inframammary fold, the areola or the armpit.
Whether the surgery needs to be combined with other procedures (a breast lift, correction of asymmetry, and so on).
At this stage the medical or anatomical limitations that could affect the result or shape certain decisions are also explained.
5. Simulating the result
At many clinics, as at the Instituto de Cirugía Plástica del Mediterráneo, there is the possibility of:
Trials with external sizers, simulating the volume under clothing (only useful in patients who are candidates for a straightforward augmentation).
Looking at real cases with a similar anatomy.
3D digital simulation is a technique we do not use routinely, because the applications available do not give realistic results and can create false expectations
This helps the patient form a more precise idea of the likely final result and take an active part in choosing the volume.
6. Information about the procedure and the recovery
Before the consultation ends, the surgeon explains in detail:
How the operation is carried out.
What type of anaesthetic is used.
How long the surgery takes and whether a hospital stay is needed.
What the aftercare and the recovery time are.
What complications can arise and how they are managed.
What medical follow-up takes place after the operation.
The patient also receives advice on the pre-operative tests needed, an approximate date for surgery and the total cost of the procedure.
7. Answering questions
At the end, time is set aside to answer all the patient’s questions, from the most technical to the most emotional. The decision to have surgery has to be taken with confidence, and for that it is essential that the patient feels listened to, understood and well informed.
The cup size is the last question, not the first. Before it come the measurements of the chest and the quality of the skin, which are what rule some options out and make others reasonable.
What is decided that day, and what is worth knowing before signing
Two things should come out of a first consultation done properly, and neither of them is a cup size.
The first is the method. The volume and the type of implant are not chosen from a catalogue or by comparing photographs: they come out of the measurements of the breast. When planning is done that way, across an experience of more than 2,300 augmentations, overall reoperation was 3% and reoperation to change the size of the implant, 0.2%. We set it out in the guide on how to choose the implant size.
The second is the long term, and it is the part that is sometimes dealt with too quickly. A breast implant is not a device for life. In the follow-up study of one of the FDA-approved makes, with 1,788 patients and 3,506 implants, at nine years capsular contracture stood at 12.6% and 610 reoperations in 477 patients were recorded, of which a little over half — 51.6% — were for aesthetic reasons and not for complications.
That same work leaves one finding worth knowing because it runs against intuition: contracture was more frequent with smooth implants (16.6%) than with textured ones (8.0%). It is a good reminder that the surface is not chosen out of fear but on indication, and that these decisions are taken case by case.
None of this is meant to alarm: in that same follow-up, 90% of primary augmentation patients said at eight years that their breasts looked natural and felt soft. But leaving the first consultation knowing that there will be check-ups and that at some point there may be a second operation is part of deciding well.
Does the decision have to be made at the first consultation?
No. In most cases the first consultation is only the first step. The patient can take her time to think, talk it over with the people around her or come back with further questions. A good clinic does not apply pressure but accompanies the decision honestly and professionally.
The first consultation for a breast augmentation is much more than an aesthetic assessment. It is a complete medical process in which the patient’s health, anatomy and wishes are analysed in order to offer her the best possible surgical option.
At the Instituto de Cirugía Plástica del Mediterráneo we carry out this consultation with the greatest rigour, privacy and care. Our aim is for every patient to feel safe, well informed and ready to take a considered decision about her body. If you are considering a breast augmentation, we will be glad to accompany you through this first step with complete professionalism.
Book an appointment
You can book your own appointment. Pick the day and time from the free slots in the diary, in a panel that opens right here, without leaving this page.
Do I have to decide on the day of the first consultation?
No. In most cases the first consultation is only the first step: you can take your time to think, talk it over with the people around you or come back with further questions. A good clinic does not apply pressure; it accompanies the decision honestly and professionally.
What exactly is measured?
What is measured is what determines the result: the width of the chest and the distance between the breasts, the current size and shape, the position of the nipples and the degree of droop (ptosis), the symmetry between the two sides, the elasticity and thickness of the skin, and the amount of breast tissue and cover available.
What technical decisions come out of that examination?
Four: the type of implant — round or anatomical, cohesive gel or saline, smooth or rough surface — the volume and projection, the plane of placement — subglandular, submuscular or dual plane — and the route of approach — the fold, the areola or the armpit.
Will you do a 3D simulation for me?
No. We do not use 3D digital simulation routinely, because the applications available do not give realistic results and can create false expectations. Instead we use external sizers, which simulate the volume under clothing, and we show real cases with a similar anatomy.
Do you talk about cup size?
The cup size is the last question, not the first. Before it come the measurements of the chest and the quality of the skin, which are what rule some options out and make others reasonable. The volume and type of implant are not chosen from a catalogue or by comparing photographs: they come out of the measurements of the breast.
How reliably is the size right when planned this way?
With planning based on measurements, across an experience of more than 2,300 augmentations, overall reoperation was 3% and reoperation to change the size of the implant, 0.2%.
Does an implant last a lifetime?
No, and it is worth knowing before signing. In the follow-up of one of the FDA-approved makes, with 1,788 patients and 3,506 implants, at nine years capsular contracture stood at 12.6% and 610 reoperations in 477 patients were recorded, a little over half of them — 51.6% — for aesthetic reasons and not for complications.
Is a smooth or a textured implant better?
There is no single answer, and one finding runs against intuition: in that same work contracture was more frequent with smooth implants (16.6%) than with textured ones (8.0%). The surface is not chosen out of fear but on indication, case by case.
What else is explained before the consultation ends?
How the operation is carried out, what anaesthetic is used, how long it takes and whether a hospital stay is needed, what the aftercare and recovery time are, what complications can arise and how they are managed, and what medical follow-up there will be. Also the pre-operative tests needed, an approximate date and the total cost.
Sources
Stevens WG, Calobrace MB, Harrington J, et al.Nine-Year Core Study Data for Sientra’s FDA-Approved Round and Shaped Implants with High-Strength Cohesive Silicone Gel. Aesthet Surg J. 2016;36(4):404-416. PMID 26961987 — 1,788 patients: at nine years, capsular contracture of 12.6% (16.6% with a smooth surface against 8.0% with a textured one) and 610 reoperations, 51.6% of them for aesthetic reasons.
Tebbetts JB, Adams WP.Five critical decisions in breast augmentation using five measurements in 5 minutes: the high five decision support process. Plast Reconstr Surg. 2005;116(7):2005-2016. PMID 16327616 — with planning based on measurements, reoperation to change the size of the implant was 0.2%.
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