02 — Patient Counseling Script (educational model)
Educational work by a pre-medical student — not medical advice. Not a clinical protocol, prescription, or patient handout, and not for patient care. See DISCLAIMER.
Post-mastectomy breast implant revision — November 2026
Purpose
This is an educational model of plain-language preoperative counseling. It is not a consent form and not text to give to a patient. It does not replace the surgeon's and anesthesiologist's informed-consent discussions or the FDA-required breast implant Patient Decision Checklist (labeling approved in 2021 S39). Teach-back checks understanding. It is not evidence that counseling occurred.
1. Opening
"Today I'd like to walk you through what will happen during your implant revision, and go over the anesthesia and pain-control options. Please stop me with questions at any point. Nothing here is decided until you and your team have talked it through."
2. What the surgery involves (plain language)
"This operation is a revision of your breast implant after mastectomy. The surgeon usually:
- Reopens a previous scar.
- Removes the implant that is causing the problem.
- Cleans the pocket where the implant sits.
- Removes or releases scar tissue if needed.
- Adjusts the pocket so the new implant sits as well as possible.
- Places the new implant using careful sterile technique.
- Closes the incision and fits a supportive garment.
Sometimes a drain is placed to reduce fluid build-up. Your surgeon will tell you if that is likely."
3. What to expect afterward
"Most people have soreness and tightness for the first days. Your surgeon will give you specific instructions about arm movement, the support garment, showering, drains, lifting, exercise, driving and follow-up visits. These depend on your operation, so I won't quote fixed numbers of days or weeks here."
v2.0's table of recovery timings was removed: no acceptable source supports fixed timings for this procedure (see RELEASE_NOTES.md).
4. Possible benefits
- Better shape and symmetry (results vary, especially after radiation)
- Relief of pain or tightness from scar tissue
- Removal of a ruptured, malpositioned or problematic implant
Breast implants are not lifetime devices; revision does not remove the chance of future surgery.
5. Risks (explained honestly)
"Like any operation, this has risks. These include:"
- Infection, bleeding or fluid collection
- Asymmetry, or needing further surgery later
- Scarring or delayed healing
- Implant shifting, or capsular contracture (scar tissue tightening), which is more likely after radiation
- Implant exposure or loss, sometimes requiring removal
- Rare implant-associated conditions, including BIA-ALCL (mainly with textured implants), and reported systemic symptoms
- Anesthesia side effects such as nausea or sore throat, and rare serious complications
- With nerve blocks: bruising, a block that does not work fully, and rare complications such as a collapsed lung or a reaction to the numbing medicine
- With opioid pain medicines: nausea, constipation, drowsiness and slowed breathing
Your team will explain which of these matter most for you.
6. Anesthesia and pain-control options (no option is "the best" for everyone)
| Option | What it involves | Main trade-offs |
|---|---|---|
| 1 — Nerve block + general anesthesia | General anesthesia plus ultrasound-guided chest-wall injections of numbing medicine | Often less pain and fewer opioids in the first hours. Adds injections and block-specific risks. The block wears off, sometimes at home. |
| 2 — General anesthesia, no block | General anesthesia plus IV and oral non-opioid medicines; the surgeon usually numbs the area during surgery | No extra block injections. Pain relief may be less complete, and opioids remain available if needed. |
| 3 — General anesthesia including opioids | A standard, widely used technique, with non-opioid medicines as well | Familiar and adjustable. Nausea is more likely, so preventive anti-nausea medicines are given. Breathing is monitored closely afterward. |
"Opioid-free" during surgery does not mean pain-free afterward, and it is not automatically safer. A large trial of one opioid-free technique found more low-oxygen episodes and slow heart rates. Your anesthesiologist will recommend an option based on your health, medicines and preferences.
7. Decision-support script
"The main trade-offs are early comfort, extra injections, and side effects such as nausea or drowsiness. A block can help early pain but adds needles and its own risks. Skipping the block avoids those injections, but pain relief may be less complete. Including opioids is a well-established choice; we prevent nausea and watch breathing closely. What matters most to you?"
8. Pain control after surgery
"We combine medicines that work in different ways: acetaminophen (Tylenol), an anti-inflammatory if it is safe for you, any block or numbing medicine from surgery, and opioids if you need them. If an opioid is prescribed, it will be the lowest dose that works and only enough for the days you are expected to need it S21. We'll cover safe storage and disposal."
9. Documentation checklist (educational)
Patient states understanding of:
- Procedure steps
- Expected recovery (per surgeon's instructions)
- Risks and benefits
- Anesthesia and pain-control options
Approach discussed: [ ] Option 1 [ ] Option 2 [ ] Option 3 [ ] Undecided — to discuss with anesthesiologist
Patient's priorities: [ ] Comfort [ ] Avoiding nausea [ ] Fewer injections [ ] Limiting opioids [ ] Familiar technique
All questions answered? [ ] Yes
Educational model only, not a consent document. The treating surgeon and anesthesiologist obtain informed consent under institutional policy. Author: Collin B. George, pre-medical student.