Breast Augmentation / Reduction / Reconstruction Consent
Informed consent for breast augmentation, reduction mammaplasty, and breast reconstruction procedures, covering implant options, risks, alternatives, and patient acknowledgments.
The Breast Augmentation / Reduction / Reconstruction Consent is a ready-to-use healthcare & wellness template you can send for signature in minutes. It is written for 1 signer (patient) and, by default, expires 30 days after it is sent if left unsigned. It covers consent, plastic surgery, breast surgery, cosmetic, surgical, reconstruction. Like every Abundera Sign template it is a convenience draft structured for ESIGN Act and UETA compliance, not a substitute for legal advice. Each signed copy is sealed with PAdES-LTA digital signatures, dual RFC 3161 timestamps, and a tamper-evident evidence package in WORM storage.
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# Breast Augmentation / Reduction / Reconstruction Consent > **Important — not medical advice.** For use by a licensed provider; tailor to the patient, your protocols, and state law. **Patient Name:** ___________ **Date of Birth:** ___________ **Procedure Date (anticipated):** ___________ **Surgeon:** ___________ **Procedure Type:** ___________ --- ## 1. Procedure Description **Planned procedure details as discussed with your surgeon:** ___________ ### Breast Augmentation Breast augmentation increases breast volume and improves shape using implants (saline or silicone gel) or fat transfer. Implant placement may be sub-glandular (above the chest muscle), sub-muscular (under the pectoralis major), or dual-plane. Incision location options include inframammary fold, periareolar, or transaxillary. ### Breast Reduction (Reduction Mammaplasty) Reduction mammaplasty removes excess breast tissue, fat, and skin to achieve a breast size proportional to the patient's body. Common incision patterns include the vertical (lollipop) and inverted-T (anchor) techniques. Repositioning of the nipple-areola complex (NAC) is typically performed. ### Breast Reconstruction Breast reconstruction following mastectomy may use implant-based techniques (tissue expander followed by permanent implant) or autologous tissue flaps (e.g., TRAM, DIEP, latissimus dorsi). Nipple and areola reconstruction may be planned as a secondary stage. --- ## 2. Implant Information (Augmentation and Reconstruction Only) **Implant type planned (if applicable):** ___________