Informed Consent for Chest Augmentation

I, ____________________________________, understand that I am considering a procedure known as Chest Augmentation ___________________________________ (hereinafter referred to as “the Procedure”). This document serves to inform me of the risks, benefits, and alternatives associated with the Procedure.

Benefits of the Procedure:

The primary benefit of the Procedure is that it may increase the size and shape of the chest. Other potential benefits include improved self-esteem, improved body image, and improved body proportions.

Risks of the Procedure:

The risks associated with the Procedure include, but are not limited to, infection, bleeding, scarring, asymmetry, implant displacement, pain, numbness, and risk of implant rupture.

Alternatives to the Procedure:

The alternatives to the Procedure include non-surgical options such as exercise, diet, and lifestyle changes.

I have read and understand the information provided above. I understand that no guarantees have been made to me about the outcome of the Procedure. I further understand that results may vary and that there is no guarantee that I will be satisfied with the results.

I hereby acknowledge that I have had the opportunity to ask questions of the physician performing the Procedure and that my questions have been answered to my satisfaction. I hereby consent to the Procedure and agree to abide by the instructions given to me by the physician.