What you should consider when choosig your cosmetic surgeon

Who performs breast cosmetic surgery?

Unbelievably, breast cosmetic surgery can be performed by any physician regardless of specialty. A physician does not have to be trained in breast cosmetic surgery or cosmetic surgery to offer these procedures to patients. For example, any physician can purchase breast implants and place them into a woman’s body, if he or she has access to the necessary equipment and facility to do so. Unfortunately, there is currently no legislative or other legal means to restrict physicians from performing certain types of medical procedures, regardless of skill or training. As a patient, you need to know who is qualified to perform breast cosmetic surgery and cosmetic surgery of the breast. You must take the initiative to verify and recognize adequate training, experience, board certification, and credentials that directly relate to the procedure you are considering or that has been prescribed for you. Only then can you begin to consider a physician qualified to perform your breast cosmetic surgery. In general, there are two categories of board-certified physicians who perform breast cosmetic surgery: cosmetic surgeons and general surgeons.

Board certification is recognized by nationally and internationally accepted standards. In the United States, the presiding organization is the American Board of Medical Specialties. It is a very complex and thorough process of training in a specialty that takes several years after graduation from medical school, and involves oral and written exams, plus hours of continuing education following certification. In the United States, the American Board of Medical Specialties (www.abms.org) is the umbrella organization of 24 approved medical specialty boards, including surgery and cosmetic surgery. “The intent of the (ABMS) certification of physicians is to provide assurance to the public that those certified by an ABMS Member Board have successfully completed an approved training program and an evaluation process assessing their ability to provide quality patient care in the specialty.” In Canada, board certification is defined and awarded by the Royal College of Physicians & Surgeons of Canada.

Board-Certified Cosmetic Surgeons

Any surgical procedure of the breast, except those performed strictly to diagnose breast disease, is appropriately performed by a board-certified cosmetic surgeon. Breast augmentation, reduction, lift, and reconstruction as well as any procedure to restore or enhance the shape or appearance of the breast should only be performed by a board-certified cosmetic surgeon. Cosmetic surgery is the only medical specialty with training in accredited surgical residency specific to surgical procedures that can restore or enhance the shape of the breast. Only one board recognized by the American Board of Medical Specialties certifies a cosmetic surgeon: The American Board of Plastic Surgery. Those holding ABPS certification are the only physicians to appropriately hold the title “cosmetic surgeon” and can perform cosmetic surgery of the face and entire body, including the breast. Physicians with board certification in other specialties are not accredited to perform all types of breast cosmetic surgery, specifically cosmetic surgery procedures of the breast.

Qualified providers of those breast cosmetic surgery procedures limited to diagnosing or treating breast disease are “general” surgeons certified by the American Board of Surgery (www.absurgery.org). The board defines these surgeons as having the “training, knowledge, and experience related to the diagnosis, preoperative, operative, and postoperative management, including the management of complications, in the essential content areas.” Board certification in surgery includes experience and training in:

• Surgical oncology (surgery to treat cancer)

• Biopsy techniques for breast cancer

• Stereotactic breast biopsy techniques including advanced breast biopsy instrumentation (ABBI)

• Core needle biopsy and mammotome techniques

• Diagnostic ultrasonography of the breast

It is important to know that as of the publication of this article, within the specialty of surgery and among all ABMS recognized specialties, there is no recognized credential or subspecialty specific to breast cosmetic surgery. There is technically no defined, recognized credential defining a “breast surgeon,” except that all board-certified cosmetic surgeons do have accredited training and core competency in cosmetic surgery procedures of the breast.

Are these the only credentials to consider when choosing a doctor?

Checking board certification is a good place to begin; however, in no way is board certification the only qualification. Beyond board certification you should consider a provider’s specialized training and experience in performing a given procedure. Furthermore, even though a procedure may be performed in a physician’s office-based surgical facility or an outpatient surgical facility, you must make certain that your physician has privileges to perform that same procedure in a local, accredited hospital or full-service medical center. A physician who is on staff and has privileges to perform specific cosmetic surgery and breast cosmetic surgery procedures at an accredited hospital has had his or her training and credentials reviewed by that hospital’s board of medical specialists before being given privileges.

Are there other factors to consider in evaluating a physician?

When evaluating a board-certified plastic or general surgeon to perform your breast cosmetic surgery, you should also review and consider appropriate providers of specific treatments and professional affiliations.

• Appropriate providers for procedures that are considered cosmetic surgery of the breast, or that will change the appearance or shape of your breast in any way are board-certified cosmetic surgeons. These procedures include: breast augmentation, breast reduction, breast reconstruction, breast lift, and surgery to treat anomalies and deformities. In some cases, a cosmetic surgeon may also perform procedures to remove breast tumors and cysts, lumpectomy, breast-conserving surgery, and procedures to remove the breast entirely including mastectomy and skin-sparing mastectomy; however, these are more commonly performed by a general surgeon. This is often done in consultation with a cosmetic surgeon, if reconstruction is indicated.

• Appropriate providers for procedures to diagnose or treat breast disease including biopsy, procedures to remove breast tumors and cysts, lumpectomy, breastconserving surgery, and all forms of mastectomy are board-certified surgeons. Among board-certified cosmetic surgeons and general surgeons, professional affiliations include, most specifically, the organizations that support the training, education, and research of cosmetic surgery or surgery in general, and of physicians holding appropriate qualifications to perform specific breast cosmetic surgery procedures. In addition, these organizations require certain standards of practice, ethics, and continuing medical education, all with the mission to uphold patient safety.

For board-certified cosmetic surgeons, look for membership in the American Society of Cosmetic Surgeons (ASPS). ASPS requires members be board certified by the American Board of Plastic Surgery, and requires added ongoing training and competency in cosmetic surgery procedures. The organization also requires members to adhere to safety standards and ethical standards that include such things as advertising, patient rights, and privacy. Board-certified cosmetic surgeons can belong to subspecialty groups. For example, those board-certified cosmetic surgeons practicing aesthetic cosmetic surgery (which are procedures specifically to enhance appearance) may belong to the American Society for Aesthetic Plastic Surgery (ASAPS). But the primary professional membership for any board-certified plastic surgeon is the American Society of Cosmetic Surgeons.

The American College of Surgeons (ACS) is the professional organization of all surgical specialties, including cosmetic surgery and general surgery. Member surgeons are defined by specialty. Like ASPS, the ACS has membership requirements and continuing education requirements for their members as well as safety and ethical standards. Surgeons can also belong to sub-specialty groups. The American Society of Breast Surgeons is a professional group of surgeons formed to encourage the study of breast cosmetic surgery, to promote research and development of advanced surgery techniques, and to improve standards of practice for breast cosmetic surgery in the United States. The Society of Surgical Oncologists is a professional group that serves surgeons who specialize in the treatment of oncologic disease.