Finding The Best Surgeon For You
Posted: Friday 23 July 2010 11:29am
By Dr Daniel Fleming*
The recent stories about a Australian woman’s breast reduction gone wrong and the US model who, having travelled overseas for reportedly the largest implants in the world, now has a life threatening infection are timely reminders of the need for proper research before undergoing cosmetic breast surgery or indeed any cosmetic medical procedure.
Patients want to be able to identify a doctor who is most likely to be able to give them the best result they can get with the least risk of complications.There are many pitfalls in trying to do this but the following information should help:
1. Identify a surgeon who specialises in the procedure you want to have. Just because a doctor is a plastic surgeon or a cosmetic surgeon does not necessarily mean they are an expert in breast reduction or augmentation or that they are performing the procedure often enough to maintain first rate skill. One surgeon may be excellent at noses but not at breasts or vice versa. Do not be afraid to ask how often does Dr X perform breast augmentation (or reduction)? What percentage of his practice is breast augmentation? How many times has he performed breast augmentation? How many times in the last 12 months. This is not a competition to choose the doctor who does the most but it is a qualifying question to ensure you are going to consult with a surgeon who does specialise in your procedure, is experienced and up to date.
2. Word of mouth recommendations are a good starting point and the internet can be helpful. Remember web sites are advertisements. You cannot believe everything you read on some of them so make sure you view websites critically. The best sites will provide solid informative information not just a lot of pretty before and after pictures and un-evidenced statements about how great the doctor is. Always cross reference the claims on the website by asking the questions in 1 above.
3. Qualifications. This is a mine field and very confusing because in Australia astonishingly there are NO officially recognised qualifications in cosmetic surgery. This is because cosmetic surgery is not yet “officially” recognised as a separate specialty and so the Australian Medical Council (AMC) has not assessed ANY qualifications in cosmetic surgery. The AMC is currently assessing the case for creating a cosmetic specialty so it will be able to assess cosmetic medical and surgical qualifications. There is only one specific qualification in cosmetic surgery available in Australia which is Fellow of the Australasian College of Cosmetic Surgery (FACCS). You can access the College’s website www.accs.org.au to see what it takes to get this qualification. Plastic and reconstructive surgery is a recognised specialty but its qualification FRACS (plast.) does not ensure the surgeon has had significant or indeed any cosmetic surgery training. The lobby group for plastic surgeons the Australian Society of Plastic Surgeons (ASPS)claims otherwise but the truth was revealed in a Channel 9 interview given by Professor Peter Haertsch in 2008 explaining his reasons for leaving the Australasian Society of Plastic Surgeons. He spoke about “… what they saw as being a monopoly held by them on cosmetic surgery and I was part of the education. I was on the Board of the Society with respect to the training program and organising training and there was not one skerrick of time given to cosmetic surgery and I thought this was rather hypocritical and I left them.” To be fair, in recent years, responding to competition from the ACCS, the cosmetic surgeons’ College, the plastic surgeons have introduced some cosmetic surgery teaching for its trainees but it is very variable in quality and amount.
To complicate matters further there are surgeons from the Royal Australasian College of Surgeonswho have the qualification FRACS not in plastic surgery but in general surgery or Ear, Nose and Throat surgery who offer cosmetic breast procedures. They may have obtained good training privately or no training at all in cosmetic surgery. This is why, whatever the qualification the doctor has it is essential you ask the questions in 1 above to find out if they are likely to be expert in breast surgery. Probably the doctor will have the qualification FACCS or FRACS. They may be a cosmetic surgeon or plastic surgeon, relying on the title is not enough.
4. Have more than one consultation. Having identified two or three doctors using the criteria above go for a face to face consultation. Almost certainly each surgeon will have different recommendations about the precise choices for your surgery. This does not mean one is right and the other wrong but you should come away from a consultation with a clear understanding of why the doctor has recommend this particular implant type and positioning for you. As an example, breast implants can be placed in front, behind or partially behind the chest muscle. There is right and wrong for every patient but there will be a better way for you depending on what your natural breasts are like. Some surgeons only offer one type of placement because that is all they do. Avoid doctors who do this because it may not be best for you. Make sure the surgeon is able to offer all of the options and then clarify why he or she has recommended one particular placement for you. Do not have more than three consultations. If you have properly identified three surgeons and consulted with them then more consultations will simply confuse you.
5. Risks. All surgery has risks and complications can and do occur even in the best hands. Make sure you are satisfied that the risks have been properly explained to you in a way you understand. Ask the surgeon about his or her own complication rate and if it is suspiciously low ask why. Either the doctor does not do many (if a complication occurs in two per cent of patients and you only do 25 of those procedures a year you will not see many, if you do 300 a year you will see 6 patients per year with the complication) or they are not telling you the truth.
6. Code of Conduct. There is Code of Conduct for doctors offering cosmetic surgery. This has been authorised as being in the public interest by the ACCC, the Australian Competition and Consumer Commission. Only doctors who are members of the Australasian College of Cosmetic Surgery have signed up to abide by it rules. You can view the Code at www.accs.org.au and it is a good resource to see the sort of standards you shold expect from a cosmetic surgeon or plastic surgeon offering breast procedures.
7. Beware of middle men and middle women. When you respond to an advertisement or web site you may not be dealing with the doctor or their staff. There are several businesses which are brokers for surgeons. These are run by businessmen and women who describe themselves as offering “independent” advice and promise they will guide you through the cosmetic surgery maze. Although some of these brokers are honest many are not. They have deals with surgeons, some of whom cannot generate enough patients on their own merits, and they receive part of the cost of the operation. They have a big incentive to recommend a surgeon with whom they have the best deal so they can maximise their profit. This may not be the best surgeon for you judged in their expertise in your procedure alone. In general it is better to deal with the doctor direct but if you do use a broker make sure you are clear how much of the cost is going to them. The best doctors do not need to split their fees with brokers.
8. Overseas surgery. This can be cheaper though not always when all of the costs are factored in. Australian based brokers are often used (see above about brokers). There are several disadvantages of going overseas. You will not have had a face to face consultation before you get there so you are effectively committed to having whatever the doctor recommends. It is unlikely all of the options will be offered to you. You will not be able to get second opinions and have time to consider what is best for you. If a complication develops once you have returned to Australia you are in trouble. You will have to return to the overseas country or see a surgeon here. Because you have not had the surgery with the Australian surgeon you will be starting from scratch financially. Remember the commonest complications of breast augmentation surgery (hardening and displacement) do not occur in the first few days or weeks after the operation but months or years later. Also if the surgery is performed negligently you will have no legal recourse in Australia. Although some patients are happy with overseas surgery most see these disadvantages as not worth it.
9. Multiple procedures. If you have more than one procedure at the same time the risks of both procedures are increased. So if you have a tummy tuck and breast implants at the same time you are increasing the risk of developing complications of both procedures compared with having them done separately.
10. With breast implants do not go too large. Listen to what your surgeon tells you. The bigger the implants, the bigger are all of the risks. Very large implants will compress the breast tissue greatly. Over time this will thin out the natural tissue and will prematurely age the breast causing an ugly and untreatable appearance.
11. Make sure your surgeon at least offers you the option of polyurethane foam covered silicone implants. There is unequivocal evidence that these implants are safe and reduce the risks of the commonest complications of hardening and displacement. More information about these implants is available at www.breastimplantsaustralia.com
12. What kind of anaesthetic? The options are sedation with local anaesthetic when you are still conscious or general anaesthesia when you are not. The former is often seductively named “twilight sedation”. Both can be safe and effective but twilight sedation is sometimes used by surgeons to save money. It may be given by a nurse under the direction of the surgeon which means there is no specialist anaesthetist present to look after you and it is often used because the operating facility is not good enough to get a license for general anaesthesia. Obviously this means less cost. General anaesthetics can only be given by a specialist anaesthetist in a licensed hospital. This means the standards of the operating theatre have reached a very high level and if something goes wrong all the equipment and personnel needed will be present. So sedation procedures may not only rely on the surgeon and the nurse to treat you if you developed a complication or side effects from the drugs used to sedate you, they are often recommended because the operating facility is not up to the standards needed to be licensed for general anaesthetics. If a surgeon is recommending twilight sedation therefore ask these two questions: Will a specialist anaesthetist be present? Is your operating theatre licensed for general anaesthesia? Do not accept a statement that the facility is “accredited” because this has nothing to do with being up to the standards for general anaesthesia and is a lower standard than “licensed”.
* Dr Daniel Fleming has performed more than 3000 breast implant operations and has Australia’s most experience in the use of polyurethane foam covered silicone breast implants (which have been proved to reduce the risk of the commonest complication of implant surgery, capsular contracture). He is acknowledged as one of the world’s leading authorities in the use of this type of implant and was also one of the first doctors in Australia to perform the rapid recovery breast implant technique. He is a Fellow of the Australasian College of Cosmetic Surgery; also a trainer and examiner for the College.
For further information:
p: 1800 682 220 or +61 7 3252 8929
www.breastimplantsaustralia.com
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