Just how important is it to find a 'Board Certified' PS?

[crossfit99]

Tried getting some feedback in the main section, no luck.

I have gone to two different consults. First was with a PS that is not board certified. He had a very very nice facility, explained the procedure etc. When I asked if he's done a lot of gyne surgeries he assured me that he had, but when I asked for pics he took me back and showed me more of reconstruction/tummy tuck type stuff (all on males), then showed me examples of how the scarring would look (or not look) on females. He has 4 pics up on his web site for male breast reduction, it looks like he has 20 years experience, getting his original education in Iraq, then following up in the UK, then a few years here at Baylor university. The reviews I can FIND seem pretty good, a few weird ones here and there, but it's hard to know who to believe. The price is really good, 4,000 and its about 3 minutes from my front door.

Other doc is a very popular one, board cert, does gyne surgery for big time body builders etc etc. He has probably 20+ before/afters on his site..All good to go, BUT his price is crazy. 8700, then the lady said she had an early opening she could get me for 6500...Then later says if I put 1k down today, they'll drop it to 6k. I felt like I was dealing with a used car salesmen. When I brought up the price of the other doc, she said I am comparing apples to oranges because he's not board certified.

I am racking my brain here because part of me believes its a relatively basic surgery and I'll probably be just fine with the cheaper guy. Then I second guess myself and ask why he doesn't have more certifications etc.

I'd love an opinion from a non-bias source, and even better a doctor. Any input would be greatly appreciated.

[Dr. Elliot Jacobs]

Board Certified is a start.  It basically assures you that the surgeon has passed rigorous examinations.  But make sure that you are dealing with a Board Certified surgeon who is certified by the American Board of Plastic Surgery.  There are other Boards and some docs may be certified in them but still doing gyne surgery.  For example, would you go to a Board Certified eye doctor for gyne surgery?  Well, in some areas of the US, that may be what is done.

The other guidline is to very carefully assess your surgeon.  Does he have sufficient before and after photos specific to gyne to show you?  How does he relate to you?  This is elective surgery -- choose your surgeon wisely and do not rush your decision.

IN terms of cost, that is important but it is one of the least important of the overall considerations.  Remember, your results will last for many years and long after the fee is forgotten.  But a bad result will haunt you for a long time.  Choose the surgeon with whom you are most comfortable and confident.

Then go for it!

Dr Jacobs

[crossfit99]

Board Certified is a start.  It basically assures you that the surgeon has passed rigorous examinations.  But make sure that you are dealing with a Board Certified surgeon who is certified by the American Board of Plastic Surgery.  There are other Boards and some docs may be certified in them but still doing gyne surgery.  For example, would you go to a Board Certified eye doctor for gyne surgery?  Well, in some areas of the US, that may be what is done.

The other guidline is to very carefully assess your surgeon.  Does he have sufficient before and after photos specific to gyne to show you?  How does he relate to you?  This is elective surgery -- choose your surgeon wisely and do not rush your decision.

IN terms of cost, that is important but it is one of the least important of the overall considerations.  Remember, your results will last for many years and long after the fee is forgotten.  But a bad result will haunt you for a long time.  Choose the surgeon with whom you are most comfortable and confident.

Then go for it!

Dr Jacobs

Dr Jacobs,

Thank  you VERY much for the response! -- I think I have all but eliminated the first doc I visited. I have emailed him to try and get some answers and I get no response, so that stacked on top of a little hesitation I already had is enough to say, forget it.

I have a consult with a doc that is certified through the "Board of Cosmetic Surgeons", when I spoke to the lady on the phone she made it sound like this is what I want, because he's been trained in cosmetic procedures rather than a lot of reconstruction and other procedures that goes into plastic surgery. He has a bunch of really good reviews all over the web, and 4 photos of gyne surgery on his site. The lady told me he'd come into the consult with plenty more to show.

Again, thanks for taking the time to give your advice. This decision is a hard one and its important to feel good about who you are going to have to do it!

[Dr. Elliot Jacobs]

One more note of caution.  There are only about 24 AMA approved "Boards."  However, there are also bogus Boards which are not AMA approved.  Some of these bogus Boards are formed by groups of physicians who decide to form their own organization, award themselves certificates and declare themselves "Board Certified."

Among the most notable of the bogus Boards is the American Board of Cosmetic Surgery.  To join, you simply have to be an MD or a DO.  You then attest to the number of cosmetic cases you do.  You can be a dermatologist, ENT, Ob-Gyn, internist or any other type of physician and you do not need the requisite number of years of intense surgical training as those docs who are diplomates of the American Board of Plastic Surgery.  In fact, many of them take a weekend course in some type of cosmetic procedure and then go out and do it.

They manage to deflect questions by saying they are "experts" at cosmetic surgery while those other general plastic surgeons operate all over the body doing all other types of surgery as well.  They actually turn the argument 180 degrees -- poo-pooing competency in surgery gained through years of training and stressing their "expertise" in a specific cosmetic procedure.

If you are interested in the second doctor, you should find out what exact specialty (if any) your doc is certified in -- and then compare his training to any one of the available plastic surgeons in your area.  Also, be aware that many "great" reviews on a website can simply be friends of the doctor.  A word to the wise.....!

Dr Jacobs

[crossfit99]

Thank you again!


Interesting fact on the board of cosmetics.-- This is frustrating, the only Doc around here I KNOW has done a ton of Gyne surgeries is just ridiculous in price. I had a friend that got the procedure done by another doctor that is in fact board certified, but its over an hour drive and i'd like to stay local IF possible. The said doc that is board certified doesn't have any pics of gyne procedure on his site, but he does advertise for it. My friends chest came out great, the only part that bugged me was he went into surgery thinking he was getting gland+fat (via lipo) removed, but apparently when the doc opened him up he decided it was just fat and ended up just doing lipo. Not sure how common that it, but it definitely made me wonder.

I am not sure the rules around here, but i'd be happy to share their websites to get your take on them? I am asking for a lot here: good price, near by, and quality lol.. What's so damn complicated about that? lol

[Litlriki]

The variations of board certification are nicely outlined in Dr. Jacobs' responses, and you should take them to heart in your decision-making.  Depending on where you are located, "local" is within an hour or two hour drive, and many of the surgeons on this board treat patients from around the country and around the world.  If you're able to travel an hour for the expertise that is more likely to provide you with a good result, you are fortunate, and you should take advantage of that, rather than taking the risk of a surgeon with questionable credentials.  Savings of a few hundred dollars or a few extra minutes traveling will have little meaning if your result is unsatisfactory.

Rick Silverman

[Dr. Elliot Jacobs]

If you're able to travel an hour for the expertise that is more likely to provide you with a good result, you are fortunate, and you should take advantage of that, rather than taking the risk of a surgeon with questionable credentials.  Savings of a few hundred dollars or a few extra minutes traveling will have little meaning if your result is unsatisfactory.

Dr. Silverman -- AMEN.

Dr Jacobs

[crossfit99]

The variations of board certification are nicely outlined in Dr. Jacobs' responses, and you should take them to heart in your decision-making.  Depending on where you are located, "local" is within an hour or two hour drive, and many of the surgeons on this board treat patients from around the country and around the world.  If you're able to travel an hour for the expertise that is more likely to provide you with a good result, you are fortunate, and you should take advantage of that, rather than taking the risk of a surgeon with questionable credentials.  Savings of a few hundred dollars or a few extra minutes traveling will have little meaning if your result is unsatisfactory.

Rick Silverman

Thanks a lot!

I know the right thing to do here, its just a mixture of being impatient and anxious to FINALLY get these god awful things off my chest. Originally the Wife and I were going to wait till 30 to both get some work done (here Mommy makeover, and my chest), but I just decided that this has been a long time coming and last summer will be the last summer I would be tortured with this stuff.

I just feel sometimes that Dr's are using their credentials as selling points to drive up the price, that's what worries me. -- This may sound stupid, but I think real life, day to day experience is much more valuable than any credential on a piece of paper. They MAY go hand and hand, but I don't think that's a for sure thing. --I would question any PS NOT on the board though, what would be a reason to not do so other than being incompetent?

[Litlriki]

Expertise and price do not go hand in hand.  I do more gynecomastia than anyone in this area, but my price is certainly not the highest in the Boston area. Those of us who "staff" this forum and who support this site have an expressed interest in the care of gynecomastia patients.  Many surgeons do the procedure, and many get excellent results, but for most, it is one of the many procedures they offer in their practice.  Most of the surgeons on this website have greater experience with gynecomastia. 

RS

[crossfit99]

Expertise and price do not go hand in hand.  I do more gynecomastia than anyone in this area, but my price is certainly not the highest in the Boston area. Those of us who "staff" this forum and who support this site have an expressed interest in the care of gynecomastia patients.  Many surgeons do the procedure, and many get excellent results, but for most, it is one of the many procedures they offer in their practice.  Most of the surgeons on this website have greater experience with gynecomastia. 

RS

Exactly.


So when I am looking for a doc, it seems more important to find someone with a lot of gyne surgeries under their belt rather than searching for only a doc that is board certified. If they so happen to be board certified on top of doing a lot of quality gyne surgeries, then cool..But I just can't wrap my head around paying thousand(s) more JUST for being 'board certified'.

Honestly, I asked Frederick Corbin what the main difference was in being board vs not board certified; he simply said its some additional training (don't quote me to a T on that part), a written, and oral exam. Once board certified you are more likely to be able to perform your surgeries in a hospital, where as a non-certifed PS would not be able to. -- So when I heard that I thought, "Cool, you take a written and oral exam (not even a hands on test) then you're able to stamp the label of 'board certified' on your resume and IF need be, perform an operation in a hospital". None of that really pertains to what I truly care about, or look for in a surgeon. YET when I brought up the price of the first doc that quoted me, Corbins first response was "Well, is he board certified", I told him no, then he kinda shrugged and said well its just not the same thing...lol, that's why I get the feeling some docs hang their hat on the board certified deal to drive their price up a notch.


So at the end of the day, I do not think being 'board certified' is the underlying important niche to look for, its simply what doc has performed the most, and the best quality gyne surgeries.

[Miguel Delgado MD]

This is a very good question.  My practice is 35 to 40 percent revision surgery because men are not happy with there first procedure. Board certification is only the start of the evaluation of a plastic surgeon.  This says nothing about his experience with a particular procedure.  You should look a before and after pics to see his work.  I do not mean only a few.  You can also talk with a patient.  This is only a start; you should feel very comfortable with your choice.

[crossfit99]

This is a very good question.  My practice is 35 to 40 percent revision surgery because men are not happy with there first procedure. Board certification is only the start of the evaluation of a plastic surgeon.  This says nothing about his experience with a particular procedure.  You should look a before and after pics to see his work.  I do not mean only a few.  You can also talk with a patient.  This is only a start; you should feel very comfortable with your choice.

Thank you very much for the time and response.


I agree, I think before/afters and the ability to call previous patients is HUGE. That really tells the whole story.


It's wonderful if the doc is awesome at breast aug's and tummy tucks, but unfortunately that does nothing for me. I'll continue doing my do-diligence until I feel i've found the right guy.

[DrPensler]

I think Dr. Jacobs' answer is great, I really do not have anything to add.

[crossfit99]

Just wanted to share my experience on this matter.

I am 1 month post op; I saw 3 different PS's, only one was not board certified. Through the process I dug DILIGENTLY to find the best PS in my area. I researched any and every review site, read through just about every thread here, read on the procedure, read on the background of the docs etc etc etc. I truly did my homework.

I came here and started this thread bc after visiting the 3 docs, I had actually felt that he 'non board cert' doc seemed the best. He didn't rush me, his price was thousands less, he emphasized how taking too much gland is the about the worst thing you could do etc etc. My ONLY hang up was he didn't have a whole lot of before/after photos..that was IT.

After visiting Dr. Corbin; the quote on quote "Gynecomastia Expert" (google that), I felt rushed. He seemed SO confident that it was almost a bit nerve racking, but at the same time it was easy for me to buy into it. He explained how he had done the procedure 20+ years, offered to give me #'s of ex patients etc. My Wife's mother and a couple of her friends had gotten breast augs (along with other PS) and swore by him. The lady came in for the chat about the price and I felt like I was on a damn used car lot. She started at $8700, then said she could do $6500 if I booked it TODAY. I said that wasn't going to happen. She 'acted' like she went to speak with the doc (as long as I got on the phone to talk to my wife, which I didn't) then she returned asking what my wife said, when I said I couldn't get ahold of her she said ok..Call me when you  do (not specifying what the 'doc said). I left feeling torn. I felt he was the 'Gyne expert', but hated the haggling.

I remembered during the consult that the doc said if I got a quote from another board certified ps he would take a look and see what he could do. Well I did, for $5k, faxed it over and bam he matched it. SO we went from 8700, to 6500, to maybe 6k, down to 5k. At this point it was bitter sweet. Thought I had MY guy, but was thrown off by the price hang up.

Went in for pre-op, doc didn't wanna give me the time of day, the damn lady that put me through the ringer is the same one that 'sized me' for my vest (which was NOT a sizing at all).

Fast forward, I am a month post op, 2 huge creases in both nipples, still knotty fatty tissue on both upper-outter quadrants of my nipple/chest, and pretty decent indentations along the incision lines. Went in thinking he would CONTOUR my chest, meaning lipo+excision (or whatever need be to make it look good), came out realizing all he did was excision. Half asses me, completely. I can get by looking a bit better WITH a shirt on, but shirtless I look much worse than pre-op. Prior to surgery I could give a pinch to the nipples and flex my chest and get by. Now if I flex my nipples completely fold in half, if I don't flex it looks like I have a half circled nipple that is sucked in at the bottom. Looks horrible.

I am already saving for a revision. I don't know what it'll take to fix the creasing/bad look but I am determined. My GUESS is some lipo to smooth everything out, but I do not know.

I know this is exactly a question to the docs, but it helps answer my original question.

DO NOT let docs/sales ladies etc, sell you on  being board certified. Go with the doc that seems like he cares. Go with the doc that doesn't try to rush in and out.

If anyone has any questions (I know you can't reply here) just shoot me a message and i'd be happy to help/prevent this from happening to anyone else. 5k is out the window that I will be paying on for 5 years, my confidence took a further dip than pre-op, overall just a horrible situation.


EDIT: Since this is in the 'ask a doc' section: What are your guys thoughts on local anesthesia for lipo? When I expressed my dislike in the contour, he mentioned maybe he'd just go back in there and do some lipo. I asked about the fees and he said "significantly lower". In my humble opinion, its complete bs that a PS would not take responsibility and do whatever it took to make it right, after someone spent $5,000 on a 1 and a half hour surgery. Anyway, i'd like to hear thoughts on the local + lipo, seems ruggid to me, but if it saved me thousands of dollars it may be what I have to do.

Also, what's a typical round about in price for general anesthesia?

Thanks in advance.

[Litlriki]

I'm sorry to hear about your experience. You certainly did your homework, and it's unfortunate that the outcome is disappointing.  I would caution you that you need to allow time for the chest to heal before jumping into a revision.  I won't typically do anything before six months to a year, depending on what the issue is. 

That said, I do sometimes do liposuction as a revision in the office if, for example, there is an asymmetry, for example.  This is easily done with local anesthesia, and if the patient is anxious, I will sometimes give some oral sedation. I'm not able to give more anesthesia in the office (intravenous sedation, for example), so if something more is required, the procedure would have to be done in the operating room--which has occurred only once in my practice. Otherwise, I've always done my revisions in the office with local.  In terms of pricing for such revisions, we only charge a nominal fee to cover our overhead and supplies (typically $300).  You should ask about your surgeon's revision policy.

Rick Silverman