Why is a Breast Augmentation in CA So Much More Expensive Than in States Like AZ?

Question

I am looking at getting a BA (silicone, under muscle) and some form of either SLIM lipo SMART lipo or VASER lipo done at the same time I have recieved quotes in both Northern CA (where im from) and in AZ and have found that in AZ the prices are all around 1/2 the price quoted in CA. I know "price shouldnt determine the DR" however in my case it is. Is there a way to ask a DR in CA if they could somehow match the prices in AZ or is that considered rude? I just dont understand the $ difference.

Ronald J. Edelson, MD · Answer

When shopping and comparing prices, it is important to make sure you are comparing apples to apples. For example, are both surgeons board certified plastic surgeons? Are both performing lipo on the same areas. Are they both quoting you for saline or is one silicone. I often review quotes from another surgeon where it was obvious that both surgeons were not doing the exact same thing. I am sure Younwould like to have the surgery closer to home. Go on a few more consults and bring the quotes with you from the other doctors. The surgeons may be able to point out where the differences are that justify the cost difference.

Eric Swanson, MD · Answer

First of all, you can negotiate with your surgeon.  It is not considered rude.  In fact, if your surgeon reacts negatively, that is a red flag.  When we do procedures in combination we can be more flexible in the pricing.  By the way, you mentioned some branded liposuction machines, none of which is proven to be  more effective that traditional liposuction or ultrasonic liposuction (remember the surgeon's experience is more important than the brand of liposuction equipment). 

	A host of things goes into the price (including real estate, the amount of competition, and how experienced and reputable your surgeon is) and it is not true that if you spend more you will necessarily get a better result.  First, priorize safety (plastic surgeon who operates in a licensed or accredited facility) and quality, look at plenty of before and after photos provided by your surgeon, and then look at price.  You may want to finance part of it using Care Credit for example.  Also, you can save about $1000 by choosing saline implants instead of silicone gel (when they are below the muscle, the feel difference is really quite minimal).  Also, surgeons who have access an on-site licensed surgery center can usually contain costs better than those who use a hospital or large, multidisciplinary surgery center.

Stewart Wang, MD, FACS · Answer

There are numerous factors in setting the cost of cosmetic surgery. It's definitely influenced by the location and the setting where surgery takes place. Make sure you are comparing apple to apple. You can ask the surgeon to break down the fee schedule for you to see the different components of the fee. The quality and experience of the surgeon and practice can vary greatly which in turn will affect the charges. Certainly not all breast augmentation are the same very much like not all haircut are the same. It is a process and personal experience, not a product you can get off the shelf. If you are still uncertain about the surgeon and the fees, keep looking and comparing. Don't stop until you find the right plastic surgeon that you trust and feel comfortable to put your body on line.

	Best Wishes,

	Stewart Wang, MD FACS, Wang Plastic Surgery

Jourdan Gottlieb, MD · Answer

The costs of doing business vary considerably by geography. When you are having a breast augmentation, you are buying implants, anesthesia services, hospital or surgicenter services and the professional services of your surgeon. 

	Implant costs are about the same all over the country, but everything else varies. Where the cost of living is higher, average salaries are higher. Anesthesia costs more, operating rooms cost more, running a plastic surgery practice costs more. 

	There is no reason not to ask about fee reduction. I can tell you that if you asked me to cut my cost in half, the remaining half would barely cover implants, OR fee at cost, anesthesia fee. That doesn't even consider my office overhead. Unless fees in northern California are way higher than here, I can't imagine someone in Arizona charging half of your local fees.
	Thanks for the question, best wishes.

Brian J. Lee, MD · Answer

The typical cost for any procedure or product on the coast or big city is usually higher. This is true with gas and groceries. There are many qualified surgeons in the country at a cheaper cost, but it does involve travel expenses and the need for follow up.

I know this well as I am in Ft. Wayne, IN in the middle of the US and we typically have lower prices than the coasts and big cities. It does require travel and possible other issues,  but cost of surgery is regionally dependent and does not necessarily mean a better outcome.

Your best option is to find a surgeon in a relatively close proximity with whom you feel comfortable and proceed with a consultation. Do not let money be your sole determining factor for surgery!

Steven Wallach, MD · Answer

Yes, there is a cost difference between states. This is because the cost of doing in business in California is probably more expensive than in Arizona. Remember running somewhere else to have lower costing surgery maybe a problem when and if you need further care back in California. Who are you going to follow-up with? Everything is perfect until it is not.

Norman Bakshandeh Day, MD, FACS · Answer

The cost for this procedure probably varies in these two states because of overhead expenses. Rent and the cost of livingand insurances may be higher in California.

Scott L. Replogle, MD (retired) · Answer

I was interested in reading the responses on this question as I run into it all the time. Most of the reasons have been mentioned. To some extent it's the same reason that gas probably costs more in CA than in AZ. But it is indeed important to break down the costs and make sure that equal parts of the procedure are being compared. The main costs are the surgical fee, the cost of the implants, the facility fee to carry it out, and ancillary costs such as for an anesthesiologist. Surgical fees are all over the place and good plastic surgeons usually set them and stick to them rather than trying to engage in "discount" surgery or one charge for this patient and a different charge for someone else. Some surgeons or facilities make a profit above the cost of the implants but to many surgeons this is a pass-through cost. Silicone gel-filled breast implants cost more than twice what saline-filled implants cost. Facility fees charged by hospitals and outpatient surgical centers are also variable depending on a number of real and inflated costs. Anesthesiologists or anesthetists can also charge whatever they want for cosmetic procedures although it's usually based on how long the procedure is expected to take. 

	The thing that keep costs in check for cosmetic procedures is competition -- your willingness to go somewhere else if the first surgeon you check out is too high. Another is to do procedures in an accredited office facility under something like local anesthesia with IV sedation. This is quite feasible for breast augmentation and/or liposuction. My office surgical facility cost is quite a bit lower than the hospital or outpatient surgical facility and I don't need an anesthesiologist for IV sedation. Oral surgeons often do this for procedures such as wisdom teeth extraction rather than taking the patient to the hospital. I would recommend making sure the surgeon is board certified, experienced with local/IV sedation technique, and has appropriate accreditation. 

	I would agree that SMART and VASER liposuction is not demonstrably better than properly done normal liposuction but will cost more because of the expense of the equipment.

Douglas J. Raskin, MD (retired) · Answer

Greetings Jenna,

	Patients, as they become more informed health care consumers, are comparing the costs of their breast implant surgery not just in their own communities but across their state and the states they live nearby.

	In your town, the fees vary based upon the selection of saline vs. gel implants and the experience and reputations of your local surgeons. The cost of your plastic surgeon's office and staff (overhead) also figure into the fees charged by your local plastic surgeons. As you might suspect, someone ultimately must pay for the fancier offices sometimes encountered by patients seeking cosmetic surgery. Local costs of living also figure into how a surgeon sets his (or her) fees.

	Doctors who may not be trained, board certified plastic surgeons, also offer breast implants to the public in America (and the prices can be lower). Take a look at the American Board of Plastic Surgery website for further information about training and qualifications needed to provide you with safe plastic surgical care.

	Fees in our community are usually lower than "the big city" and may be higher than those found in other states with lower costs of living.

	The expense of the breast implants, the anesthesia,and the outpatient surgery centers are going to be comparable among your local docs.  I prefer the safety of a well staffed, licensed, and certified surgery center despite the fact that it costs me a bit more. For reasons of patient safety, the savings of doing cosmetic office surgery is not something that I am comfortable with.

	When you travel from city to city in your state or to neighboring states, all of the above factors may contribute to higher fees or, as you have found out, lower surgical fees. Like any business, your surgeon must be comfortable with what he (she) earns after all the expenses are paid.  No matter where you decide to have your surgery, select a plastic surgeon with a good reputation who you are comfortable with and trust. 

	I hope this rather long answer helps you better understand the variation of fees for your surgery.

	 

	Best Regards

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