What is best for breast augmentation surgery? Accredited facility or hospital?

I had a consult with a plastic surgeon who told me accredited surgical facilities are not safe in fact he compared them to joan rivers case in which she died. It's making me second guess my decision to have ba surgery. I'm very unhappy with my breats to the point of tears but I don't want to be the lady who died getting boobs. Any advice would be great. Thank you!

Doctor Answers 26

Accredited facility vs hospital

An accredited surgical facility is one that goes through very vigorous review to be accredited to perform surgery safely. It is not taken lightly.  Choosing a hospital vs a facility is truly personal for the patient.  There are pros and cons to both I suppose.  I mainly operate in my accredited facility but sometimes use the hospital for patients that are not as healthy, have reconstructive procedures or for hospital based patients covered by insurance, or in patients that prefer having their procedure done at the hospital.  Hospitals can cancel your surgery for emergencies, delay your surgery for emergencies, not give a surgical date/time until shortly before you surgery, and potentially carries higher risks of infection due to the high volume of patients treated there for many different reasons.

New York Plastic Surgeon
4.1 out of 5 stars 24 reviews

Facility choice

Facility accreditation is very serious and there are several agencies that a charged with the task. In general board certified plastic surgeons only operate at properly accredited facilities. We all signed a pledge to this effect with our professional society. The facility where Joan Rivers trsgedy happened was not accredited to administer general anesthesia. You should always be comfortable with your choices! If you trust your surgeon, follow their recommendations on the choice of the facility. Good luck!

Choice of location for your surgery

Accredited ambulatory operating facilities adhere to rigorous standard and guidelines, and have routine inspections.  They are extremely safe. For a surgeon to say that they are not safe is not only incorrect, but does a disservice to all plastic surgeons everywhere.  This is dangerous misinformation to say the least. In addition, for him/her to compare it to the Joan Rivers situation is equally distasteful. It is unlikely that your surgeon has any real knowledge about what happened in that case, aside from what has been published in the papers. And, if he/she does have real knowledge about what happened, he/she should not be discussing it with people as this is a direct violation of patient privacy (which continues after death and forever). I would look very closely at where your surgeon is permitted to operate. Most of us operate in both hospitals AND ambulatory facilities, so we understand the pros and cons of each and can help someone make the best decision for them. I am willing to bet that your surgeon may only be permitted to work in a hospital, and therefore, saying that ambulatory surgery centers are unsafe is self-serving. Sorry for the rant, but for any surgeon to spread misinformation is extremely dangerous and needs clarification.

Out of hospital surgical facility safe

In Ontario, Canada, accreditation for out-of-hospital surgical facilities are strictly governed by the College of Physicians and Surgeons of Ontario, the governing body for all licensed doctors and surgeons in the province. Standards are equivalent to those that a hospital must meet, and are sometimes even stricter. The primary difference is that a hospital may be more equipped in the event a complication occurs during surgery, but such complications are relatively rare. The choice is ultimately yours, but I would ask your surgeon why s/he considers out-of-hospital facilities “not safe” for clarification.

Accredited Surgery Center vs A Hospital For Cosmetic Surgery

In my opinion, Outpatient Surgery Centers that are accredited and have board certified anesthesiologist on staff can be just as safe as a hospital.

I prefer outpatient surgery centers for cosmetic procedures for a variety of reasons.  First, the cost is much lower for the patient.  Second, the staff are specifically trained in outpatient procedures.  Third, there usually aren't really sick people with bad infections at these facilities.  The third factor is so important when doing elective procedures and putting in implants.  

I would suggest having another consultation or two with other board certified plastic surgeons in your area.

Choosing a surgical center over a hospital...

The doctor that told you that probably doesn't have his own surgical center because it is a completely false statement to say that an accredited surgical facility is not safe. In fact many have better safety records than the hospital. The key is to know the details of the accreditation and the record of the surgeon performing there. The AAAHC has a long history of accrediting facilities and making sure they are safe. A center that is Medicare certified has to meet rigorous safety standards and is even better. Make sure your surgeon does have surgical privileges at a local hospital to perform the same procedures - that way you know the hospital has done significant research to ensure the surgeon is qualified.


I performed all of my surgery at a AAAASF facility which means that it has a "mini-hospital" designation.  My facility is inspected several times per year to make sure that it is meeting standards and code.

The Joan Rivers incident occurred for a whole other set of circumstances, not because of the facility it was performed at.

Be sure to discuss in detail with your board certified Plastic Surgeon.

Best wishes,

Dr. Desai
Harvard educated, Beverly Hills & Miami Beach Trained Double Board Certified Plastic Surgeon

Which is Better for Breast augmentation...Accredited Surgery Center or Hospital?

Being accredited means that the facility has met with strict standards of safety. You will find, depending on your surgeon, different preferences. I have my own accredited surgery center and my patients appreciate the privacy it offers plus with only cosmetic patients coming through, there is less exposure for infections. My staff is trained by me and we have the advantage of working together all the time, not who ever happens to be on the schedule for that day. Get more than one consultation with Board Certified Plastic Surgeons, and choose who you feel comfortable with. Good luck!

Miguel Delgado, MD
San Francisco Plastic Surgeon
4.8 out of 5 stars 63 reviews

Location for Breast Augmentation


There can be pros and cons to either setting but if properly accredited, safety is not in question. I operate out of both and Work with highly skilled and experienced staff at either location. Many patients find the private clinic to feel more private and comfortable but the procedure and protocols are the same.

I recommend that you research your chosen surgeon and their practice, then make the choice that you are most comfortable with.

All the best

What is best for breast augmentation surgery? Accredited facility or hospital?

An accredited surgical facility certifies that the operating facilty complies with all safety standards and is a very   common type of facility used throught the country for cosmetic surgery. In my practice the vast majority of cosmetic procedures are performed in my AAAASF certified facility. The hospital is certainly another choice although the fees are highre. Ultimately you must be comfortable with your surgeon. Good luck!

George Lefkovits, MD
New York Plastic Surgeon
3.8 out of 5 stars 45 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.