Why Are Oral Surgeons Allowed to Do Breast Reduction Surgery?

In today's Seattle PI there is a story about a woman who is suing an oral surgeon for a botched breast reduction ("Oral Surgeon faces new suit").  The doctor also has a record of a cosmetic facial procedure that led to a death. How does this happen in the first place? The story says the doctor was not trained in plastic surgery.  Why isn't this against the law, or is it?

Doctor Answers 16

Consumers need to look for ABMS board certification

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Unfortunately there is no law in any state that restricts the scope of practice strictly to a physician's board certification. While there are some "pedigree" laws that require physicians disclose board certification, unfortunately few consumers understand or recognize the authenticity of board certification in the 28 member boards that are recognized by the American Board of Medical Specialities (ABMS) and the countless self-proclaimed and unrecognized board that provide nebulous credentials.

In the state of California for example, oral surgeons have long lobbied for legislation that would allow them the hospital privileges to perform procedures that are not formally including in oral surgery training programs, such as breast reduction or augmentation. This is a detriment to public safety and health, as no one would allow an internist, for example, privileges to perform neurosurgery.

The most important steps any consumer can take include: Verifying a physician's board certification by an ABMS member board; verify licensure and good standing with the state medical board or local courthouse; verify membership in good standing with specific ABMS specialty professional societies such as ASAPS and ASPS for plastic surgeons; verify hospital privileges for the procedure the surgeon recommends he/she will perform on you; ask to see photographs of the physician's own work for the procedure you plan to undergo; specifically ask about accreditation of surgical facilities and the qualification of anesthesia providers. When in doubt, don't take the chance.

Sad but true- look for certification by the American Board of Plastic Surgery

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As the popularity of plastic surgery has increased over the past several years, more and more providers are trying to get involved in the specialty of plastic surgery. These providers can range from spa personnel with no medical training, to physicians trained in non-plastic surgical specialties. Unfortunately, any licensed physician can call themselves a plastic surgeon, regardless of their lack of training in the field of plastic surgery. Certainly, it is in the patient's best interest to find a caregiver that is an expert in their field.

In the world of contemporary advertising, it is relatively easy for any physician to give the impression that he or she is qualified in plastic surgery. While "Board Certification" is an important credential that any patient should seek in their physician, a provider who is "Boarded" in another specialty, but not by the American Board of Plastic Surgery, can easily mislead the patient. It is easy to become confused by a statement that says a physician is a "Board Certified Plastic Surgeon" when in fact he or she has been certified by a non-plastic surgery board and has had no formal training in plastic surgery.

Becoming certified by the American Board of Plastic Surgery is a very difficult process. It is no wonder that some providers have not or can not achieve this goal. In order to be certified by the American Board of Plastic Surgery, a physician must, among other things:

1. Be properly licensed as an MD or DO
2. Undergo training programs in prerequisite surgery in addition to specific training in the field of plastic surgery, a total of which ranges between 5 and 10 or more years in length following medical school
3. Limit his or her practice to the field of plastic surgery
4. Undergo rigorous written examinations, as well as a multi-day oral examination which includes examination of the physician's practice
5. Practice in accordance with the strict ethical codes established by the American Board of Plastic Surgery
6. Provide evidence of ongoing continuing education in the field of plastic surgery

So what have other doctors done instead of becoming certified by the American Board of Plastic Surgery?

Aside from the misleading advertising practices listed above, some groups of physicians have created their own "Boards". One of these, American Board of Facial Plastic and Reconstructive Surgery, does require significant and proper training in the field of plastic surgery that is limited to the head and neck region. The majority of these physicians are originally trained in Ear, Nose, and Throat Surgery and have good and safe knowledge of this region of the body. Other Boards, such as the American Board of Cosmetic Surgery, accepts physicians that have had residency training in areas of medicine that do not even emphasize surgical practice.

So how can a patient be sure of their physician's training, ethics, and certification?

There are two important things to look for when evaluating a plastic surgeon. The first and most important is to figure out which Board has certified the doctor. A patient who finds that their doctor is certified by the American Board of Plastic Surgery can be assured that he or she has undergone the proper training in plastic surgery, passed the demanding plastic surgical examination process, and continued to practice with a very high level of ethical standards.

Secondly, patients should look for their provider to be a member of The American Society of Plastic Surgery (ASPS), which is the largest organizational and educational society of plastic surgeons who have been certified by the American Board of Plastic Surgery. All members of the American Society of Plastic Surgery are required to be certified by the American Board of Plastic Surgery. Additionally, physicians who belong to this organization have committed themselves to further interests of ongoing plastic surgery education, plastic surgery research, and patient safety in plastic surgery.

We (Plastic Surgeons) ask the same question....

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Confidence and trust are the two main requirements in choosing the right plastic surgeon. However, there is one very important factor that often gets missed when emotions are running high and the goal seems so close within reach! Many states do not have laws that protect the consumers from false or misleading advertising when it comes to choosing a plastic surgeon. Washington is one of those states. Within the medical community it is a well know fact that anyone with an active medical license may perform cosmetic procedures. Some of these procedures, such as Botox, Restylane and other fillers do not require that the physician be a surgeon. On the other hand, it is becoming increasingly more common that OB/GYN’s, Dermatologist’s, ENT’s, Oral Surgeon’s and General Surgeons are practicing the art of Plastic surgery. This movement is driven almost exclusively by the diminishing returns in serving the public based on medical reimbursements. As the cost of being a surgeon increases, and the reimbursements from insurance plunge, many surgeons are reaching out to one of the only venue that relies solely on cash returns…plastic surgery!

Since there are no laws in Washington that require such full disclosure, whose responsibility is it to keep you informed?...Well it’s yours of course. That may sound a bit unreasonable considering that you are choosing a medical professional. Why would you be responsible for such an important decision; it’s not like you would choose a plastic surgeon to perform brain surgery; you would depend on the medical community to identify the right surgeon for the job. Well it’s quite simple, most plastics surgical procedures are considered elective and are performed under the guideline that “beauty is in the eye of the beholder” and is governed mostly by combining art and science to provide an aesthetic result. Unfortunately, plastic surgery is not as protected by the same regulatory standards that protect other surgical fields.

Now that you know it’s up to you, the consumer, to sleuth out the truths and tails, let’s start with the basics. First off, all surgeons within good standing are board certified in something. It is up to you to ask what they are board certified in. For example: It is best to ask the question “are you certified by the American Board of Plastic Surgery (ASPS)?” rather than “are you board certified?”. This line of questioning should also be followed by the most important question of all…”do you have privileges to perform my cosmetic surgery at a local area hospital”. If the answer is “yes” then that individual has been recognized by that hospital’s regulatory committee as trained and qualified as a plastic surgeon. If the answer is “no” then it can be assured that the physician that you are considering has not completed the additional surgical education that qualifies him/her in this field, keeping in mind that just because they are not board certified in plastic surgery does not mean that they are not well qualified in their field of practice; in most cases, quite the opposite. But if it’s a plastic surgeon you are looking for than it is a plastic surgeon you should have.

We will continue to fight for better laws!

Best of luck,

Marshall T. Partington, MD FACS

It is an outrage

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There should be laws against doctors practicing surgery beyond their scope of training. An oral surgeon has no formal training in plastic surgery of the breast. As such, it is only ego and hubris that allows someone to think they can do this operation. Foolishly and naively, they are taking on a very challenging operation, one which has been a leading cause of lawsuits even against doctors properly trained in performing it.

Unfortunately, the law does not protect the public against these doctors as well as it should. Having a certificate from a weekend meeting makes these type of doctors believe they are adequately trained to do a new surgery. If the government tries to stop them they claim it is a restraint of trade infraction against them.

All of us learn new procedures and teach them as we practice plastic surgery over our careers. But these are variations on themes for which we have received extensive formal training. On the other hand, an oral surgeon has never had formal Board Certified training in plastic surgery and has no training at all in surgery of the breast. So it is totally outrageous.

One would think that there would be laws against this!

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This is a good question and there really is no answer.

Unfortunately, almost anyone can set up shop and unknowing patients fall victim to unscrupulous doctors (and non doctors). My best advice to you is to throughly research your doctors prior to seeing them. Go to the internet, message boards, talk to friend, etc. Also, look at your doctor's credentials. Do they have a board certification? Are they on the staff of a reputable hospital? Have they had any sanctions against them? If you are at their office, ask yourself why they are performing the surgery in their back room and not in a certified operating room. In this day and age, all of this information is available and you should use all of these tools so that you are an informed patient and not a victim.

I hope this is helpful.

David Shafer, MD
Shafer Palstic Srugery - New York City

Look for a doctor trained by the American Board of Plastic Surgery

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In America, there are many competing forces that act to influence which laws are passed: lobbyists from organizations, restraint of trade laws, etc. The lawmakers will simply not protect you from having any surgery done by any doctor or dentist, no matter how minimal their qualifications. By the time the Medical Board and malpractice attorneys have caught up with unqualified doctors, these doctors have often disfigured hundreds of patients over many years. I have seen the work of several such doctors, and they are often very slick advertisers. The one constant the patients have noted is that they had a bad feeling about the surgery but went ahead with it anyway.

Somebody who would go to an oral surgeon for a breast reduction surgery has not done their basic homework: to find a board certified plastic surgeon to do their work. Sadly, they have suffered the consequences.

As a comsumer, you can empower yourself by simply doing a little research on your doctor before going to the appointment. Are they board certified in plastic surgery? Go on the American Board of Plastic Surgery website, it only takes a second. Do they have hospital credentials? Call the hospital and confirm, it only takes a second. It is a good idea to meet with several surgeons before making your decision. Look at before and after pictures. Read the doctor's CV (resume). Where did he go to school? Where did he do his residency? Did his staff try to explain the options to you or hard sell you a surgery? The right doctor will be surprisingly easy to choose. If you have really done your homework and there are several fine surgeons to choose from, consider yourself lucky to have that problem, rather than to be in the dentist's office preop for a breast reduction.

If in doubt, do not proceed. As you can see from this post and others, this may be the most important decision of your life.

Brent Moelleken, MD
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 188 reviews

Don't ever let an oral surgeons do your breast reduction!!

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In America, doctors and dentists can do anything that a patient will let them. Unfortunately the result is often that patients receive surgery from doctors or other people that have no business doing these procedures.

In the United States, it is up to the patient to do their homework and pick a qualified doctor.
Here in Miami, we have unfortunately seen many patients who have suffered very serious competitions or even lost a breast because they received surgery from a physician that was not board-certified by the American Board of plastic surgery. Always keep in mind that your health must come first and remember that sometimes the cheapest surgeries often end up being the most costly.

Good question, but not a good answer.

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State license boards do not limit procedures to a license. This means that anyone can call themselves a "Cosmetic Surgeon", even an oral surgeon or dentist. You need to be educated as a consumer. You need to seek out the most qualified doctor to take care of you specific needs. You wouldn't have a neurosurgeon do your breast augmentation, just like you would not have your plastic surgeon do your brain surgery. I may have done brain surgery during my residency, but that doesn't make me qualified.

You should always seek out a Plastic Surgeon, who is board certified by the American Board of Plastic Surgery. They should also be a member of the American Society of Plastic Surgeons. Don't go to someone who claims to be board certified in Cosmetic Surgery. There is no such recognized board. Anyone with a medical license can send in some money and claim to be a board certified cosmetic surgeon without any training.

As a group, plastic surgeons have attempted to fight to limit dentist and other non qualified surgeons from performing plastic surgery. This is ongoing and consumers need to protect themselves.

Ask questions, and if you don't like the answer, go somewhere else.

It is a shame!

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The laws that regulate medicine in this country do not make much sense sometimes. Further they are made to satisfy a lobbyist with a big checkbook, not the patient. I agree with everything the questioner poses. A doctor should be trained and certified in the specialty that trains physicians to perform a certain procedure. Now there is certainly an overlap between specialities, for example - both plastic surgeons and ENT physicians are trained to perform rhinoplasties. But There is no reason that an oral surgeon should be performing anything other than oral surgery, unless he or she takes the requisite training to be a plastic surgeon.
From the patients perspective, become educated, look up your physicians record, their training and talk to their patients. Do your homework and you will be rewarded.

Breast Reduction - Why Are Oral Surgeons Allowed to Do Breast Reduction Surgery?

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Well, the answer is that they're probably not.

There is a huge issue with board certification, both in general and with respect to plastic surgery.  The bottom line is that nobody has ever defined exactly what a "plastic surgeon" is and what you have to do to be one...I advise patients to choose surgeons who are certified by a board that is recognized by the ABMS (the American Board of Medical Specialties, which is under the aegis of the AMA).  But do you see how complicated it is already?  The bottom line is that there are many problems in the world, and in this country, and the government has not seen fit to intervene adequately to establish standards in this regard.  Which leaves it to the individual patient to assess - caveat emptor (let the buyer beware).  Not comforting to say, and not happy to have to deal with - but that seems to be the way it is.  And I am, obviously, SO sorry for the patients involved in that story and, assuming it's accurate, devastated with the actions of the surgeon in question.

I hope that this helps, and good luck,

Dr. E

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.