Dr. Richard Moss, Boston breast enlargement expert has 27 years experience with breast augmentation and has some definite ideas as to what offers great value and what does not. “First and foremost I feel that a patient interested in breast augmentation surgery needs to select a physician who is board certified in Plastic Surgery for her breast augmentation surgery. Plastic Surgery residency programs are the only residency programs that train surgeons in breast augmentation surgery.”

Patient before incision	Sizer for stretching breast

“Experience is another important factor,” Dr. Moss explains. “Not only do I have 27 years experience with breast augmentation, I also have almost 15 years experience implanting silicone gel breast implants. Many surgeons have experience that began only in 2006 when the newer style silicone gel breast implants received their FDA approval for sale in the United States. I have experience with the earlier models of silicone gel implants from the 1980’s and 1990’s as well as the newer models from 2006.”

“I have found that pricing is a factor that is very important to patients, more so than I would have thought. However, it is very important to know what exactly you are getting for the price you are paying,” Dr. Moss stresses. While the price we charge for breast augmentation is very competitive we offer much more than many patients realize when they first call.”

Besides the surgical fee, silicone gel implants, hospital fee, and anesthesia fee, Dr. Moss’ pricing includes quite a few additional items that provide for a more pleasant experience and can contribute to a better outcome. Dr. Moss, Boston, breast augmentation specialist explains, “The price quoted to the patient includes 2 bras as well as a state of the art pain suppression pump, and the Marcaine medication that is used in conjunction with this pump. Patients don’t have to worry about purchasing bras for surgery and my staff will assist them with proper fitting. In addition, the pain suppression pump that I utilize with my breast augmentation patients allows them greater post operative comfort and it most likely results in patients needing less pain medication the first night. We have definitely seen a difference in the amount of pain and discomfort that patients experience post operatively, when the pain suppression pump is used,” continues an enthusiastic Dr. Moss.

Breast sizer being inserted – left breast	Breast sizer with syringe attached for filling right breast

The other two items that Dr. Moss includes in his surgical fee is the use of 2 disposable breast implant “sizers” for the use of stretching the breast cavity to accept the pre-filled silicone gel implant and the Keller Funnel for the purpose of placing the gel implant into the breast cavity. The Keller Funnel prevents the silicone gel implant from touching the patient’s skin during placement as well as reducing stress on the implant during implant placement. The Keller Funnel also allows surgeons to use the same small incision for placement of silicone gel filled implants as for saline filled breast implants. Boston plastic surgeon Dr. Moss relays, “Most patients are unaware of the surgical challenges presented when trying to place a relatively large implant into a breast cavity. Unlike the saline filled breast implants which are implanted in a deflated form and then filled, the silicone gel filled implants are manufactured in a filled state and are therefore more challenging to implant.”

Patients easily understand the added benefits such as bras and a pain suppression pump. It can be more difficult for them to understand the benefits of surgical equipment that is utilized during a surgical procedure to make the procedure run more smoothly. For this reason, Dr. Moss has absorbed the cost of the breast implant “sizers” and the Keller Funnel in his surgical fee. He did not raise his price when he added these two items to his surgical regimen. “I feel that having the implant “sizers” and Keller Funnel available during surgery allows me to do a better job for the patient and also allows me to give her a greater selection of implant size choices,” states Dr. Moss.

Breast sizer being filled – right breast	Breast sizer being filled with more – right breast

Another benefit that Dr. Moss feels he offers patients is the extensive consultation that is initially provided. “I sit down with my patients and spend a full hour to review all of the pertinent information. I also examine every patient at her consultation. Plenty of time is allowed during this consultation to answer any questions a patient might have. I want a patient to leave her breast augmentation consultation, feeling confident that she has all the information to make a decision, and has had all her questions answered,” he further explains.

Another added benefit in choosing Dr. Moss for breast augmentation surgery is the breast implant sizing experience that is provided at both the initial consultation and the pre-operative visit. “A major factor in the success of a patient’s breast augmentation surgery is the size selection of the breast implant,” states Boston breast augmentation expert, Dr. Moss. “This relies on a patient’s input and I have found that the best way to assist a patient in selecting the size is to allow her to try breast implant samples on with a sizing bra. In my experience this provides for a much happier patient than me trying to guess what she thinks she wants,” he further elaborates. “There is no standard in the bra industry and many patients already own different size bras, so trying to guess what size a patient wants based on a bra size can be problematic. I avoid these problems by allowing time for breast implant sizings, supervised by my competent staff.”

Breast sizer – right breast filled	Both breasts with implant sizers filled

Breast Augmentation surgery continues to be the most popular cosmetic surgery procedure. There are many factors that a patient should consider when selecting a plastic surgeon. While pricing is important, it is also essential to choose a plastic surgeon that has experience, an excellent reputation, and provides the necessary time to explain the procedure properly. If you are interested in breast augmentation surgery call Dr. Moss’ office at 508-747-1322 or 781-337-2421 and inquire about a consultation with Dr. Moss.

Keller Funnel out of packaging	Trimming the Keller Funnel to accept the implant size

“Regardless of how much experience one has with silicone gel implants it always is a bit of a struggle to get the implant in.” Dr. Moss further elaborates. “And the larger the implant, the more of a struggle it can be to push it through a small incision.” Dr. Moss knew the minute he saw the Keller Funnel for the first time that he wanted to try it.

Pouring breast implant into Keller Funnel	Keller Funnel with implant loaded

“I loved it the first time I tried it.” It turns out that there are more benefits than just an easier surgery. With time, the Keller Funnel is being thought of as not only better for the surgeon, but also better for the patient. The Keller Funnel allows the surgeon to insert a silicone gel implant through a smaller incision which all patients like. Because it allows for easier insertion, it limits stress to the shell of the breast implants. Boston plastic surgeon Dr. Moss believes that the Keller Funnel also may reduce trauma to the patient tissue because there is less of a struggle to insert the implant. And lastly it allows the implant to be implanted without it touching either the surgeon’s surgical gloves or patient’s skin. This is considered excellent surgical technique, and it is thought by many, that this feature may reduce the chance of either infection or capsular contraction.

Implant positioned in funnel	Keller Funnel being placed into incision – right breast

So what does the Keller Funnel look like? “Sometimes the simplest tool can provide the greatest solution for a difficult task,” says Dr. Moss, Boston Breast Augmentation specialist. The Keller Funnel looks like a pastry funnel. It is made of nylon and is coated with a patented material called LubriLAST™. The effectiveness of the Keller Funnel is due to the combination of design elements including the LubriLAST™ coating. LubriLAST™ is a water activated lubricious coating that makes the breast implant slide very easily through the opening in the smaller end of the Keller Funnel into the breast implant pocket.

Keller Funnel introducing breast implant into the left breast	Keller Funnel squeezing to introduce implant

Dr. Moss determined that after a few surgeries with the Keller Funnel, that it provided such an advantage that he currently uses it for all silicone gel implants of at least 300cc. Even though the Keller Funnel costs $130 each he has decided to use it without charging the patient any additional fees. “Sometimes you know something is just better for the patient and you can’t always expect the patient to thoroughly understand surgical technique. If I made it optional some patients might not want to pay the extra $130. At the same time, I understand that in this economy some patients might find the extra $130 difficult for them to afford. For these reasons I just decided to use the Keller Funnel whenever I wanted and not to pass the cost on to the patient,” Dr. Moss explains. “I think that this has been a wise choice.”

Both implants in position – last layer of closure	Surgery finished – bra in place

Dr. Moss always takes the time to explain the Keller Funnel to all of his breast augmentation patients who are considering breast augmentation with silicone gel implants.

This picture shows a patient who has Mondor’s disease. The patient had her breast augmentation approximately 2 weeks earlier.

After examining the patient, Dr. Moss usually comments, “What you have is Mondor’s disease.” While this sounds serious and ominous, Mondor’s disease, when associated with breast augmentation is usually self limiting and resolves on it own. “So what exactly is Mondor’s disease?” many patients ask. Dr. Moss will respond that “Mondor’s disease is a benign condition. Most patients,” he continues, “present with inflammation or thrombphlebitis of the veins in the breast area, usually just below the inframammary crease when it is associated with breast augmentation surgery. At first the vein or veins are tender and then they become asymptomatic and ultimately disappear.” It should be noted that these cord like structures are more evident when a patient lifts her breast upward or applies traction to the area. In fact, it is not uncommon for Dr. Moss to notice the visual symptoms of Mondor’s disease when he examines a breast augmentation patient and realize that the patient has felt nothing and is unaware that she has Mondor’s Disease. Dr. Moss always reassures patients that they need not worry and the situation will resolve on its own. “My wife, Carla had it when she had breast augmentation surgery and it resolved on its own with no problem,” he further elaborates.

“What patients may not be aware of is that all competent plastic surgeons are always emphasizing patient safety throughout a patient’s entire surgical experience. From the first phone call a patient makes requesting information about a consultation to the last appointment before patient discharge (sometimes a year after surgery) I, like many of my colleagues, always have a patient’s safety foremost on my mind. Patients are not necessarily aware of the many decisions that are made concerning patient safety unless it becomes an issue. For example I will not bring up the maximum amount of surgery a patient can have at one time unless it becomes an issue. This type of safety issue will be discussed only with a patient who is attempting to have too many procedures at once,” Dr. Moss elaborates.

Dr. Moss’ staff inquires about a patient’s medical history during the initial contact, prior to setting up an appointment.

There are many topics that are related to patient safety. Some are specific to a surgeon’s training and competence and others are related to a patient’s individual situation and choices that she/he might make. The following is an overview that should put patients at ease with Dr. Moss and his attention to detail when it involves patient safety.

Medical Licensure: Any physician in practice must have a license to practice medicine. What many people do not realize is that licenses to practice medicine are issued at the state not the federal level. Therefore any information on a physician such as malpractice claims would be provided by the state that the physician practices in and not by any federal agency. Dr. Moss holds an active medical license in the state of Massachusetts. In Massachusetts the licensing board for medical doctors is the Commonwealth of Massachusetts Board of Registration in Medicine. Their website is: http://www.massmedboard.org/.

You may view information concerning Dr. Moss at this website. Dr. Moss has never had a malpractice judgment against him during his 26 years in practice. He also has no outstanding malpractice claims against him. “I attribute my excellent track record to many things, including close attention to patient safety,” states Dr. Moss. “In addition I always inform my patients fully before they make any decision to proceed with surgery. And obviously I always try to obtain the surgical result that was anticipated.” For a direct link to the information on Dr. Moss provided by the Commonwealth of Massachusetts Board of Registration in Medicine please go to: http://profiles.massmedboard.org/MA-Physician-Profile-View-Doctor.asp?ID=26890

Board Certification in Plastic Surgery: This is not only one of the most talked about issues in cosmetic surgery but also one of the most misunderstood issues in cosmetic surgery. Most patients have no idea what “board certification” really means. First and foremost patients need to understand that there is no such thing as “board certification in cosmetic surgery.” Secondly, any physician can legally call himself/herself a “plastic surgeon” and not actually be “board certified in plastic surgery.”

The American Board of Medical Specialties is the official organization in the United States under which the individual specialties are organized. The following is a paragraph from their website explaining who they are:

Established in 1933, the American Board of Medical Specialties (ABMS), a not-for-profit organization comprising 24 medical specialty Member Boards, is the pre-eminent entity overseeing the certification of physician specialists in the United States. The primary function of ABMS is to assist its Member Boards in developing and implementing educational and professional standards to evaluate and certify physician specialists. By participating in these initiatives, ABMS also serves as a unique and highly influential voice in the healthcare industry, bringing focus and rigor to issues involving specialization and certification in medicine. ABMS is a designated primary equivalent source of credential information.

For more important information about this organization please go to: http://www.abms.org/

There are only three specialties that receive the required training to perform “cosmetic surgery.” Plastic surgery is one of the three and is the only board specialty to provide the required training for cosmetic surgery of the breasts and body as well as for facial cosmetic surgery. Board certification in plastic surgery is provided by The American Board of Plastic Surgery. For more information on the certification process and the rigorous training required please visit their website at: https://www.abplsurg.org/.

How do I find a board certified plastic surgeon? Board certified plastic surgeons belong to The American Society of Plastic Surgeons. This society provides each member with information on the continuing education that is required and also offers website locations where prospective patients can search for qualified plastic surgeons. Many of the courses provided for plastic surgeons by The American Society of Plastic Surgeons, involve topics specific to patient safety. In addition, to remain an active member of The American Society of Plastic Surgeons, members must earn a certain number of their continuing medical education (CME’s) credits in patient safety. The website of The American Society of Plastic Surgeons is http://www.plasticsurgery.org/. This website provides a listing of all board certified plastic surgeons who are members of this society. To view Dr. Moss website page on this website please go to http://www1.plasticsurgery.org/ebusiness4/md/DRMOSSCOSMETIC.aspx.

This is Dr. Moss’ page on the American Society of Plastic Surgeon’s (ASPS) website.

It should be noted that The American Society of Plastic Surgeons stresses patient safety at all times. Unfortunately there are surgeons who are not properly trained in cosmetic surgery, yet desire to perform cosmetic surgery. This has caused problems that the public attributes to the cosmetic procedure rather than the real problem which is the surgeon is not properly trained. It is important to note than some of the “famous television personalities” who are leading viewers to believe that they are “board certified in plastic surgery” have not receive certification in this specialty. The other two specialties that receive the required training for some or all of the facial cosmetic surgery procedures are “facial plastic surgery, (a subspecialty of otolaryngology)” and “ocular plastic surgery (a subspecialty of ophthalmology).”

Now that we have provided our readers with sufficient information on licensure, training and credentialing, it is important to discuss with potential patients how we protect their safety once they have arrived at Dr. Moss’ office.

Medical History: This is of utmost importance for the patient who has any medical problems. Your medical history is reviewed many times before your surgery.

1. Prior to scheduling an appointment; Dr. Moss’ staff will ask you if you have any medical problems and what medications you are currently taking.

2. At your initial consultation; you will be asked to complete a medical history form. Dr. Moss will review this with you. If your medical condition requires a medical clearance from your primary care physician or some other medical specialist Dr. Moss will explain to you what is necessary and Dr. Moss’ staff will assist you in obtaining the necessary clearance(s).

3. When Dr. Moss fills out your history and physical form for the hospital; Dr. Moss again reviews your medical history to determine if all the necessary clearances, tests and information are in order.

4. At your pre-operative visit; Again Dr. Moss and staff review your medical history to confirm all the necessary paperwork and instructions are complete and patient is “set for surgery.”

5. At your anesthesia pre-operative visit (or anesthesia telephone pre-test), the anesthesia staff and nurses will ask all the necessary questions and review all of the paperwork faxed from Dr. Moss’ office to ensure that the patient is “set for anesthesia.”

6. The morning of surgery Dr. Moss, the anesthesiologist, and nursing staff will review patient’s medical history to ensure that patient’s surgery and care will be provided in the safest possible manner.

7. During surgery; Anesthesia and the surgery itself is performed keeping in mind at all times any pre-existing medical conditions.

8. Post-operative care; From the recovery room to and including all of your post-operative appointments, care will be provided in a manner that takes into account your previous medical history. This might include restarting medications patients are already taking or adjusting diabetic medication to account for reduced eating patterns after surgery.

Medical Clearances: Dr. Moss may ask that you get a medical clearance (or any other relevant clearance) before your surgery. You may also need testing such as an EKG, lab work or other relevant tests performed in order to obtain these clearances. All of these clearances and tests are provided to all physicians (including anesthesia) and hospital operating room staff in advance of your surgery to assure you receive the highest level of care and safety.

Carla always assists Dr. Moss and patients in obtaining the appropriate medical clearances.

Some other examples of medical clearances that might be required are the following:

1. Endocrinology clearance for a patient who has diabetes

2. Neurological clearance for a patient who has multiple sclerosis

3. Cardiology clearance for patient who has a cardiac condition

4. Hematology clearance for a patient who has blood disorders

5. General surgical clearance for an abdominoplasty patient who has a pre-existing hernia

6. General surgical breast clearance for a breast augmentation patient who has potential issues for breast cancer

Dr. Moss will always speak with a patient’s primary care physician or other specialist whenever it is necessary, in order to ensure a patient’s safety during surgery.

Pre-operative Tests: Some patients will need specific tests before having their cosmetic surgical procedure. These tests are sometimes ordered to eliminate “surprises” during the cosmetic surgical procedure or to rule out problems that could result in a patient having her cosmetic surgery result compromised at a later date due to existing medical problems. Some of these tests may be performed to ensure that the patient can safely undergo anesthesia. Examples of tests that might be needed:

1. Mammogram is required for all women ages 40 and older who would like to have any cosmetic breast procedure such as breast augmentation or maxtopexy (breast lift). This is done to preclude any possible issues such as breast cancer before cosmetic surgery is performed.

2. CAT scan of the abdomen to rule out hernia. If Dr. Moss discovers a possible abdominal hernia during his initial examination of the patient, he will require the patient to have a CAT scan to rule out an existing hernia. If the patient does have a hernia this may need to be repaired prior to abdominoplasty surgery.

3. EKG: All patients 50 years of age and older are required to have an EKG to ensure that their heart can safely undergo anesthesia. If the patient is younger than 50 but has cardiac issues then she will also be required to have an EKG.

Psychological issues related to Cosmetic Surgery: Most of the information above has dealt with medical issues. However, for positive outcomes to be obtained, cosmetic surgery more than any other surgery requires that the patient be appropriate from a psychological standpoint and that the surgery selected be appropriate. Dr. Moss states, “It is so important with any cosmetic surgery procedure that the patient is well informed and is making the decision to go forward for the right reasons. Cosmetic surgery is totally elective, we are not saving lives, and therefore as healthcare providers we need to do what we can to ensure that these surgeries are in the patient’s best interest.” So what is done in Dr. Moss’ office helps ensure that from a psychological standpoint the patient is making an informed decision?

Dr. Moss’ medical history intake form specifically asks if the patient has been under psychiatric care over the last 5 years and if the patient is taking any medication such as anti-depressants or anti anxiety medication. If the answer is yes then Dr. Moss will ask the treating physician or therapist for a clearance. Dr. Moss will always dictate a letter to the treating provider explaining what the planned surgery is and what he is requiring to proceed with surgery. In the vast majority of situations Dr. Moss receives clearances of this nature and can proceed with the desired surgery.

Dr. Moss and his staff members are always assessing patients for any signs that cosmetic surgery is not in the patient’s best interest. If a patient seems unable to focus on the information presented or seems unaccepting of potential complications, Dr. Moss would suggest deferring any elective procedures until a later date. Patient compliance is another important issue that needs to be in place. While a non compliant patient may simply be aggravating to staff and physician before surgery, she/he could present issues of safety once surgery has been performed. Therefore it is always important that patients who are planning to undergo cosmetic surgery follow instructions that are presented to them before surgery.

Another aspect to the psychological well being of cosmetic surgery patients is that the patient has realistic goals, having the surgery for the right reasons, and is not undergoing an unreasonable amount of stress over other issues. An example of a poor reason to have cosmetic surgery such as breast augmentation would be to solve marital problems or “hold on to my man”. The last thing a woman needs who is undergoing this type of stress is more decisions to make and the stress of surgery and subsequent recovery. Dr. Moss would recommend that this patient resolve her other issues and then decide “she want to have breast augmentation to please herself.”

Informed Consent: Another issue involving patient safety is that of giving the patient sufficient information to make an informed consent. A patient needs to understand what risks a surgery involves before she/he makes the decision to have elective surgery. “There is no such thing as “risk free” surgery and a patient has to be accepting of that before I will perform surgery on them,” states Dr. Moss. I spend at least thirty minutes with every patient during consultation and for some surgeries that are more intricate the consultation takes at least an hour. Consultations on multiple procedures take at least one hour as there is more information to provide patients. The subject of complications is also discussed in great detail with each patient prior to their making any decision to have surgery. “While I feel that my complication rate is very low, I spend a large amount of time reviewing potential complications which each patient,” states Dr. Moss. “That way every patient can be making a well informed decision as to whether or not to proceed with surgery,” he further elaborates.

During your pre-operative visit Carla will review many of the pre and post operative instructions. All patients then meet with Dr. Moss to review the goals of the surgery, have pre-operative pictures taken. Dr. Moss will also examine the patient as well as answer any remaining questions that a patient might have. Prescriptions are also provided at the pre-operative visit.

Patient Instructions: Additionally all patients need to be given sufficient instructions to be followed both pre-operatively and post-operatively. Dr. Moss’ patients should plan on spending at least one hour in his office for all pre-operative visits. The following is a summary of what is covered in a pre-operative visit at Dr. Moss’ office to ensure a patient is “Safe for surgery.”

1. All consent forms are reviewed and signed

2. All prescriptions are given to the patient. Both oral and written instructions for these medications are provided

3. Two full pages of pre-operative instructions and post-operative instructions are provided to the patient. All of these instructions are reviewed with the patient by Dr. Moss’ staff and a written copy is provided to the patient

4. Dr. Moss sees all patients to “review the goals of the surgery,” take pre-operative photos, examine the patient and answer any questions the patient might have. If the patient is on prescription medication for other reasons a review of those medications will be done by Dr. Moss.

Dr. Moss examines all patients at their pre-operative visit. In some instances he also performs pre-operative testing. This picture demonstrates the Shirmer’s test, which is a test performed to determine that a patient produces enough tearing.

Dr. Moss always takes a patient’s pre-operative pictures at the pre-operative visit. These pictures allow a patient to compare their post operative result to what they looked like before. Dr. Moss will provide all patients with a copy of their pre and post operative pictures when they have achieved their final result, usually somewhere between six to twelve months.

Patient Safety during the surgical procedure: Dr. Moss performs all of his surgery himself. While he will have available all the necessary help such as surgical scrub technologists, nurses and surgical assistants, the actual surgery itself is always performed by Dr. Moss. In addition all of the anesthesiologists are “Board Certified” in anesthesia. Patients should also be aware that The American Society of Anesthesiologists undertook a massive effort in 1985 to greatly improve the safety of anesthesia. The number of problems with anesthesia has dropped precipitously since then. Dr. Moss will provide a patient with access to an anesthesiologist who wishes to discuss their surgery prior to making the decision to have surgery. In addition, they can visit the website of the American Society of Anesthesiologists at www.asahq.org.

Dr. Moss performs all of his surgeries at accredited facilities. Dr. Moss always performs all of his surgeries.

Post-Operative Care: Dr. Moss provides the “Gold Standard of Care” when it comes to post-operative care. Like all surgeons he provides 24/7 care postoperatively to all of his patients. Surgeries are scheduled so that all patients should be getting all of their postoperative care by him. When he his out of town another “Board Certified” Plastic Surgeon covers for him.

Dr. Moss is readily available to his postoperative patients for any questions and be seen even for non-scheduled appointments. All patients are seen the day after their discharge from the hospital even if that day is a Sunday or holiday. This allows Dr. Moss to closely examine all surgical sites and for patients to ask any questions.

Occasionally patients will telephone Dr. Moss’ office with a question of some sort and then ask “Is this normal?” In situations like this Dr. Moss will always want to examine the patient rather than diagnose or treat over the phone. “While almost all of these situations are quite normal, I can only be sure after an actual examination,” states Dr. Moss. “Diagnosing and treating over the phone can lead to problems that otherwise could be avoided by performing a medical examination on the patient. I would rather err on the side of safety rather than risk missing something important. I would much rather come in even if it is a Sunday, than worry about a patient’s condition. We never charge the patient for any of these extra visits.” Dr. Moss and staff find that most patients appreciate Dr. Moss’ availability and desire to put them at ease.

Hospital or Surgical Facility: Another important aspect of patient safety is the facility(s) where the surgery takes place. Dr. Moss operates at three local hospitals all of which are accredited by The Joint Commission on Accreditation of Health Care Organizations also known as JCAHO. To visit the website of JCAHO please go to http://www.jointcommission.org/. There is a section devoted to “patient safety” on this website which can be readily accessed from their homepage. Any plastic surgeon who is “board certified” in plastic surgery can operate only in facilities that are accredited when anesthesia is administered. This is true whether it is a facility within a doctor’s office or a hospital. Dr. Moss has chosen to operate at local hospitals rather than in his office because he found that it was more economical to the patient to have these surgeries in a local hospital than building an operative suite within his office. In addition, the hospitals all have overnight capabilities for those surgical patients who require an overnight stay before being discharged.

Day Surgery or Overnight Stay: Another issue that involves patient safety is whether or not to admit the patient for an overnight stay. Dr. Moss admits almost all abdominoplasty patients for an overnight stay. With lesser surgeries such as breast augmentation, rhinoplasty or liposuction he will usually discharge the patient the same day of surgery. Dr. Moss takes into account the length of time of the surgical procedure(s), the invasiveness of the actual procedure(s) and the overall health of the patient when he makes his decision whether or not to admit the patient or not for an overnight stay. Dr. Moss is usually able to tell the patient in advance as to whether or not an overnight will be required. In addition, he always has the option of admitting the patient overnight after the surgery has been performed if this seems to be in the best interest of the patient. While very few patients are unexpectedly admitted overnight, the decision as to when a patient is discharged from the hospital is always made when the patient is ready for discharge and patient safety is always a priority.

How Much Surgery is Too Much? First let us tell our readers that when a patient calls and wants everything done and can’t prioritize “what bothers them the most” Dr. Moss’ staff informs them that “they are not yet ready for a consultation.” Massive weight loss, pregnancy, and the aging process all can result in the patient needing multiple procedures. However, the first step that needs to be achieved before even a consultation can be planned is that the patient needs to be able to communicate to staff and doctor “what bothers her the most.” Dr. Moss always lets patients know, “I operate on patients to make them happy. Therefore, I need to know what bothers them, not me. Certainly, I will let them know what surgical procedure will address their concerns or if I feel their goals are unrealistic. But the need should always come from the patient. Occasionally, I or my staff will point something out to a patient if we feel at there is some cosmetic surgery that they should consider that they have not brought up. An example of this is that some patients who consult with me for a rhinoplasty also have a recessed chin and need a chin implant as well to achieve a more proportioned appearance.”

There are many factors that are considered when multiple surgeries are planned at one time.

1. The length of time of each individual procedure: It is easier to combine 2 smaller procedures than 2 large procedures.

2. The location of each procedure being considered: Often times it is best to stage procedures at or near the same place on the face or body at two separate times. Examples of 2 surgeries that Dr. Moss likes to do at separate times would be breast lift and breast augmentation or brow lift and upper lid blepharoplasty (eye lid lift). This provides a more predictable result.

3. The health and age of the patient: The healthier the patient, the more likely that Dr. Moss will consider combining procedures. The patient’s medical history is more important than her/his age although age is a factor considered.

4. Weight: The closer a patient is to her/his ideal weight the more likely it is that Dr. Moss will combine procedures. Likewise, the more overweight or obese a patient is the less likely it is that he will combine procedures.

5. A willingness to stay overnight: Sometimes Dr. Moss will consider combining cosmetic procedures that he would individually perform on an outpatient basis, however if performed together he would require the patient spend the night in the hospital.

Another issue that always needs to be considered when a patient requests a consultation with Dr. Moss on multiple procedures is, “are these procedures being considered for the right reason?” Dr. Moss’ staff would be concerned if a patient calls and instead of focusing on one or two procedures is “all over the place” and in a period of five minutes has usually brought up half a dozen surgeries. These patients often present in an almost manic or depressed like state. In addition, these patients often bring up a multitude of personal problems and crisis currently taking place in their life. Cosmetic surgery in situations like this is not appropriate because it is for the wrong reasons and the end result is always a dissatisfied patient.

Cosmetic Surgery / Pregnancy, Childbirth, and Breast Feeding: Dr. Moss will not consider performing any cosmetic surgery procedure on a woman who is pregnant or breast feeding. The risks outweigh any possible benefits including unnecessarily exposing the fetus or infant to potentially harmful medications. Likewise he will not consider scheduling a patient for a cosmetic surgery procedure if she is actively trying to get pregnant.

It is not unusual for patients to call Dr. Moss’ office a few months after the birth of a child, looking to schedule a consultation for cosmetic surgery of the breasts and/or abdomen. The staff can usually hear the infant crying in the background. The mother often seems overwhelmed with both the care of her baby and the condition of her body. She often times is still carrying much of the weight gained during her pregnancy. While it is understandable that a mother of an infant would be looking for a “quick fix,” safety takes precedence in situations like this. The restoration of a mother’s body to pre-pregnancy appearance is not as easy as the Hollywood glossy tabloids like to make it appear.

As anxious as many mothers are to restore their bodies with cosmetic surgery, Dr. Moss requires mothers be at least six months from the birth of their baby for abdominoplasty surgery. For breast surgery Dr. Moss requires that mothers be at least six months from childbirth or breast feeding, whichever is the latest. These requirements provide for the safety of the patient.

Dr. Moss requires all women who would like to have cosmetic breast surgery such as breast augmentation to have stopped breast feeding for at least six months. If the patient did not breast feed the baby then she would have to wait six months from the time of childbirth. This is to ensure that the milk glands of the breast are not actively producing large amounts of breast milk. Dr. Moss’ office will schedule an appointment at around five months post partum or five months after she has stopped breast feeding, whichever comes last. “Quite frankly an examination and consultation is of little value until we can get an accurate picture of what her breasts are going to look like once they have stopped producing breast milk,” states Dr. Moss. “It is impossible for me to even make any size recommendations until we know what size her breasts eventually be, once the milk production has stopped. We will accommodate these women on my surgical schedule so that they can have their surgery as soon as it can safely be performed; however even preliminary evaluations cannot be made until at least five months after the breasts have stopped producing milk,” he further adds. For further information on this subject please go to another blog article of Dr. Moss’ at http://www.drmossthebeautyboss.com/blog/2007/10/breast-implant/cosmetic-surgery-in-boston-breast-implants-and-pregnancy/.

Abdominoplasty surgery, (also commonly referred to as tummy tuck) is another procedure that mothers flock to in an attempt to restore their bodies. Again all patients need to wait six months after having their baby(s) before having this surgery so that their body can return to its final post pregnancy condition before planning any cosmetic surgical procedure. It is also important for patient’s considering any type of cosmetic breast or body surgery to have lost as much pregnancy gained weight as possible before coming in for a consultation. “All patients will obtain their best result when they are at their ideal body weight; abdominoplasty and breast augmentation are no exceptions to this rule,” says Dr. Moss. It is also important that any patient considering an abdominoplasty who still wants to have additional children must realize that future pregnancies could undo all the results of an abdominoplasty. Therefore she might want to wait until she has had all of the children that she plans on having, before having an abdominoplasty. “A woman can safely get pregnant a year after having abdominoplasty surgery; however she may loose all of the benefits from her surgery,” states Dr. Moss. For more information on this subject please go to another blog article of Dr. Moss’ at http://www.drmossthebeautyboss.com/blog/2007/10/abdomioplasty-procedure/tummy-tuck-in-boston-abdominoplasty-and-pregnancy/.

Pulmonary Embolus: Although rare this is one potential complication that all surgeons are watchful for because it can be life threatening. A pulmonary embolus is a blood clot from another part of the body (usually an extremity such as the leg) that has travelled to the lung. It is treatable but it is life threatening. All of Dr. Moss’ patients are made aware of such a situation, the symptoms, and what she/he should do (phone 911). In over 26 years of practice as a plastic surgeon, Dr. Moss has had less than five patients develop a pulmonary embolus and all were successfully treated.

To help reduce the incidence of pulmonary embolus all hospitals now utilize “compression boots” during and after surgery. Patients are encouraged to ambulate after surgery as soon as is safely possible. There are situations where there can be a higher incidence of pulmonary embolus. The following are situations where a higher incidence of pulmonary embolus can occur and precautions may be taken:

1. The longer the surgery the greater the risk of pulmonary embolus. Therefore Dr. Moss will always consider an overnight stay for surgeries over five hours in length.

2. Patients who have a previous history of pulmonary embolus are more likely to have another.

3. Patients who have certain pre-existing blood disorders may be more prone to a pulmonary embolus.

4. Patients who smoke have a higher incidence of pulmonary embolus.

5. Patients who are obese have a greater incidence of pulmonary embolus.

6. Hormonal medication including birth control pills can increase the incidence of pulmonary embolus.

7. Patients with a previous diagnosis of cancer have a higher incidence of pulmonary embolus.

8. Older patients have a higher incidence of pulmonary embolus.

Smoking: It is a well known fact that smoking can interfere with the healing process. The nicotine interferes with the oxygen in the blood stream which is necessary for healing. Therefore, applying a nicotine patch within 2 weeks of surgery, in hopes of lessening or stopping smoking before surgery will not improve the postoperative healing process. What will help the healing process is to stop smoking entirely for two weeks or more before surgery.

Smoking can also affect the safety of anesthesia. This is due to the fact that smoking has a negative effect on the lungs. However, most healthy patients who smoke 1 pack or less per day less will be able to safely have cosmetic surgery with Dr. Moss. Dr. Moss is very reluctant to perform cosmetic surgery on a patient who smokes over 1 pack of cigarettes per day.

Smoking can interfere with the healing process. The healing process may be improved if the patient stops smoking for at least two weeks prior to surgery.

Alcohol and/or Substance Abuse: Dr. Moss would not consider performing any cosmetic procedure on a patient with an active addiction to either alcohol, narcotics or recreational drugs. These patients have enough to deal with without adding the stress of elective surgery to their life. In addition pain control would be extremely difficult.

Dr. Moss has experienced success in providing cosmetic surgery for patients who have recovered from either alcohol or narcotic addiction. The first requirement is that the patient be psychologically fit and appropriate for cosmetic surgery. Once that is established, the main issue is one of pain control. Past exposure to alcohol or narcotics makes pain control more difficult and requires a greater amount of narcotics. Dr. Moss always requires a consultation with an anesthesiologist at the hospital where the surgery is being performed for the purposes of planning post operative pain control. Anesthesiologists are the specialists in pain control and can safely monitor the larger amounts of narcotics that are required.

Dr. Moss also requires that the patient stay overnight in the hospital so that she/he has access to intravenous (IV) narcotics which are more effective than oral narcotics. In addition, the patient is required to be able to tolerate the pain and discomfort with only oral narcotics (no IV narcotics) for eight hours before she/he will be discharged from the hospital. This is to prevent the patient needing to return to the hospital for the purposes of reestablishing IV narcotics. Dr. Moss has found that with these procedures in place, he has been able to provide cosmetic surgery for many grateful patients. In addition these patients when screened properly have been some of the nicest patients in his practice.

What can you do to insure that you receive the highest level of care and safety? There are a few things that patients can do to increase the safety of their cosmetic procedures with either Dr. Moss or any other plastic surgeon.

1. Disclose all appropriate information accurately to any surgeon you are consulting with for cosmetic surgery.

2. Make sure that you have all of your questions answered in a way that you understand.

3. Listen to what your surgeon and staff tell you.

4. Confirm you surgeon’s credentials.

5. Follow preoperative and postoperative directions that are provided to you.

6. Keep all of you scheduled appointments to ensure proper follow-up.

7. Arrive on time for your appointments.

8. Be honest and forthright with your surgeon. Express any concerns that you have both before and after surgery.

For many breast augmentation patients, the 64 million dollar question is “What will my breasts look like the first time I see them after surgery?” Breast implants Boston expert, Richard A. Moss M.D., hears this question all the time. “And even if I don’t hear it, I make sure any breast implant patient is given the answer at both her consultation and her pre-operative visit,” Dr. Moss emphatically states.

When asked to elaborate, Dr. Moss continued, “All patients expect to see larger breasts after breast implant surgery. What most patients are not prepared for is the way they will look in the immediate post-operative period. That is, unless they have been properly counseled to expect what is clinically referred to as “superpole fullness.” This is a very normal post operative condition, where there is swelling in the upper portion of the breasts. In addition, the implants may not have settled yet to the bottom of the breasts.”

Before Breast Implants	3 Days After Breast Implants

The pre-surgical photo on the left shows a woman who before surgery wore a 36B bra. She chose 325 cc saline implants which were placed below the pectoral muscle. The post-surgical photo on the right shows her 3 days after the surgery. The swelling that is present in the upper portion of the breast is quite normal at this stage in the post-operative course. The swelling is caused by a number of factors. The main one is that the breast tissue has not yet stretched to accommodate the presence of the implant. Normal surgically induced tissue swelling and fluid collections also contribute to the swelling.

Dr. Moss continues, “I counsel patients that they will need to wait six months from the time of their surgery to receive their final result. I show all of my patients a series of pictures that demonstrates the healing process and what to expect concerning the appearance of their breasts over this six month period. I have found that unless I show patients photos of what to expect, they will inevitably become very concerned.”

Dr. Moss will also show many breast augmentation patients this series of photographs on their first post-operative visit. “I find that at this point in time, these pictures now have more meaning to many of my breast augmentation patients. It puts them at ease.”

Another subject that comes up in relationship to “superpole breast swelling” is the question, “Will I look funny or strange in my clothes immediately after surgery?” Dr. Moss’ wife, Carla, who has had breast implant surgery herself, is the one who usually answers this question for patients. “I assure patients that they will look fine in most clothing, even in the immediate post-operative phase. The one outfit that can be difficult is a bathing suit or a bikini. If a patient has the opportunity to have her surgery in the spring versus the summer and going to the beach is important to her, then I would encourage her to have her surgery in the spring. I also tell patients that are having their implants in the summer, that by wearing a tee shirt over their bathing suit, they will look very presentable. Of course we also counsel that no fresh post-operative surgical patient should be baking in the sun or exposing their wounds to the sun, as this would impede healing and cause the scars to be more prominent.”

This type of bathing suit would be difficult to wear during the first few months after breast implant surgery. Superpole fullness would be visible.

This type of clothing usually works well after breast augmentation surgery.

As time progresses patients will see that their breasts start to take on a much more normal appearance. The swelling subsides and the breast implants settle to the bottom of the breasts. Although a breast enlargement patient does not receive her final result for six months, she will often start to see changes in the second or third week, as the swelling starts to subside. At two months she will often notice her breasts have a much more natural appearance.

Before Implants	3 Days After	6 Weeks After	6 Months After

The third photo at 6 weeks shows the swelling has subsided, but it still present. The last photo shows her final result at 6 months. Dr. Moss reminds patients that with or without breast enlargement surgery, breasts will continue to sag with aging, and having breast implant surgery will not stop this process.

Another detail that Dr. Moss likes to counsel and reassure patients on is what a post operative augmented breast will feel like to the touch. “This can be another area that will concern a patient if she has not been adequately educated before surgery,” states Dr. Moss. “I let all patients know in advance that their breasts will be quite hard and will not feel natural. However, as the breasts stretch, they become much softer with time. This process also takes about 6 months.”

Dr. Moss finds that with appropriate counseling, most patients find that their breast enlargement recovery period is more pleasant than they expected. Knowing what to expect can go a long way in making a patient feel comfortable and secure.

Learn More About Breast Enlargement in Boston

• See Breast Implant Before and After Pictures
• Read Breast Augmentation Information on Our Web Site

MRI (Magnetic Resonance Imaging) uses magnets and radio waves instead of x-rays to produce very detailed, cross-sectional images of the body. This technology incorporates the use of computer software that processes the signals to generate these images, each of which shows a thin slice of the body. MRI studies do not expose patients to x-ray radiation.

Currently, MRI utilizing additional dedicated equipment called a breast coil is the test that physicians use to determine whether a silicone gel breast implant is intact or ruptured. The FDA recommends that patients have an MRI of their breasts 3 years from the time of surgery and then every two years after that. Although the rupture rate is not very high, if a breast implant has ruptured most women would want to replace it.

While most hospitals have MRI capability, few have the necessary technology required for breast imaging. Quincy Medical Center in conjunction with Alliance Imaging, Inc. is in the process of setting up their MRI equipment with a dedicated breast coil. Part of the set up included calibration of the equipment involving a patient who had silicone gel implants. Dr. Moss’ wife Carla, who has 200cc silicone gel implants, participated in this calibration. The following is a recap of her experience.

“I was delighted to be involved in the calibration of the new equipment for breast MRI. Since we may have patients who want to avail themselves of this test in the future, I find it advantageous to have experienced it personally. Having an MRI is not painful. While it does take about 30 minutes and involves lying on your stomach, you are able to move slightly in between the scan sequences. Most importantly, since you are lying on your stomach you are able to look up and out of the front of the MRI unit. Therefore, any sense of claustrophobia I might have had was essentially eliminated.”

This is a picture of Carla Moss lying on the MRI table. Her breasts are positioned in the breast coil which is anatomically designed to accommodate two breasts.

MRI’s of the breast are also used for detection of breast cancer. While breast MRI’s are not currently recommended for routine screening of patients who are not at increased risk for breast cancer, they are recommended as a screening test for women at high risk (greater than 20%) for breast cancer. It is recommended that women at moderately increased risk (15%-20%) discuss with their physicians the benefits and limitations of adding MRI screening to their yearly mammogram. The American Cancer Society classifies women at high risk as those with a strong family history of the disease or with a genetic mutation that predisposes them to breast cancer.

Whenever MRI’s are used for the screening of breast cancer the MRI is used as an adjunct to the mammogram, not as a replacement. An MRI is more sensitive (detects cancer more frequently) than a mammogram, however an MRI also has a higher level of false positives. This would mean that patients might have a higher number of unnecessary biopsies.

MRI tests are always read and interpreted by a radiologist. A radiologist is a physician who is trained to interpret many different types of imaging. He/she then dictates a written report that is provided to the physician who has ordered the MRI test. Radiologists who are involved in interpreting breast MRI’s receive training specific to this area of radiology.

This is an example of what an MRI looks like. The large oval in the breast is a 200cc silicone gel implant.

The radiologist who will be reading and interpreting the breast MRI’s at Quincy Medical Center is Dr. Nanci M. Mercer. Dr. Mercer received her MD degree from the Medical College of Pennsylvania. Her post-graduate training was at the Oakwood Healthcare System. She also completed two fellowship training programs as well. One was in Neuroradiology at William Beaumont Hospital and the second one was in Radiology at the University of Chicago. Dr. Mercer is also on staff at Boston Medical Center. Dr Mercer has been reading Breast MRI since 2004, and started Breast MR services at two hospitals prior to joining the BMC team last year.

Dr. Moss will be providing more information on the breast MRI capabilities at Quincy Medical Center once the department is able to schedule patients. Quincy Medical Center will be providing a comprehensive Breast MR service including state of the art vacuum assisted core biopsies under MR guidance. It is expected that patients will be able to be scheduled for breast MRI’s at Quincy Medical Center starting in either November or December, 2007.

Learn More About Breast Implant Surgery in Boston

• See Breast Implant Before and After Pictures
• Read Breast Augmentation Information on Our Web Site

During consultation, Boston breast augmentation surgeon, Richard A. Moss M.D. is often asked questions concerning breast implants and pregnancy. One group of patients is that of young women, who still have their child bearing years ahead. This group wants assurances that breast enhancement (another name for breast augmentation) surgery will not preclude their ability to have children and breast feed. The second group of patients is composed of women who have had children. These women are primarily looking to undo the unwanted after effects of pregnancy and breast feeding. Not only are they looking for advice from Dr. Moss on increasing the small size of their breasts, but some also have concerns about breast sag. As reality sets in their first question often is “How soon can I have breast augmentation surgery after child birth and breast feeding?”

The following are the answers that Dr. Moss provides his patients. Written by the doctor himself, the information is straight forward and realistic. Dr. Moss is known for his honest and sincere manner.

“Women often ask what effect breast augmentation will have on future pregnancies. Once someone has had breast implants there are no contraindications to future pregnancy, however there are certain facts and guidelines that patients should be aware of.

It is my recommendation that conception of a child should be delayed 6 months after breast augmentation surgery which will allow internal healing to occur. This will minimize the risk that the milk that naturally forms in the breast during pregnancy will not find its way into the implant cavity. Similarly, if a woman wants breast augmentation after having had a child, she should wait 6 months after cessation of breast feeding. Even if she did not breast feed, all milk production should have stopped. This means that all women who choose not to breast feed should wait six months after childbirth before having breast implant surgery. If there is persistent milk production, then OB/GYN consultation may be required.

I like to remind my patients that a significant number of all women cannot breast feed their babies. If after breast augmentation, they find that they cannot breast feed; this does not mean it was the result of breast augmentation surgery. Also there is no evidence that milk from an augmented breast is in anyway harmful to a newborn.

Often patients will ask me what effect pregnancy will have on the shape of breasts once they have been augmented. Before I discuss the effect of pregnancy on augmented breasts it is important that readers have an understanding of what pregnancy and breast feeding does to breasts in their natural state (without breast implants).

It is well known that pregnancy and breast feeding will have a profound effect on breast shape in all women. Unfortunately, the final effects that many women have after pregnancy and breast feeding are not positive ones. While these women may have enjoyed larger firmer breasts during pregnancy and breast feeding, they often find that after milk production has stopped, their breasts have a saggy and deflated appearance. In fact women, who breast feed as opposed to those who choose not to breast feed, may be left with breasts having a greater amount of sag (medically referred to as ptosis). In addition, the breasts of these women who have breast fed may also have a greater amount of deflation (flatness). Sometimes a woman will tell me that their baby(s) favored one breast over another and the favored breast will have a noticeable greater amount of sag or be of a slightly different size than the less favored breast. The nipple may also be in a more inferior position on the breast that was favored during breast feeding.

This patient has had children and breast fed. While she had virtually no sag, she also has very little volume to her breasts.

Breast augmentation surgery provided this patient with much more attractive breasts. Because her problem was one of volume and not sag, her end result is similar to that of women who have never had children and have no sag to their breasts.

This patient has had children but did not breast feed. She had a slight amount of sag and wanted more volume.

For this young woman near Boston, Breast implants gave her more volume and more attractive looking breasts. The implants however, did not lift her breasts.

It is also important to note that women with large breasts (in the range of D Cup or larger) will often complain that after pregnancy and breast feeding that their breasts are larger than before pregnancy. In many of these situations the cause of their problem is that they simply gained a large amount of weight and never lost it after pregnancy. Many women with naturally large breasts have a tendency towards weight gain. Conversely, many of the women with small breasts have fewer issues with weight gain. While this is not universally true, it is often the case.

The effect of implants (before pregnancy) will not make the changes of pregnancy better or worse, but these changes will occur. Breast implants will not prevent either the changes from pregnancy, breast feeding, or the natural changes in breast shape that come to all women as they grow older. Women should note that if their “perky” augmented breasts show signs of sag after pregnancy and/or breast feeding, or the simple process of aging, a mastopexy (breast lift) can always be considered. This is the same surgery that a woman without breast implants would consider if she wanted a correction to the sag in her breasts. While many women desire less sag to their breasts, not all will choose to have a breast lift. This is because the scars that result from a mastopexy (breast lift) are fairly extensive and much more visible than those of a breast augmentation.

This patient has never had children. She has no sag to her breasts.

After surgery this patient has no sag because she had none before surgery. She also has much more volume to her breasts from the breast implants. Please note however, future pregnancies, breast feedings, and/or aging could all cause her breasts to sag. It is impossible to predict whether or not any of these situations would cause her breasts to sag. Even if she did not have implants her breasts could sag due to pregnancy, breast feeding or aging.

Women (without implants) who are looking to have larger and/or more attractive breasts after pregnancy and breast feeding will often choose breast augmentation surgery. Breast implants, Boston women find, provide an excellent method of correct for breasts deflated from these conditions. However, when it comes to breast sag, I often find that I have to restrain a patient’s enthusiasm so that she has realistic expectations for her particular situation. Breast implants fill a woman’s breasts but they do not lift them. For some women this is all that is needed, particularly if the skin envelope of her breasts is fairly small. But for women with large, flat, and deflated pendulous breasts, both a mastopexy and breast augmentation may be what she needs to provide adequate correction. In almost all situations, I would perform these surgeries sequentially rather than together as I feel that I can provide a more accurate and predictable outcome.

Women who are left with two slightly different breasts after pregnancy and/or breast feeding often ask about different size implants. I tell them that different size implants are appropriate if in fact the difference is in the size of their breast. Often the difference is not so much size related but rather one of shape. One breast may sag more and therefore seem larger because it hangs lower. Or it may be that the nipple of one breast is lower than the nipple of the other breast. In these situations I would most likely place breast implants of equal size and evaluate the breast after six months for a possible breast lift. Generally I find that once the breasts are augmented the patient is satisfied and chooses to have no further surgery.

Often times during the initial examination of a patient’s breast, I will notice differences between the patient’s two breasts that the patient never noticed. I will always point out these differences because after breast implantation the patient may then notice these differences. We often find with our patients in Boston, breast implants can magnify differences and while I do not find that these differences bother most patients after surgery it is important that she be told in advance. Patients are much more accepting of imperfections if they realize that they were always there. They tend to look at these imperfections realistically. Very few people have perfect bodies and faces yet most of us are happy with ourselves. Cosmetic surgery including breast augmentation can improve a women’s breast but they may not make them perfect, especially if pregnancy and breast feeding have already been a part of her life.

I find that breast augmentation surgery is very popular and that my patients are very happy that they decided to proceed with surgery. I always suggest that they visit my website and then call for a consultation if they feel that they would like to further explore their options.”

Learn More About Breast Implant Surgery in Boston

• See Breast Implant Before and After Pictures
• Read Breast Augmentation Information on Our Web Site

Dr. Richard A. Moss, Boston Breast Augmentation expert explains the surgical procedures available to women who are considering cosmetic surgery for their breasts. For some residents of Boston, breast augmentation surgery is the surgery that will most likely address their needs. For others, a breast lift, commonly referred to as mastopexy will better help them achieve the desired goals. Dr. Moss also addresses what would be considered realistic goals and expectations for patients considering breast implantation surgery and breast lift surgery.

There are many ways to treat the patient who has breasts that are both deflated and saggy. The usual cause of this problem is pregnancy and/or breast feeding. It can also be caused by losing large amounts of weight. Dr. Moss approaches this common situation in a way that will address the patient’s needs and also let her undergo as much or as little surgery as she feels is necessary to get the result that she wants.

Women who are considering breast augmentation surgery should be aware that if they did not have cleavage before surgery they might not after breast augmentation surgery. If a woman’s breasts were close together before surgery, then she has a greater chance of cleavage after being implanted with breast implants.

The surgery that addresses the problem of deflated small breasts is called breast augmentation. It is also known by the terminology of breast enlargement, breast enhancement and clinically as augmentation mammaplasty. This surgery is also commonly performed on women who have never experienced any deflation of their breasts but nevertheless still want larger breasts.

Breast augmentation is currently the most popular cosmetic surgical procedure in the United States. In 2006 there were 329,000 breast augmentation surgeries performed in the United States.

Thin athletic women who have small breasts with little sag before surgery tend to have more fullness to the top of their breasts after surgery.

If a woman has a large amount of sag to her breasts it would be unrealistic for her to expect to have “perky” breasts after breast augmentation surgery.

One of the reasons that breast augmentation is so popular is that the surgery has a very high patient satisfaction rate. Most patients usually achieve the result they want. Another reason for the popularity of this surgery is that the scars are minimal. Dr. Moss performs breast augmentation from either an inframammary incision or a peri-areola incision. Neither of these incisions are very noticeable post-operatively.

Another factor that is increasing the popularity of breast augmentation surgery is the re-introduction of silicone gel breast implants. Boston cosmetic surgeon Dr. Moss was pleased when these implants received approval from the FDA in November 2006 for sale in the United States. Many women prefer the silicone gel implants because they are more natural feeling than the saline implants. Silicone gel implants account for about 90% of the breast implant sales in Europe and have for some time.

Many women who have breast augmentation surgery are hoping to achieve results that are proportional with their body. These women will often choose a smaller size implant.

The surgery that addresses the problem of breast sag (ptosis) is called a breast lift. The clinical term is mastopexy. A breast lift neither increases nor decreases the size of the breast but rather reduces the sag of the breast. The surgery addresses the sag of the breast from the lower portion of the breast. It also raises the position of the nipple. What a breast lift does not do is give the breast a lot of fullness on the top (superior position) of the breast.

Actual Boston Breast Lift Patient

Mastopexy Before and After

There are limiting factors to a breast lift. As discussed above a patient’s end result is not one of an appearance of “perky” breasts of an eighteen year old. Rather there is a reduction in the sag from the lower (inferior) position of the breast. Another limiting factor to a breast lift (mastopexy) is that it is not permanent. A woman who has had a breast lift may have a reoccurrence of breast sag (ptosis) later on in life. This would result in the surgery having to be performed again if the patient wanted the sag reduced.

Probably the most limiting factor in the popularity of breast lifts (mastopexy) is the scars that are left on the breasts. The scars resulting from a breast lift can be minimal or quite extensive (run under the entire length of the breast and also run around the nipple and then go vertically down to the inframammary crease). Therefore patients need to compare the improvement in the reduction of sag in relationship to the newly acquired scars. This is probably the main reason that the number of patients who undergo breast lifts is far less than the number who have breast augmentation surgery.

So what surgery(s) does a patient have if she perceives she has both problems? Does she have both surgeries (breast augmentation and breast lift) at the same time? In most situations Dr. Moss prefers to perform these surgeries sequentially rather than at the same time. The one exception is that if the patient has so much sag that her nipples are pointing down towards the floor (referred to as Grade III ptosis), then Dr. Moss will perform both surgeries at the same time.

In most instances Dr. Moss will ask the patient “what bothers you the most, the size of your breasts or the sag?” If it is the size of her breast then Dr. Moss will perform the breast augmentation surgery first, if not, then the mastopexy is done first. In Boston, Breast augmentation is usually what most women choose to have first.

Another reason that most women choose to have breast augmentation first is that many times they do not feel the need to have a breast lift after they have been augmented with breast implants. While breast implants do not “lift” the breasts per say, they do fill them out enough that most women do not want additional surgery. They often feel that the scars that would result from a breast lift would negate any improvement resulting from the lift. One of the main reasons that Dr. Moss prefers to wait on the breast lift (mastopexy) is that so many women prefer not to have the breast lift and therefore he can avoid putting unnecessary scars on their breasts.

Actual Boston Breast Augmentation Patient

This patient had a small amount of sag to her breast before surgery. However after breast enlargement she felt that her breasts were fine and opted not to have a breast lift. Picture same pt. breast aug before side

Mastopexy side profile before and after

There are other reasons that Dr. Moss prefers to perform breast augmentation and mastopexy surgeries separately rather than together. On a national basis the complication rate of these two surgeries performed together is higher than when they are performed separately. Some of these increased complications include infection, nipple malposition, loss of nipple sensation, and implant exposure. Dr. Moss has a very low complication rate for both surgeries and feels that the increased rate of complications makes it more desirable to perform the surgeries separately.

If a woman does want a lift after breast augmentation then Dr. Moss will often be able to accomplish this in his office with a local anesthetic. This is not as large a surgery as a breast augmentation and the recovery is usually easier. By having the surgery in the office, Dr. Moss can provide the patient a significant savings on the cost of the surgery. If the patient does want to have her breast lift surgery in the hospital under general anesthesia, Dr. Moss can accommodate the patient’s wishes.

Dr. Moss spends considerable time with patients, discussing the goals of their surgery. He finds that when a cosmetic surgery patient has an accurate understanding of what realistically can be achieved, the level of patient satisfaction increases dramatically.

Learn More About Breast Implant Surgery in Boston

• See Breast Implant Before and After Pictures
• Read Breast Augmentation Information on Our Web Site