“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

Read about Mammogram Requirements for Boston Cosmetic Breast Surgery. Information on how to get prepared for mammogram if you have breast implants.

Women age 40 and older should have a screening mammogram every year, and should continue so for as long as they are in good health.

Women at increased risk (due to family history, past breast cancer, etc.) should talk to their doctor about the benefits and limitations of starting mammograms when they are younger.

Dr. Moss’ mammogram requirements for cosmetic surgery of the breasts such as breast augmentation, breast lift, and breast reduction

All patients who are having cosmetic breast surgery, (breast augmentation, breast lift, or breast reduction) and are forty years of age or older, should have a current (within one year) mammogram. This is because all women forty years of age or older, should have a current mammogram to rule out breast cancer regardless of whether they want to have cosmetic breast surgery or not. Obviously, no surgeon or patient would want to proceed with a cosmetic procedure of the breast, without the standard screening tests being in order.

If a woman has a family history of breast cancer then her physician (primary care physician) may recommend that the mammogram screening start at an earlier age. If this is the case, then Dr. Moss would require a copy of this mammogram, before he would operate on her breasts. This again, is to insure that there are no problems that would preclude the patient having cosmetic breast surgery.

Dr. Moss’ requirements for consultations for cosmetic surgery of the breasts: Breast augmentation, breast lift, or breast reduction

Because Dr. Moss spends considerable time with patients during his consultations and most of these consultations are provided at no charge, Dr. Moss does require that the proper mammography screening be current before he will see a patient in consultation. It is as follows:

• If a woman is younger than forty with no family history of breast cancer, then Dr. Moss does not require a mammogram be performed prior to consultation.
• If a patient is forty or older and has had a mammogram within the last year then Dr. Moss would require a copy of this mammogram report prior to the patient’s consultation.
• If the patient is younger than forty and has had a prior mammogram then Dr. Moss would also require a copy of this mammogram report, prior to the patient’s consultation.
• If a patient is forty or older and does not have a current mammogram (within one year), then this patient will have to have her mammogram before Dr. Moss will see her in consultation. Dr. Moss’ office staff will assist you in scheduling this test if need be.

How does a patient obtain a copy of her mammogram report for Dr. Moss

If the mammogram was performed at Tobey Hospital, Jordan Hospital, or Quincy Medical Center, Dr. Moss staff can usually retrieve the report directly with no steps required by the patient (because Dr. Moss is on staff at these hospitals).

If the mammogram was performed elsewhere, call either the facility where the mammogram was performed or the office of your primary care physician and request that a copy of your mammogram be faxed to Dr. Richard A. Moss at 508-747-6613. Obtain the name of the person you spoke to and ask them when they expect this report to be faxed to Dr. Moss. Please note that some facilities will fax this report to Dr. Moss without a request in writing from the patient. However, many facilities may require the request be in writing. Then call Dr. Moss’ staff and give them the phone number of the facility (or physician’s office) you called, the name of the person you spoke to and when it was expected that the mammogram would be faxed. Dr. Moss’ office can usually obtain the mammogram once you have called them with this information.

If a patient is age 40 or over and does not have a current mammogram, Dr. Moss’ office will assist her in obtaining one.

If a patient has previously had a mammogram at a local facility, it may be easier for her to call her primary care physician to schedule her mammogram. This is because that facility already has her previous films on file to compare to the new mammogram. However, if the patient is having difficulty scheduling her mammogram in a timely manner, Dr. Moss’ office can assist the patient by scheduling her mammogram at Tobey Hospital. Tobey Hospital can typically schedule a patient to have a mammogram within two weeks.

The following pictures demonstrate what a patient should typically experience when having her mammogram at Tobey Hospital. Tobey Hospital is located in Wareham, MA and is one of the hospitals that Dr. Moss frequently performs surgery at. Both Dr. Moss and his wife, Carla have been patients at Tobey Hospital and have found their personal experiences to be wonderful.

If a patient has had prior mammograms elsewhere, it is important that she bring the films and reports from these mammograms to her mammogram appointment at Tobey Hospital. Simply call the previous hospital mammography department or mammogram center and request that the films and reports be available for you to pickup. Give the facility at least a few days notice. You should then pick up these films and reports at the previous hospital and bring them with you to Tobey Hospital, when you go for your mammogram.

Beth Bark Mammography Technician greets a patient who has brought her mammogram films and reports. This patient has had previous mammograms elsewhere.

Beth Bark, Mammography Technician, checks to see that all the appropriate films are in the patient’s packet.

A few important reminders:

This is an example of the mammography report that is sent to physicians.

Learn More About Breast Implant Surgery in Boston

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

Dr. Moss provides very lengthy and complete consultations. Therefore it is in everyone’s (both patient and doctor) best interest that the patient is properly prepared for this consultation. Keep in mind that for most surgeries outside of cosmetic surgery, patients have already met with their primary care physician and discussed the proposed surgery or at least the potential need for surgery. The primary care physician to some extent has already assessed the patient as to whether she/he is appropriate for the surgery, before referring her/him to the surgeon. The Primary Care Physician (PCP) has often ordered all the necessary laboratory and radiological tests, before referring the patient to the surgeon.

An example of this would be that the PCP would make sure that any patient 40 years or older has a current mammogram before referring a patient to a surgeon for breast surgery.

Learn More About Plastic Surgery in Boston

• Meet Quincy Plastic Surgeon Dr. Moss
• Information About Your Consultation with Dr. Moss