November 30th, 2009 Troy Andreasen M.D.
On November 21, at 8:00 p.m. by a vote of 60-39, the Senate approved a motion to proceed to consideration of the Patient Protection and Affordable Care Act, better know as the Senate health reform bill. At the 11th hour, a cosmetic surgery tax provision was slipped into the bill proposing a new 5 percent tax on elective cosmetic procedures. This was a surprising addition to the 2,074-page bill that is calculated to generate only $5 billiion over the next ten years to help fund the $849 billion plan. This new tax would fall on individuals who undergo these procedures and could be effective as early as January 1.
The American Society of Plastic Surgeons has vehemently opposed this new tax arguiing that it is discriminatory, arbitrary, and ineffective. As 86% of all cosmetic surgery patients are women, elective surgery taxes unfairly target females. Moreover, cosmetic surgery is no longer an exclusive luxury reserved only for the wealthy–the vast majority of patients in my practice are working women. Recent research reveals that 60% of people considering plastic surgery within the next ten years report an annual household income of $30,000 – $90,000. Only 10% report incomes greater than $90,000. This evidence seems to refute the argument of some that elective surgery taxes are similar to “luxury” taxes that affect only a privileged few.
This tax reminds me of the state sales tax placed on saline breast implants a few years ago. This tax did increase the price of Inland Empire breast augmentation procedures slightly and was later repealed. In my practice, we absorbed this fee in the global surgical price since it represented only a small portion of the overall charge. Although this 5% tax will affect the breast augmentations, breast lifts, tummy tucks, liposuctions, and facial rejuvenation procedures that I perform, the overall effect on pricing will not be prohibitive.
As a member of the American Society of Plastic Surgeons and the American Society of Aesthetic Plastic Surgeons, I will join my voice to the opposition and see how this all pans out over the next several weeks. I do want my patients aware of these current events, however, and the issues that board-certified plastic surgeons face. And, as always, I will try to keep you apprised of the changes as they, and if they, occur.
Please have confidence that, in my practice, we will try to absorb some of these cost challenges internally and we will not use them as an excuse for across-the-board fee increases. I am hopeful that only the surgeon’s fee will be taxed and not the global fee that includes the anesthesiology services and the surgery center charges. If that is the case, the overall effect on pricing will also be minimal.
We have been aggressive in our price reductions during this recent economic downturn but have still insisted on only the highest quality of care. I have avoided taking the cost-reducing shortcuts that compromise the quality of the patient experience and, by so doing, have not joined in the low-cost, low-quality model of plastic surgery so prevalent today. I will continue to do so despite this new tax proposal and its implications on pricing.
I continue to be grateful for your loyalty as patients and for the continued referral patterns we see witihin our practice. Nearly 90% of our new patients come from previous patient referrals–a testament of our mission to take excellent personalized care of each patient. We wish you the best as you prepare for the holidays.
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October 13th, 2009 Troy Andreasen M.D.
One of the most frequent questions I hear these days from patients is: 
“Where do you perform your surgeries?” This has become a very important question for many patients as reports of complications occurring in office-based surgery rooms have increased. Many board certified plastic surgeons own and operate their own office-based surgical facilities and take great pride in their accreditation and safety records. I do believe that office-based surgical centers can be very safe insofar as they are operated under appropriate accreditation guidelines. Many of my colleagues do just that and can provide high levels of care within their office-based surgical settings. There are practitioners, however, whose standards are not as rigorous and whose facilities are not as safe as others. None of this is noticed by patients, however, until there is a complication that draws attention to the deficiencies. Many of these facilities can exist under the radar.
Over the past several years as a board certified Inland Empire plastic surgeon, I have
performed my surgical procedures only in accredited hospitals and outpatient surgery centers. Obtaining surgical privileges in these institutions is a more rigorous endeavor than for office-based facilities since applications are reviewed by a credentialing committee and are subject to peer review. Adequacy of training and certification must be provided with each application and renewal. It has been my preference to use these centers rather than build and operate an office-based facility to help ensure the safety of my patients. I perform all breast augmentation procedures, breast lifts, breast implant revisions, abdominoplasty or tummy tuck procedures, and liposuction procedures on an outpatient basis at these types of institutions. Procedures such as the facelift, eyelid lifts, and browlifts are performed in this manner.
I perform the majority of my procedures at Benefit Surgery Center in Rancho Cucamonga. Benefit Surgery Center is an accredited outpatient 
surgical facility whose staff is well-trained in the management of plastic surgical patients. The comfort and privacy of this facility makes it an excellent venue for cosmetic procedures. The anesthesia providers are also especially skilled in addressing the special needs of the cosmetic surgery patient. I also maintain full plastic surgery privileges at several local hospitals including Arrowhead Regional Medical Center, the county’s trauma center.
As the Inland Empire’s premier plastic surgical practice, patient safety is our top priority. With that goal in mind, we have ensured that our operating environment is top-notch and that patients can feel secure in their surgical facility.
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September 9th, 2009 Troy Andreasen M.D.
“Weekend Recovery Breast Augmentation”
Early last Tuesday morning I performed a breast augmentation on a young woman using moderate volume saline-filled implants, increasing her breast size from an A cup to a full C cup. I saw her for her first post-operative appointment early the next morning so that she could go back to 
work later that day. As I met with her, she related to me stories of how her friends had taken up to two weeks off from work following their breast augmentation procedures and she was surprised at how uneventful and pain free her recovery had been up to that point.
Breast augmentation today in my practice can be considered to be a “weekend recovery” procedure. Although returning to work after 24 hours is not the most common story we hear, certainly returning to normal, non-strenuous activities within two days is very commonplace. Patients routinely discontinue their pain medications after 24 hours and many don’t take any at all. Patients very rarely experience significant bruising and have nearly full range of motion in their arms within 24 hours as well. Incisions placed along the contours of the areola or hidden in the inframammary crease allow direct visualization of the implant space and allow greater and more precise control over pocket creation and dissection. This precision allows for a less aggressive treatment of the chest tissues and leads to a more comfortable recovery.
With the challenges that taking time off from work can create, many might put off a breast augmentation or breast lift with augmentation believing they need weeks of down-time and bedrest or extended periods of immobility. By using these gentle surgical techniques that avoid excessive rib and muscular trauma, patients are finding themselves pleasantly surprised with their rapid recoveries. Gone are the days where patients can’t wash their own hair or grab a coffee cup from the cupboard the day after surgery. Although we have three full operative days each week, we always like to reserve several spots on the Friday surgery schedules for patients requiring this “weekend” type of breast augmentation recovery and can schedule your breast procedure accordingly at your convenience.
Call our Ontario California Plastic Surgery office at (909) 291-4900 to schedule a complimentary consultation where we can discuss this procedure more in detail. You may also feel free to visit our website at www.inlandbreastandbody.com to see three-dimensional procedural animations of the actual implant procedures so that you can become better familiarized with the chest wall anatomy and implant positions. You may also browse our extensive Breast Implant photo gallery of previous “weekend breast augmentation” patients on the site as well. We look forward to assisting you reach your aesthetic goals with the least possible recuperative requirements.
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June 11th, 2009 Troy Andreasen M.D.
Not a day goes by that I don’t receive in the mail or by way of the internet advertisements for plastic surgery. It appears to me that many plastic surgery providers have been forced to dramatically increased their marketing expenditures in this sluggish economy. In addition, many different “institutes of plastic surgery” and “specialty surgery centers” have emerged and have begun to advertise deeply discounted surgery prices. It is somewhat alarming to me how prices for some procedures have been reduced to nearly 50% of the fees back in 2006 prior to the economic slowdown. 
I know that anesthesiologists have not reduced their fees to the same degree, surgery center expenses have not decreased, and the cost of breast implants has not dropped in this same time.
I have watched this occur over the last several months with interest wondering what corners are being cut in order to offset this fee reduction. Recently I received an e-mail from a patient whose experience confirmed what I have been fearing. I would like to share her story with you briefly.
I met Darla (patient’s name has been changed to protect privacy) in March of this year when she came for a consultation for a tummy tuck and breast lift with augmentation. She was referred by her personal physician. After our visit, I gave her a global surgical fee quote that included implants, surgery center charges, anesthesiology charges, and the surgeon’s fee. Darla sought other consultations and I didn’t hear back from her for nearly 6 weeks. She wrote me an e-mail saying she had found a surgeon who would perform her requested procedures for nearly $2,500 less than what I had quoted her and asked if I would match the new quote. I told Darla that I could not maintain the standards of care that I do for that type of fee structure and I wished her well.
I received another e-mail from Darla the day after her scheduled surgery. She was called the night before with news that her scheduled time had been moved back several hours. When she arrived at the surgical facility for her procedure, she was pushed
into a corner bed and waited for nearly 4 hours before seeing the physician. Apparently, there was not enough staff to perform the surgery, the anesthesiologist had not shown up, and the physician was in his office seeing scheduled consultation patients. After this experience, she wanted to leave but no one would remove her I.V. She ended up removing it herself and walking out.
Darla’s experience underscores the importance of a surgical practice that puts patients first. In my practice, you are our top priority and your safety and comfort are paramount. We have not chosen to pursue the low-cost, used car approach to elective surgery and, consequently, our prices may be slightly higher than those who have. I have retained each important member of my surgical and office staff and I do not try do do more with less. My office staff and location are a stable and consistent resource for you during all phases of your surgical experience. This caliber of service and support may cost a few more dollars but is certainly worth the investment.
In addition, our standards and quality of care have not been sacrificed to offset fee reductions. We have offered special pricing on our surgical procedures in order to make them more affordable in these challenging times and we will continue to offer our experience and expertise to all patients through complimentary consultations and complimentary skin care services.
Thank you for entrusting your surgical care to me and to my staff. We are the Inland Empire’s Premier Breast and Body practice for a reason and we appreciate our relationship with you and those you refer to us.
Sincerely,
Troy J. Andreasen, M.D.
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