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West Orange, New Jersey 07052
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Monthly Archives: February 2012

Breast Implant Replacement in New Jersey

PIP Breast Implants in New Jersey

The French manufacturer PIP produced both saline filled breast implants and silicone filled breast implants since the 1990’s. Their saline implants were trialed in the US as far back as the early 90’s but their silicone gel filled implants WERE NEVER APPROVED for use in the US.

The PIP saline filled implants were different than the other two main implant manufacturers’ saline implants in that the PIP implants were pre filled into the implant shell bag. The problem over time was that this type of saline pre fill process had a higher failure rate over time when compared to the other manufacturers. Therefore the PIP saline implants were not approved and hence are no longer available in the US.

The PIP silicone gel implants were never approved for use in the US. Most women with PIP silicone gel implants received their surgery in France or the UK. However other Latin American locations were known to have obtained PIP implants.

Recently, it was identified that the silicone gel used in the PIP silicone implants exclusively was a type of NON MEDICAL GRADE silicone gel. Again, they were never reviewed, used, or approved for use in the US and are not the same as the medical grade silicone gel used in breast implants in the US!

Additionally, it was found that the PIP silicone implants leaked at a higher rate over time than the typical silicone gel implants in use in the US.

A recommendation was recently made by both the Aesthetic Society and the American Society of Plastic Surgery regarding PIP silicone gel implants and was reiterated by the society president at the Atlanta Breast Surgery Symposium which I attended in January. It was recommended that these implants be empirically removed even if the patient has no symptoms. So, if a patient living in the US, was known to travel outside the US and had a breast augmentation, or post mastectomy breast reconstruction, with PIP silicone filled breast implants, they should consult with a Plastic Surgeon  (preferably member of at least one of the two accredited societies mentioned above).

My practice for many years has attracted many women who seek help with breast implant concerns regarding previous surgery done elsewhere by other surgeons. Patients have come to me from across the US, Europe, Russia, the Middle East, and Asia for treatment of breast implant leakage,  implant deflation, implant asymmetry, capsular contracture, implant malposition, etc. My unique approach to these problems will be discussed in upcoming blogs…

 

Lower Eyelid (blepharoplasy) Surgery in New Jersey

Management of the lid cheek interface

Surgery to treat the aging lower eyelid has undergone significant evolution in the last decade. For years the treatment of lower lids amounted to just plucking fat out of the lower eyelids and removing a strip of skin. For more than 10 years now, I have looked at things differently. A major part of the visual effects of aging include the enhancement of the lid check interface tear trough deformity). My approach to treatment requires a lesson in aging so here it goes.

As we age our thicker cheek tissue stretches subtly away for the underlying bone. This allows this skin and fat to fall. As it falls it shows the demarcation between thin eyelid skin and thicker cheek skin and there is a hollow that reveals itself in this wake.  Eventually, the covering over the eyelid fat pads thins out and shows as fat bags. If the skin is poor enough it too will sag down on top of the cheek.

So correction often necessitates a combination of skin removal, conservative fat removal, separation of lid cheek binding at bone level, fat transposition of extra eyelid fat over orbital rim and under lid cheek tear trough, and finally a lateral upper cheek lift to elevate the cheek mound back up to cover the orbital rim further. Check out examples of this technique on my web site- www.drspiro.com

Breast Augmentation alone or Mastopexy (breast lift) Augmentation

To lift or not to lift that is the question…in New Jersey Plastic Surgery

The decision making involved in evaluation, planning and executing cosmetic breast implant surgery is critically important. Many patients come to see me knowing that they need a breast lift along with implant augmentation. Some patients, however, present with little idea that they need a lift, (mastopexy) along with implants. In the New York – New Jersey area, they just assume an implant will improve everything. This is true in some cases. Let me elaborate.

If a patient has minimal sag and minimal excess but good quality skin then implants alone, saline or silicone gel, can provide the lift needed without other incisions. Placement of implants under muscle should always be used. Never have them placed over muscle. (more about this in future blogs)

If the skin quality is poor, such as stretch marks, or the sag is great, or if the nipple position is low, especially when there seems to be a disconnect between skin, gland and chest wall, then a lift is mandatory to give the best cosmetic outcomes.

Mastopexy incisions vary based on the above mentioned variables. They can be just periareola or circumareola, circumareola plus vertical, or circumareola- vertical plus horizontal. The objective should always be the best breast outcome. Never minimize incisions as a marketing scheme. Understanding the dynamics and relationships between skin, gland, muscle, implant, and chest wall are paramount.

Some surgeons are fearful of the dynamics of changing three dimensions and anatomy constraints in these surgeries and therefore shy away from the combo. My marketing is the best possible breast outcome. Scars fade, aesthetic outcomes are the key. Sometimes this just requires a series of shared incisions. We’ll discuss how I treat revisions – patients who come to me to revise breast implant or mastopexy surgery done elsewhere by others in future blogs.

For now, check out my web site- www.drspiro.com  to see these and other outcomes.

More Implant Augmentation Pearls

Cosmetic Breast Implant Selection Criteria

An understanding of gravity’s effects on fluids helps in deciding what implant best suits a certain patient. For instance, lean women with very small breasts are far more likely to palpate and even see the rippled edge of a saline filled implant than a woman who is either less lean or has a larger starting breast. Now, if. That woman goes  under water and lays flat on her back- not a common position- she would find far less ripples: simple!

So, for lean women, and for women who have very small breasts and a relatively long starting nipple to inframammary fold distance, a silicone gel breast implant is often a far better choice. Simple, right!

Silicone gel implant feel more natural and are less heavy feeling because of the density of saline,( water), and the pull gravity exerts on the saline implant against the curve of the chest wall. So over time, the silicone gel implants tend to decent and lateralize less, so, a longer lasting aesthetic result with silicone commonly.

I’m not knocking saline here, just pointing out some facts that I have seen proven out over 19 years of careful evaluation with a keen eye in thousands of women. You can get a great outcome in cosmetic breast implant augmentation with either saline filled implants or silicone gel filled implants but there are undeniably subtle differences.

Stay tuned for a discussion on round vs shaped implants.

 

New Jersey Breast augmentation implant selection pearls

Saline versus Silicone gel implants

Chest wall shape, gravity, and base coverage in breast augmentation.

Decision making and planning in breast augmentation cannot be overlooked. It takes a keen and critical eye to see the subtle features that can make or break an ideal breast augmentation.

 The contour of the rib cage is often overlooked and its influence is underestimated particularly regarding implant selection.  Silicone gel vs. Saline filled, profile projection – high, moderate plus, or moderate, are integral decisions validated by a proper understanding of gravity influences on fluids on curved mobile surfaces.

 For instance, a high profile saline filled implant may be a poor choice on top of a keel shaped dramatically curved chest wall, but may be a better choice for a patient who wants maximal projection of her breast with a relatively flat rib cage.

 We all have a curved torso, it just depends where it curves as to how it influences implants! Again if we lived underwater or on the moon it wouldn’t matter as much, but here on earth, gravity WILL influence your breast outcome.

 Next, let’s discuss the concept of base coverage. This is the footprint your breast makes on your chest. A patient may have an A cup breast but there are many ways that A cup breast relates to the underlying chest wall. A keen eye during evaluation before surgery should allow the surgeon to see what needs to be done out of the ordinary in order to help the patient get the best outcome possible. Some breasts are oddly angulated, sometimes asymmetrically so. Some are foreshortened. Some are widely set apart, even unusually so.  It requires then, the technical skill to convert this unfavorable shape to a more favorable shape for aesthetic breast augmentation with implants.

 Look for my discussion regarding nipple location and how it influences decision making!

 

 

 

 

Breast reconstruction with implants in New Jersey

Breast implant reconstruction and acellular dermal matrix and insurance company battle

Ok, now I’m really shocked and angry!

As many know, breast reconstruction has always been an important part of my practice and I’ve always made time and many personal sacrifices for my patients. Recently, I met a young woman with breast cancer who planned to undergo bilateral mastectomy and together we planned an innovative type of staged breast reconstruction using de-epithelialized local flaps from her sagging breast together with acellular dermal matrix (ADM) allograft and tissue expanders. She was happy with my plan and confident in me. The problem here was that her insurance company waited till nearly the last minute to refuse certifying the use of the ADM as part of the surgery. In essence, they refused their client, my patient, state of the art and generally accepted standards as part of her surgery. This required that my office staff fight for my patients rights for the two days prior to her double mastectomy! Imagine the anger we had and disgust we had when the insurance company said that what we were planning to use was experimental.

Not only did they refuse to cover it as reimburseable but they threatened to not to cover the hospitals cost for the product therefore leaving the patient with a very large (significant) cost even as I considered waiving my fee for the ADM!

I blocked out the controversy as I concentrated on helping this young woman, but I felt so sorry for her that she had to deal with this nonsense in addition to her diagnosis of breast cancer and double mastectomy. She was so brave and calm through it all and we used the acellular dermal matrix as part of the original plan in spite of her insurance company, and I am happy to report it aided me in helping her achieve a great beginning outcome in breast reconstruction.

So, I ask you- people- are we just going to stand around and let insurance carriers dictate to us now not only whether they will cover procedures but how your surgeon should technically perform the very essence of surgery?!

This portends to bad things to come and forshadows a future where doctors are forced to acquiesce and do inferior work just to save the insurance company a buck. Disgusting ! Don’t stand for it people. That is why I am an out of network provider. I had the ability to refute what this insurance company tried to pull on our patient. I don’t know if an in network provider could have done the same without reprisal?

Speak out against this type of corporate micromanagement and allow your surgeon to be your advocate and make the medical decisions that are best for you.

 

 

Abdominoplasty New Jersey

Abdominoplasty: A Little Background

Let’s talk a little about abdominoplasty (or as it is more commonly known by its slang name – tummy tuck) .

I’ll address a fundamental  point often overlooked in both planning and execution of the surgery. I think it helps separate my outcomes from others.

Many women consider abdominoplasty (tummy tuck) a purely cosmetic procedure.  Is this view accurate?
 The most important and overlooked benefits of abdominoplasty are improved function and core strength, which are critically important parts of a woman’s outcome and her well- being.  Many woman experience loose or excess abdominal skin resulting from pregnancies or abdominal surgeries, and also suffer abdominal wall laxity and weakness due to muscle separation or hernias.  Left untreated, these problems – which can’t be solved by exercise – often lead to poor posture, back fatigue and the ability to sustain activity or achieve peak performance.  They can also be psychosocially frustrating and sources of depression.

What is my approach to this procedure?
 My surgical method, which I like to describe as “human origami”, tightens both the abdominal wall and its musculature, and in doing so places the muscles in a functional position.  They become properly aligned and can therefore work together equally.  When the muscles of the abdominal wall remain misaligned, the physiology of conventional exercise and conventional core fitness training methods simply don’t work.  My technique has enabled many hundreds of patients , ranging in age from 20’s to 60’s, to regain impressive core strength along with an attractive, more feminine shape.

I hope that gives you a better understanding of how I view a women’s abdomen. Much more on abdominoplasty to come…

 

American Health Front Segment

Plastic Surgery and a Healthy Lifestyle: How do they compliment each other?

We had a very interesting day today at Spiro Plastic Surgery.

Today we filmed a segment for NBC New York for their show “American Health Front”; a half hour program which provides up to date and comprehensive healthcare and medical information to viewers in the tri state area. It will air on Sunday, March 25th, 2012

The intent of our segment was to bring to light the interaction of surgery and complimentary healthy  lifestyle, (fitness and nutrition) in body transformations. We focused on breast and body contouring as a rejuvenation process. The body contouring may include liposuction, fat grafting, breast lifting, augmentation, abdominoplasty, or body lifting.

Thanks to three of my former patients participation it was a great success!

They filmed for two hours and at the end the film crew said we were the best, most organized segment they have filmed!

It was so nice to see my three patients here for the TV show. Elaine, Jamie, and Allison each looked beautiful and radiant! (Not to mention that their outcomes are amazing.) They were great sports and I am so appreciative that they gave their time on a Saturday morning for me and for NBC. I sensed it was truly heartfelt on their part and it inspires me and was very uplifting to me. I try so hard to deliver like no one else could in so many ways that to see that type of gratitude years later- words are hard to find.

Finally, my staff- Kristina, Mary Beth, and Veronica, gave their all and were so good in front of the camera and in preparation -maybe a spinoff for them onTV is in the making! Nevertheless I hope it provides insight for women everywhere.

Plastic Surgery Blog New Jersey

A New Blog from a Plastic Surgeon In New Jersey

Today marks the beginning of a new era in plastic surgery blog postings. I aim to provide the reader with insight, fact, dispel fiction, debunk innuendo, with a concise, and informal approach.

You will be educated as well as entertained. There will be some humor and irony with a touch of satire. Nothing will be off limits. Some of what I will discuss will pertain to our own plastic surgery family – my patients and what is going on in our own practice. I will, however, also keep you posted on current events in general– not only those in plastic surgery.

We’ll comment on breast augmentation,implant selection, styles, saline vs silicone gel, as well as updates on the latest technology. I’ll give you my thoughts on different procedures- those that we find worthy and those that are not.

I’ll talk about RETAF – a component of my abdominoplasty procedure that helps give my patients their outstanding outcomes.

We’ll review my philosophy of composite SMAS lift and variable vector approach to face lifting that has benefited many of my patients. I’ll also explain my strong convictions regarding lower eyelid check interface management.

Look for my discussion on fat grafting- I’m confident you’ll find it enlightening.
I hope you’ll find my approach to rhinoplasty refreshing.

Finally, I will discuss over time my many years of experience with breast reconstruction including tissue expansion, latissimus flap and implant, and TRAM flap.  Together we’ll draw from my 19 years experience and over 15,000 procedures!

Look forward to the interaction
Best
Dr Spiro

 

Regeneration
Promises to fill the needs of our patients who are seeking non-surgical facial & body regenerative skin care.