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Category: Breast Augmentation

Positive Evolutionary Changes In Shaped Gel Implants

Shaped gel implants have undergone a renaissance in the last year or so. In one of my first blogs I was particularly difficult on them. There were limited options of shapes and sizes. The manufacturer’s have implemented significant advances including many many new shapes and sizes which open up the use of Shaped Gel filled implants to augmentation and reconstruction patients. Lets make it clear, no one style implant fits all patients.

There are a multitude of body shapes, breast shapes, conditions and patient desires. There is no perfect device.

I have been using shaped gel implants more and more for certain characteristics with good results. It is not necessarily based on a patients desire to have a Shaped or “natural result”. Some of the most natural results come from round smooth surface gel implants!

It is a complex decision process that only an experienced Plastic Surgeon has a grasp of. (torso curvature, rib asymmetry, starting breast volume, internal tissue laxity or tightness, nipple to breast fold starting distance, existing asymmetries and goals for outcome just to name a few…).

…So don’t look at the website and try to guess who has what. You (along with other plastic surgeons) will be and have been statistically wrong in your guess nearly 50% of the time!

In the end it takes good listening, thoughtful examination, and planning to limit the innumerable variables the human body presents.

Follow her Recovery…

The “follow her recovery” section of our website is a  unique section where we follow the progress of healing from surgery with periodic post op photos. This is particularly useful to see in breast augmentation where variability in female chest wall and breast anatomy as well as patient desired outcomes often require a certain period of healing time in order to see the “final” cosmetic outcome. In breast augmentation, the immediate post op outcome may be visually altered for a period of weeks by tight tissues and sub-optimal cosmetic anatomy. Release of constricted anatomy, for instance, may take several months to fully loosen and soften. (see new case 1 in follow her recovery.) Extra tight (tighter than typical) tissues may take more time to soften (about six weeks) than more ideal anatomy (which may take only three weeks to soften). Implants (Technically speaking) in my practice are precisely placed, it is the anatomy surrounding the implant that needs time to soften and remodel. By doing this, the volume within the implant re-positions itself( generally speaking) to the anticipated planned outcome set forth at he original surgical procedure.

Therefore, it is constructive for patients to see how typical outcomes come about. Enjoy!

Beauty and Shape

There is something magical about the combination of tummy tuck, liposuction, fat grafting and breast augmentation or lifting: it is the beauty of shape, of curves , of connotation of youth and femininity. It is truly transformational. Please check out the abdominoplasty section of before and after photos to see what I mean!

Patient Testimonial

I have decided to share with my blog readers some of the kind words my patients have had about their experiences with me. So each week for the next nine weeks you will get to read the reflections of former patients. Their words will reveal a lot about me to you.

I have wanted breast augmentation ever since I had two biopsies on my left breast six years ago which left my A size breast now disfigured somewhat and even smaller than the other. As I have approached my fifties, I have realized that I wanted to feel better about myself and had upper lid blepharoplasty last year and felt and looked younger. And now I did not hesitate to research Dr. Spiro after a friend of mines sister had her breast augmentation last November.

I agree, Dr. Spiro is an artist. He made me feel confident about my decision and his staff is the absolute greatest.

His office is run so smoothly and professionally. I never had to wait; the staff is extremely attentive and courteous. His nursing staff is the absolute best, because I have used the 24/7 service for so many unexpected questions that came up that I did not anticipate…And the results are phenomenal. They look and feel real. There is no way you can tell I had the procedure. I look nicely proportioned with my 36C plus breasts. If I do any other procedures, which I may in the future, I will certainly see if Dr. Spiro performs those as well. I am absolutely beyond happy!



Patient Testimonials

I have decided to share with my blog readers some of the kind words my patients have had about their experiences with me. So each week for the next nine weeks you will get to read the reflections of former patients. Their words will reveal a lot about me to you.


Dear Dr. Spiro,

I am sure I am just one of the thousands of thank you letters you must receive, for changing people’s lives, but I need to thank you as well.

I appreciate the time and attention you gave me, listening to me, educating me and putting me at ease.

There is no doubt I chose the right doctor and I thank you for taking care of me and helping me finally feel like a complete woman.

There is no other eloquent way to say this than, “I Love my new boobies!”

From the bottom of my heart, thank you.


Ps- Than you to your wonderful Staff!


Click Here to read last weeks testimonial…

Management decisions for possible ruptured silicone gel implants previously placed over muscle

Prior to the late 1980’s it was commonplace and standard practice to place silicone implants under or within breast tissue over the muscle. As awareness of breast cancer surveillance became increasingly important along with the general understanding that implants were better off under muscle, implant placement underwent a renaissance by the late 80’s early 90’s.

Now we are seeing many women in their late 50’s to late 60’s with 30 year old disintegrating implants. They are not experiencing health issues, but rather cosmetic concerns of hardened malshaped breasts.

My solution has always been to remove all existing implant and scar capsule called total capsulectomy. This is combined with new implants (usually silicone gel) placed under muscle with the addition of a-cellular dermal matrix as a needed tissue graft support for the new implant space. Often a breast lift is necessary at the same time to optimize aesthetics.

This procedure is done as an outpatient and the recovery is fairly simple.

Occasionally, patients will request that no implant be replaced. This may present a challenge to create an aesthetic appearing breast. I use auto augmentation techniques when applicable to solve the dilemma of camouflage.

Finally, it should be restated that there are numerous options for women with “old tired” implants that need attention.

Revisions In Breast Implant Surgery

How Do We Rescue Your Breast?  Dealing With Capsular Contracture or Implant Malposition.  Well, You Needed A Lift!

Look, no one wants unwanted scars. But there’s a difference between unnecessary scars and needed. My experience over 20 years has been that the saggy flat breast which has an implant placed within it is generally looked upon as ugly and matronly and rejected by the patient as not ideal. Fixing this issue entails not only doing a lift usually, but also reconfiguring the implant space internally higher since it was likely originally placed too low in an effort to better match the existing breast. This requires another type of capsulectomy and capsuloplasty– read the previous recent blogs to get up to speed on these fancy terms–

After the lift and implant repositioning, even though there are scars now , and initially more visible, the patients universally accept this new breast as being far more aesthetic, and more attractive. They gladly trade the old aged look for a fresh young look. Instead of being a detractor to their appearance, their new breast helps to convey a youthful interpretation of body image and gives these women a new sense of confidence.

When I do this procedure the objective is to correct or eliminate the disconnect between natural breast gland, fat and skin and underlying implant. So,  I carefully sculpt overlying breast tissue, preserving an envelope of volume to help hide the implant while tangentially eliminating the most sagging breast. Under the muscle, I raise, recreate, or create  the implant space to coincide. The result is a high centrally positioned implant joined with overlying breast tissue in unison. Everything form fits. There are no loosely disconnected parts. Just an ideal feeling new breast !


Revisions in Breast Implant Surgery

How Do We Rescue Your Breast?  Dealing With Capsular Contracture or Implant Malposition

Capsule formation is a natural process of healing around any implant; not necessarily a breast implant. There is no true “normal” capsules; Just variations. Capsules  are a layer of scar tissue the body forms circumferentially around a breast implant. They may be ideally soft or unusually hard. To complicate matters, the timing of capsule formation, the type of breast implant getting encapsulated, as well as the chest wall shape that the encapsulation is occurring on, all influence breast  appearance outcome.

For the purposes of simplicity, capsule formation has classically been gradiated in four grades. Grade 1 being soft capsules not influencing breast implant shape. Grade 2 capsules are firmer and make the breast implant subtlety firmer. Most women don’t even realize they have this type of scar formation. Grade  3 and 4 scar capsules alter appearance of the implant and generally will necessitate revisionary surgery.

Interestingly, grade 1 capsules- not even palpable, and leaving implants ideally soft, may also have an implication in reoperation  for conditions known as implant malposition.

Here, for instance, if the chest wall is keel shaped or curved, and implants are saline filled, and negligible  scar essentially forms around the implant, then , the implants may insidiously migrate low and laterally. Not ideal, and not where surgeon or patient had envisioned for the outcome. This requires selective capsulectomy and capsuloplasty for management. This means tightening the lower and or lateral internal space so the implant can’t migrate as well as removing part, most, or all of the remaining capsule so allow for better projection or position of the new implant. If the muscle was incompletely divided medially, the forces exist which would tend to push the capsule laterally. Switching to silicone gel implants and properly dividing muscle often helps stabilizes and neutralize the physiologic dynamics associated with implants under muscle. Most often I see this incompletely done – in effect underestimating what it really takes to get a great outcome. Some of the best of the best beautiful breast outcomes come from rescues I’ve performed as secondary augmentation.


Breast Augmentation Characteristics

The seven characteristics that go into breast augmentation

Finally we are at  number seven! Shape of the breast. This is where artistry and surgical skill come into play. And I hope this is where I really separate myself from the others. Breast Shape is a combination of the surgeon creating the implant space by creative internal tissue release, the implant choice, the implant size, the firmness or laxity of breast and its connections to overlying skin envelope and  underlying chest wall characteristics such as rib cage shape.

A good plastic surgeon will discuss this with the patient so that everyone has realistic expectations. If you review my web site you’ll see the artistry!!!

I hope this journey has educated and enlightened you. You’re now an expert in cosmetic breast augmentation. Congratulations!!!

Click here to read about the 1st characteristic

Click here to read about the 2nd characteristic

Click here to read about the 3rd characteristic

Click here to read about the 4th characteristic

Click here to read about the 5th characteristic

Click here to read about the 6th characteristic


Breast Augmentation Characteristics

The seven characteristics that go into breast augmentation

Sixth and most important to most patients is breast size!! By the way, what is bra size anyway? It’s just a relative relationship of breasts displaced size compared to the torso that the breast sits on, nothing more. That is “cup size” a 32D cup breast is a smaller breast by absolute volume than a 36C cup. Did you know that?

Bra manufacturers in recent years are pushing women to buy C and D cup bras because the connotation is that this is the desirable breast. Just like a dress manufacturer who wants to make a big marketing splash will change their size 6 dresses to fours and size fours to twos!! Women love them. They think that this dress maker is brilliant because they feel thinner!!

The idealized breast is somewhere between a C cup and a D cup for most women. A cup is filled by volume and skin envelope. So, saggy breasts that fill a cup are more skin and less volume. As I discuss this with patients in my office we discuss all these things.

But here’s the catch: there are about 200 different implants and four billion women!! You first have to match the proper base diameter to the chest, body, rib cage. Available volumes in profile projections next are evaluated. And there you are. We can arrive at a realistic goal outcome for size!! Seems easy but you’d be amazed at how many women come to see me with disappointing outcomes from surgery done elsewhere by others that I am asked to correct.

Click here to read about the 1st characteristic

Click here to read about the 2nd characteristic

Click here to read about the 3rd characteristic

Click here to read about the 4th characteristic

Click here to read about the 5th characteristic


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