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101 Old Short Hills Road Ste 510
West Orange, New Jersey 07052

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Category: Breast Reconstruction

Nipple Tattooing

There has recently been a lot of press about certain tattoo artists who are all of a sudden seemingly specializing in 3D tattooing of a nipple and areola in breast reconstruction. This is nothing new to me or our practice as I have been doing this for nearly twenty years. As an accomplished artist, it was a natural marriage of sorts between art and surgery of sorts. I have done thousands of nipple reconstructions for post mastectomy patients with a fairly unique technique I developed in the 1990’s. (it can be seen on our YouTube channel at Spiro Plastic Surgery). I have done the tattooing personally into most of those nipples I reconstructed over the years. There is a subset of women who just don’t want a formal nipple reconstruction procedure, so for these women I do 3D tattooing. I use only approved medical grade, natural pigments (nonmetals) and often blend or use a variety of colors (sometimes up to 5 per patient) to get a real Trompe-l’oeil look! Check out my YouTube video documenting me doing nipple tattooing- you’ll love it!

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.


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:

A year ago, I chose you to perform my breast reconstruction, after I was diagnosed with cancer.

Today…I wanted to take a moment and share with you and your excellent staff my sincere gratitude for all you have done for me.

I am very pleased to have found you as my plastic surgeon and I’m very happy with the results of my breast reconstruction. I feel great about myself now.

You performed a wonderful job on me and are an example of what the practice of medicine and patient care should be.

You have my gratitude and respect in ways I cannot possibly put words to. So…I say humbly, thank you Dr. Spiro: You are the BEST!


 Read Last Weeks Testimonial Here…

What the heck is a gummy bear implant anyway?

What makes happy breasts?

Gummy bear implants are a slang term associated with the consistency of the silicone gel within the shell wall of a breast implant. Nowadays, Mentor, Allergan, as well as new US approved maker Sientra, produce various versions of cohesive silicone gel implants. The discussion about the implant that is best for any one patient and any one type of procedure, augmentation, revision, mastectomy reconstruction, is a relatively complex one and should not be oversimplified by the marketing implications of over hyping one gimmicky terminology.

So” gummy” just refers to the most firm of the cohesive gel implant materials. This does not mean the best at all…

Certain types of the most highly cohesive gels are packaged with shell walls which themselves are more firm and shaped and this does not necessarily make for the longest lasting best looking and feeling breasts!!

Shape primarily comes from careful evaluation, subsequent planning, and surgical execution. Also pre-existing breast and chest wall shapes play heavily in this.

See my web site, especially, the sections on augmentation, breast lift, reconstruction, and most importantly revisions, to see what I mean here. I have treated patients from all over the world. Don’t believe for one moment that implant gel consistency alone make the outcome or is more safe. All approved implants containing silicone gel have similar safety.

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…


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.



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