Eva Sheie (00:03):
The purpose of this podcast is simple. We want you to get to know your doctor before meeting them in person because you're making a life-changing decision, and time is scarce. The more you can learn about who your doctor is before you meet them, the better that first meeting will be. There's no substitute for an in-person appointment, but we hope this comes close. I'm your host, Eva Sheie and you're listening to Meet the Doctor. Welcome to Meet the Doctor. My guest today in New York City, uh, is Dr. Adam Schaffner. He's a plastic surgeon practicing for 20 years in New York City. Welcome Dr. Schaffner to Meet the Doctor. 

Dr.Schaffner (00:43):
Thank you. Great to be here. 

Eva Sheie (00:45):
Let's start with, um, the softball, which is just tell us about yourself. 

Dr.Schaffner (00:51):
Well, I'm a board certified fellowship trained plastic surgeon. I'm in private practice here in New York City. We are on Fifth Avenue between 47th and 48th, just two blocks south of Rockefeller Center. So conveniently located. We have two accredited operating rooms and are able to perform surgeries in an accredited facility. Uh, so it's providing privacy, comfort, and outstanding care. Our practice focuses on aesthetic procedures, non-invasive, minimally invasive and surgical of the face, breast and body. 

Eva Sheie (01:25):
And uh, do you have a specific area of specialization that you focus on? 

Dr.Schaffner (01:29):
I have a few areas. So I'm fellowship trained in breast plastic surgery, so I do a tremendous amount of breast surgery, including augmentation with implants, fat and both revision augmentation, reconstruction, lifts, reductions, and uh, basically dealing with complex complications from prior surgery and trying to optimize the appearance once that happens. 

Eva Sheie (01:57):
And I think, uh, you said most of your patients are coming for revision, is it more than half? 

Dr.Schaffner (02:02):
I would say that at this point, certainly the longer that I'm in practice, it seems that more and more people find out, uh, who you are and where you're located and what you can do. And so yes, at this point it's probably about a little over half of my patients are revision patients. And that's not to say that it's the fault of the doctor, just to be clear here. It's just that even in the best of hands, there are risks associated with any surgical procedure. And it's good when doctors know their limits and know when they need to refer to others for help. 

Eva Sheie (02:34):
I think also breast implants aren't going to last forever, so there's some element of just things needing to change over time. Maybe a little bit of a tangent already, but we were recently talking about this idea that breast implants have to be replaced every 10 years. And where did this come from? Because certainly if something's not broken, you don't fix it, but do you find that that is a myth that that is out there, that people think this needs to happen? 

Dr.Schaffner (03:02):
What, what I explained to patients that that this is not a 10 year, a hundred thousand mile warranty and that this is something that I think are originated from the warranty on the implants, which in certain cases for certain companies is still 10 years for others. In certain cases it's 20 years, but as you said, if it ain't broke, don't fix it. Meaning that you don't have to go ahead and change the implants at 10 years or at 20 years if there's no complications, meaning there's no rupture, there's no capsular contracture, someone's happy with the look, shape and feel, they can be left alone. Obviously if there's a problem or question or concern, then it should be addressed and of course they should be monitored. 

Eva Sheie (03:48):
Do you have a particular breast implant brand preference? 

Dr.Schaffner (03:52):
So I work a lot with Sientra as well as with Allergan. And on occasion with Mentor.

Eva Sheie (03:58):
Do you find that patients actually know the difference between the brands or is that usually not something that they're talking about with you? 

Dr.Schaffner (04:04):
Some of them are quite familiar with the brands, especially those who have had previous surgery. But uh, sometimes they're not as familiar. And so we have the implants in the office from all three manufacturers and are able to share those with the patients so that they can feel them look at them and make a judgment on what's best for them. 

Eva Sheie (04:27):
Now there's, there's a lot going on in in terms of breast implants and in particular breast implant illness. And I think there's two directions that I want to go here. One is just to speak generally about if someone doesn't want breast implants, they don't have them yet, but they don't want them, but they still want to look different and be either smaller or larger and or want a different shape. So maybe talk a little bit about how you address that and what you're able to do when they just don't want a breast implant. 

Dr.Schaffner (05:00):
This is more and more common as time goes on. People are concerned about having a breast implant in place either because of the risk of rupture or  capsular contracture or breast implant illness, or in certain cases A L C L, which is anaplastic large cell lymphoma, which is associated with textured devices or squamous cell carcinoma. So people say, Hey, look, what else is out there? What can I do? I want more upper pole fullness. I want more projection. I want a better shape. In some cases I want to have size enhancement, but I don't want an implant. And so options may include bringing tissues such as fat from another part of the body to the breast. Another option would be a, in addition to or in lieu of, is to go ahead and do a lift if the patient is a candidate for a lift whereby we reposition tissue from the lower portion of the breast to the upper portion and central mound of the breast. 

Eva Sheie (05:59):
And uh, when you transfer fat to the breast area, are you finding that that's becoming better over time? I know in the past that the, uh, people were not getting great results or that the fat wouldn't stay or you know, that, um, there's still surgeons who say it doesn't work even, and I've heard that recently. Are you having success moving fat? 

Dr.Schaffner (06:24):
We've had tremendous success. Uh, to those surgeons who say that it does not work, I would have to respectfully disagree. Uh, the literature is clear. We know for a fact that when you take fat and transfer it either for aesthetic purposes or for reconstructive purposes, that when properly performed, that the fat will survive. Not all of it, but a portion of it, things that can be done to help maximize fat graft survival include, but are not limited to, the way in which you will suction the fat to obtain it, meaning lower pressures, the way in which you transfer it using certain cannulas. Also the way it's processed beforehand, trying to minimize the amount of non-viable fat that is transferred. And then also making sure that when it is transferred, that it's done in a way where you maximize what's called the surface area to volume ratio. So in plain English that you have as much vascularized tissue as much healthy tissue around a given fat cell that has blood flow so that it can then sort of share that blood flow with the fat cell that's just been brought in through a process called angiogenesis and neovascularization, long fancy scientific words for basically saying, Hey, I need some blood flow in here, sends out some signals and blood vessels grow into that fat cell so that it can live. 

Eva Sheie (07:50):
Is there a part of the body where the, the fat is more ideal for moving it to the breast? 

Dr.Schaffner (07:55):
There have been studies that have evaluated this, and the answer is yes, abdomen and inner thighs certainly are more receptive. That's not to say you can't transfer fat from elsewhere, but certainly, uh, in non scarified fat where it has not been previously operated on or been previously treated with either cool devices or heating devices. Uh, so that is quote unquote virgin fat, uh, that you're gonna have generally higher chances of success and viability. 

Eva Sheie (08:23):
Okay. So let's kind of switch over to the other use case here, which is, I already have breast implants, I want them out, but I don't wanna look terrible. So talk about your approach to that. 

Dr.Schaffner (08:35):
That is certainly a challenge because of the fact that when fat is transferred, you need to put it into a space and that space needs to be able to hold the fat, but you don't want the fat just sort of swimming around in a very large space because then it won't adhere to a new blood supply and then the fat will ultimately die. So we have to be very thoughtful and careful when doing that. So when we go ahead and remove an implant, one option is that if we're not gonna be replacing it with another implant would be to evaluate for a potential lift at that time. Another option is to evaluate for fat grafting. Another option is to do both. And another option is to do neither at the time of the removal and let things settle because of the concern of the aesthetic appearance of the breast following removal. 

(09:32)
Most people don't opt to do nothing, although some do. Many want to go ahead and replace that volume and we do so, but not in the plane, not in the level in which that implant was removed. So if the implant was say, put below the muscle, then we may put fat above the muscle below the gland and above the glam, but below the skin in the subcutaneous layer so that therefore we're taking advantage of those layers where the implant was not housed and we're leaving that layer alone where the implant was previously so that we don't go ahead and put fat in that's not going to live. 

Eva Sheie (10:13):
And so if you're confronting this situation where you're, you know, considering a revision for whatever reason and you do want them replaced, is there anything happening in this particular space that is helping patients get a longer lasting result or a better result than they did the first time? 

Dr.Schaffner (10:39):
Technology is always evolving. Currently we have fifth generation silicone gel breast implants. I think that the data shows that we have a long term option for a breast implant, which will yield satisfaction for many years, which is why some of the warranties, as we were referencing before, have changed from 10 to 20 years. So I think that we have very good options for those who want to consider a breast implant to be either replaced or placed. 

Eva Sheie (11:19):
I think you're saying that breast implants might be lasting longer now than they were. Is that fair? 

Dr.Schaffner (11:28):
The implant itself, even in the earlier generations was still present. It didn't get resorbed or evaporate, so to speak. However, the rate of complications ruptures, capture contractures, mal positions, I think that we're having better tech technologies, better techniques, and we can do things before and during and after surgery that help to optimize outcomes, to minimize complications, minimize dissatisfaction, minimize the need for revision surgery. 

Eva Sheie (12:07):
What kinds of research are being done around that, right now? 

Dr.Schaffner (12:13):
There are a number of active issues surrounding breast implants, one of which is breast implant illness, the United States Food and Drug Administration, the FDA held hearings on this issue. And there are currently studies that are ongoing to investigate signs and symptoms associated with breast implant illness. At present, the data is such that we know that we need more study and unfortunately we cannot to a reasonable degree of medical certainty identify in advance who may or who will develop and who may or will not develop breast implant illness following placement of a breast implant. In addition, you can have a patient who believes that she may have signs or symptoms of breast implant illness and we can't, to a reasonable degree of medical certainty make any sort of guarantee to that patient that removing the breast implant will help alleviate their signs or symptoms, whether it is just removal of the implant, removal of the implant in capsule or removal of the implant capsule and surrounding tissue. And so there are active studies currently ongoing in the United States on this issue, but to be clear, even with this knowledge that breast implants are still being placed, including by those involved in the clinical studies, both for cosmetic and for reconstructive purposes. In addition, these are still devices that are being placed not just here in the United States, but in countries around the world for cosmetic and reconstructive purposes. 

Eva Sheie (14:05):
The women who believe that they have this breast implant illness, they have very strong opinions about it. And I think one of those strong opinions is often that they want the entire capsule removed. They don't want anything left in there. Is that something that you do? Do you try to take the whole thing out? 

Dr.Schaffner (14:22):
Absolutely. We discuss options of implant removal, only implant removal with capsulectomy or implant removal with removal of the capsule and some of the surrounding tissue. So at present, they are evaluating whether or not there is any advantage to one approach versus another with respect to resolution of signs and symptoms of breast implant illness. But certainly we discuss the option for that with the patient as well as the risks associated with that and the postoperative course and how it differs depending on the type of operation that's performed. 

Eva Sheie (15:02):
What do you think is causing BII?

Dr.Schaffner (15:06):
I am asked this question many times a day. The answer unfortunately is I don't know with certainty, and I look forward to the day when we can answer that question based on science and based on evidence-based medicine. But at this point to speculate, I think would not be helpful, uh, could be misleading and even irresponsible on my part, uh, as people view me as an expert in this field. And I don't want a, uh, opinion of a speculation to be somehow misinterpreted. So the reality is, I don't know. And the reality is, is that I still insert breast implants into patients for both cosmetic aesthetic and reconstructive purposes. And if I felt that in any way that it was going to cause harm, obviously I would not do so. And neither would any plastic surgeon worldwide I think deliberately place an implant that they knew would cause harm. 

(16:20)
But there's always risk associated with anything that we do. And as I tell patients, you know, you could get hit by a bus crossing the street, people have gotten unfortunately killed by bikers in Central Park, um, and these are freak events that happened, but they have happened. And while I'm not trying to say that they're equivalent, the fact is is that they only way to have zero risk with something is not to do it. And so I think one, as they do with anything in life, has to evaluate the risk benefit ratio, perform their own analysis, formulate their own opinions, and then come to their own conclusion on what's best for them. 

Eva Sheie (17:06):
Okay. So my last breast question is I've been hearing a ton about GalaFLEX and first I heard about it for secondary surgery. So people were using it in the internal bra technique very successfully. And I've started hearing that people are using it for primary augs. Is this something that you're looking at and are you doing this? 

Dr.Schaffner (17:25):
So we do use this on a regular basis. It is something that we've used for a long period of time, meaning about a decade. As far as for use in primary augmentation, it is not common that we do so, but in certain cases where we believe that there is a high risk of either bottoming out lateral fold malposition, uh, or because of the thinness of the tissue, the laxity of the tissue, especially in people who have had large volume weight loss, lots of stretch marks where we're concerned about the integrity and the tissue quality, yes, we will go ahead and do that. In addition, when one is gonna consider a cosmetic breast implant placement above the pectoralis major muscle below the gland, the sub glandular approach, that that will also be especially considered as you're not gonna have the support from the underlying muscle. 

Eva Sheie (18:26):
Let's talk about you. You are obviously very driven and you work very hard. I understand that you just built a beautiful new office, so that probably occupied some of your time, but what do you like to do away from work? 

Dr.Schaffner (18:42):
I am very fortunate. Uh, I'm married, three children, dog, so we have a busy house and household, uh, with a lot of bustling activity. And so when I'm not at work, I like to spend time with my family.  

Eva Sheie (18:56):
Mm-hmmm. <affirmative>, Me too. Do you live near your office or far away?

Dr.Schaffner (18:59):
No, I live, uh, in suburban New York on Long Island. 

Eva Sheie (19:03):
Oh, so you have take a helicopter to work?

Dr.Schaffner (19:05):
Not quite. Uh, so thankfully we have Grand Central Madison now, uh, and so we're able to go ahead and come in, uh, to the east side, come out at 47th and Madison, or 48th and Madison. And my office is on fifth Avenue between 47th and 48th. So my commute once I get to street level is one avenue. 

Eva Sheie (19:28):
Oh, that's lovely. Before you had kids <laugh>, do you even remember what it was like to have a hobbies? 

Dr.Schaffner (19:39):
I'm not gonna say I have a tremendous amount of free time at the moment. Certainly I'm, uh, devoted to my family, uh, to being a good father and husband, uh, and obviously, uh, to be a good surgeon. Uh, and certainly there's only a limited number of hours in the day, so it doesn't allow for a lot of free time. So aside from exercise and sleep, that pretty much does it. But with regard to what I did before, children, yes, uh, certainly had more free time and traveled more. We still travel as a family and enjoy, uh, tho those opportunities. 

Eva Sheie (20:14):
Okay. Who is the last celebrity that you saw on the street in New York? Did you get a selfie? No? You just took a stalker photo? 

Dr.Schaffner (20:22):
Nope. My office is on fifth Avenue and 47th. If you come out and you go to 47th, if those who know the plaza for Rockefeller Plaza. And the summer concert series, 

Eva Sheie (20:37):
Who is it? 

Dr.Schaffner (20:38):
We're gonna check your knowledge of video. 

Eva Sheie (20:42):
Is that Ed Sheeran? It absolutely is. <laugh>. That's great.

Dr.Schaffner (20:47):
Dancing with my eyes closed, you're hearing in the background him singing. 

Eva Sheie (20:51):
Oh, that's so nice. 

Dr.Schaffner (20:54):
Absolutely. So, uh, 

Eva Sheie (20:56):
Yeah. You know, when you said Rockefeller Plaza, all I thought was 30 rocks, so now you know how old I am. 

Dr.Schaffner (21:01):
Absolutely. So, yeah, so, uh, Rockefeller Plaza of course has the tree. You have 30 rock, you have the ice skating rink, but also in the summertime there is a concert series and they bring in artists from all over to play. And so it is a real treat, uh, for those of us who are starting surgery at 7:30 in the morning, <laugh>, uh, and arriving about six. The Today Show starts at 7:00 AM and so the artists are doing their rehearsals at early in the morning prior to 7:00 AM 

Eva Sheie (21:31):
Right. 

Dr.Schaffner (21:32):
So we're literally, you know, coming out and, you know, listening to them, uh, with the rehearsal, so as you saw the video. So it's pretty remarkable. We got to see the Jonas Brothers, Ed Sheeran and others and, uh, it's a real treat. 

Eva Sheie (21:46):
Only in New York. That is fantastic. Let's take it back to, to patients for, for one more question. When someone comes to see you for the first time, what can they expect from that experience? 

Dr.Schaffner (22:00):
When someone comes to our office for the first time, we hope that they feel welcome. We know that they're going to be nervous. We know that it's intimidating. They're coming to a plastic surgeon's office. They know that we're going to be examining them, and many patients are sharing with us their concerns that they may not even share with their spouse or their significant other. They're showing us parts of their body. They may not frequently, if ever show others.

Eva Sheie (22:31):
They might not even look at them themselves. 

Dr.Schaffner (22:33):
And that's very true <laugh>. And we've had that happen where people have had, uh, for lack of a better term, botched procedures and, uh, say that they don't even take off their shirt in front of their significant other, that they get dressed in the dark, that they know don't look down when they're showering. And we do our best to reassure people that whatever their state is, that they're not alone, that there are others that have been down that road, and that in almost all circumstances we can improve upon their current situation. That it may be a multi-step process, but that we're here to support them and we want them to have an experience where they feel they have adequate time to express themselves, to share all the information where they don't feel rushed and that they don't feel judged. And the facility is designed as such to allow for that .

Eva Sheie (23:37):
And the team around you. Can you talk about them a little bit? 

Dr.Schaffner (23:40):
Absolutely. So I'm extremely fortunate to have a great team from a practice manager, a patient coordinator, a full-time nurse, operating room director, uh, and many others who provide outstanding patient care on the operating room side, a team of board certified anesthesiologists who are experienced, uh, and render outstanding care. Um, and these people really care about their job. They care about their patients. They want to make sure that people have the best experience and the best outcomes. And I think that that shared goal allows us to really provide care and quality experience to our patients. 

Eva Sheie (24:24):
If we want to learn more about your practice and get to know you even better, where should we go look for you online? 

Dr.Schaffner (24:31):
People can go online to our website and they can type in either Dr. Schaffner, that's d r, and then s c h a f f n e r.com or to plastic surgeon in nyc.com, or they can call 2 1 2 6 8 8 6 6 0 0. 

Eva Sheie (24:55):
Is there anything else that you wanna talk about before we go? 

Dr.Schaffner (24:59):
I think people should know that it's okay to want change. It's okay that they want to do something for themselves. Many people feel guilty about this, uh, and they say, you know what? I'm always giving to my spouse, to my significant other to children and feel guilty when they want to take time and spend money on themselves. And you can't be there for others unless you're whole yourself. And so I think it's important to focus on whether it's good diet, good nutrition, good sleep hygiene, uh, interpersonal relationships, but also to recognize that whether it is face, breast or body, that it is something that's important to you. That when you go to bed at night, when you wake up in the morning, there's something that bugs you. It's worth at least taking time to schedule a consultation with a board certified plastic surgeon to find out what your options are. Even if you choose not to do anything, at least you've had an opportunity to investigate, to get information. And then even if that's not a procedure that you are ready to go through, that you want to go through, you know what your options are at that time. And you can also go ahead and keep up updated. So as new developments, new techniques, new procedures, new devices, new medications become available, maybe if that's not the right time, a time in the future may be.  

Eva Sheie (26:43):
Do people come to you from all over the world? 

Dr.Schaffner (26:46):
They do, yes. Yeah.

Eva Sheie (26:48):
I can see why. 

Dr.Schaffner (26:49):
Thank you so much. 

Eva Sheie (26:50):
Thank you for sharing yourself with us today. 

Dr.Schaffner (26:52):
My pleasure. Thank you. 

Eva Sheie (26:58):
If you are considering making an appointment or are on your way to meet this doctor, be sure to let them know you heard them on the Meet the Doctor podcast. Check the show notes for links including the doctor's website and Instagram to learn more. Are you a doctor or do you know a doctor who'd like to be on the Meet the Doctor podcast? Book your free recording session at Meet the Doctor podcast.com. Meet the Doctor is Made with Love in Austin, Texas and is a production of The Axis, t h e a x i s.io.