Tracy Pfeifer, MD - Plastic Surgeon in New York & Florida

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. Hello, and today on Meet the Doctor, I am so happy to have Dr. Tracy Pfeifer, my longtime friend and former client on the show, and she works in two places now, both in New York and in Florida. Welcome, Dr. Pfeifer. Can you just tell us about yourself a little bit?

Great to see you today. Thrilled to be here. Yes, I can absolutely tell you something about myself. So, um, a plastic surgeon specializing in aesthetic, uh, surgery. I've been in practice for about 22 years. I started my journey in medicine, always knowing that I wanted to be a surgeon from the time I was a little child. I went to school in New Jersey, which is where I grew up. And then I did my general surgery residency in New York City at Cornell. And I subsequently did my plastic surgery at NYU in New York City. And then I did a breast fellowship in Atlanta. And then I've been in practice here for, you know, 22 years. And I recently started working in Florida also.

When you left New York finally and went to Atlanta, was that the first time you'd ever lived somewhere other than New York City?

Yes. Well, I grew up in New New Jersey, so, um, but I always spent a lot of time in the city. Yes, that was my first time out of the northeast other than visiting relatives in Texas. So.

Do you remember having any kind of culture shock in Atlanta?

Well, it was kind of funny because as a New Yorker we're pretty direct what we say and it took me a while to figure out that if they say, "Oh, you know, isn't she sweet?" Or that's, that meant like, oh, she's kind of, you know, off the rails. So <laugh> <laugh> for a while I couldn't figure out what was going on, but uh, I caught up pretty quickly. But they're always very polite in the south, so they would never say anything very direct that was negative.

You said you were interested in medicine from the time you were a little girl. That's not normal. Like that's pretty unusual. Do you remember if there was something specific that happened or was there someone around you that was inspiring you?

No, I really have no idea where it came from. I just, my father tells me from the time I was six years old, I said I wanted to be a doctor and a surgeon and nobody really knows where I came from. I had a great uncle who was an anesthesiologist, but I did not know him. I have no close family members in the medical field whatsoever. I always wanted to help people. So I do remember that. I remember thinking I wanted to, you know, go to Kenya and, and work in Kenya to helping people.

Did you ever do it?

No. No. There's still time.

There is still time. Have you, have you ever done any of those kinds of medical missions?

Yeah, we went to, um, Haiti after the earthquake. A lot of the injuries, uh, after something like that, uh, required plastic surgery. So we had, uh, rotating teams of plastic surgeons that were going down to Haiti. We actually were in, uh, stationed in the Dominican right across the border from Haiti and basically was a makeshift clinic that for the majority of the year was not used. It was used as an ophthalmology clinic where once a year somebody would come and do eye exams, but there were, you know, hundreds of patients there. Just, they knew there was a medical facility there, so they just came across the border and kind of stayed there and the doctors found them there. And there were orthopedic surgeons and teams from other countries. I particularly remember Spain was there and there were lots of, you know, volunteer like missionary type medical groups that were there also. It was really a very rewarding experience working with the patients. They were just very stoic and they really, they have a lot of, uh, religious faith. So they think that, which I do too, that what, what we go through here, you know, on earth is like temporary and you know, the reward is beyond when you pass and you go to heaven. So they have a very good positive attitude and it was a pleasure to be able to help them in some way.

How did that experience change you?

Oh, it made me realize, you know, how much we have here in the US. I mean, we had almost no supplies, but we were still able to take care of patients. We packed up a whole bunch of supplies with us and we had to take a small plane from the main airport in, um, Santa Domingo. I take a small plane to this area where we were gonna be working. And I remember the pilot telling me, you know, okay, you're bringing all these supplies, you literally have to weigh the bags and let me know what they are, and if you're not being honest with me, you know, we could crash. So that was interesting. But we brought some things with us, but we still didn't have a lot. And we were able to do, you know, care for the patients in a way that made a positive outcome for them.

(05:17)
So when you come back to the US and you see us, you know, opening all these sterile gauze and drapes and you know, just everything you can imagine, then even if it's clean and you don't use it or just like throw it in the garbage, it made me think that imagine what we could do if like every hospital took the things that were not touched. They were opened, but they weren't touched or contaminated in any way. And we started a collection system and we could reuse those materials. I mean, how many hospitals are there across the country? I don't even know. But it would be a massive amount of medical equipment that could be repurposed.

Were there any patients that you, I mean this was a long time ago now. How many, what, 10, 12 years ago? What year was that? 2010. Yeah, it was 13 years ago. Were there any patients that you still remember now that all this time has gone by?

Yeah, I remember a couple patients. So there were several patients who had kind of minor injuries, but they still required like dressing changes and things and their family would stay with them, you know, 24/7, they weren't gonna leave them at all. I remember a lady who had a crush injury to her leg. I remember a young girl, she really needed an amputation, but they don't have any social programs there and a lot of the streets are just dirt roads. So for her, she really wouldn't be able to get to work or do any work unless she had a prosthesis. So the prosthesis team was working with her and reassuring her that, you know, she would have a prosthesis and she would be able to walk. But it, it was very sad and it was a lot of poverty there, obviously. And there like, you know, if you can't work, you can't eat.

(06:55)
So very different from how it is here in the United States. And then we met really great teams. They were more like community activist people, but they weren't, it wasn't political and they were young people about 24 years old. And they were working with, I think it's called Engineers Without Borders, just like Doctors Without Borders. And they were bringing in water filtration systems into the local areas. Cause apparently what happens is that the big NGOs like the Red Cross, they come in, but they will only stay in the major areas of the Port-au-Prince and the major cities where there's, it's relatively secure. So they don't really venture out into the countryside, into these smaller areas because they're worried that if they come in, you know, they're gonna be assaulted or they're gonna be robbed of their supplies. So these young people were very smart. I thought they would make up t-shirts that were super bright, you know, like let's say bright yellow.

(07:53)
And they would go in as a group with these water sterilization kits that had to be set up, but the setup could be done like within an hour. And they would have their own supplies with them, like bottled water, you know, for their team. But they didn't have enough for the whole village. So they would come into the area and immediately identify like who was sort of like, you know, the alpha figure in the village and slap a t-shirt on that guy <laugh> so that the community would know that, you know, anybody in a yellow T-shirt don't touch them. Right? And then they would try to get more and more people wearing the T-shirts and then, you know, get them to explain to the people what were happening. So they'd be patient and let them set up the water filtration systems. And then, you know, they would all be online with their water buckets and you know, put it through the filtration.

(08:40)
And they had, you know, drinkable water. So very, very clever. There were dentists down there who were doing oral care even though there weren't a lot of oral injuries, but they were teaching the children how to take care of their teeth and how to brush their teeth with toothpaste. I mean, many of them had never seen a toothbrush or toothpaste. And then there were the prosthetic limb people. I remember they were from Utah, and they would come into different disaster areas, assess the need for how many prosthesis were gonna be needed, and then they would start getting them made and deliver it to the areas. So it was interesting. And there was a big orthopedic team from, I think they were from Ohio, but they were rocking and rolling <laugh>. They had X-rays set up, they had the air conditioner in their or and they were just operating like 24 7. Cause obviously there's a lot of broken bones and things that need to be fixed.

Wow.

Yeah.

Were they triaging and sending patients to the specialties that they needed? Or were you guys all just kind of doing everything that needed to be done?

Everybody just kind of pitches in, like the team stayed, like if you're from a team, from a certain country, like they stay together and they have like their own system and like they'll say, okay, we're taking care of like, kids younger than eight or something like that. People would, but it was very haphazard. It wasn't, you know, really, it wasn't one person in charge. So it, it could get a little crazy sometimes. But other areas, I think it was more organized. Like when the Israelis come in, apparently they're very good at setting up like field hospitals and they have like a barcode system and they're actually like making charts for the patients and things like that. So we didn't have that level of, um, you know, organization. But I, I think we still do pretty good.

I know humans tend to organize themselves. It's just what we do.

Yeah. You don't really need somebody to tell you what to do.

No, I know.

You know, uh, they're a little like turf battles, you know, like certain people wouldn't share their equipment and things like that. But you know, that's, those things can be worked out.

Definitely. What was it in your training that set you up well, to be able to do, to do anything really? And not just, you know, make, make beautiful breasts every day. <laugh>.

Well, you know, obviously surgical training is like, you know, you're learning your skills. That's key. Because if you can't operate and produce a good result, you're not gonna be successful. But I think the rest of it just kind of comes from who you are and how you conduct yourself. So in plastic surgery, interpersonal communication is, I think, very important because you want the patient to feel heard and you wanna really have a clear understanding of what their goals are. So that requires pretty good communication skills.

I would argue that aesthetic surgeons are exceptional at that part.

Yeah, I mean it's, it's not like, oh, you have a ruptured appendix, we're gonna take it out. There's like, right, not much to talk about <laugh>. So, um, I, I think you, you know, you have to be a hard worker. That's something that you're just born with or, you know, you find it enjoyable because medicine is not nine to five, even though some people are trying to make it that way. But your patients are trusting you. You have to be available to them day and night 24/7, and you have to be comfortable with that.

I know that you are a very hard worker and in fact, you've been going back and forth between New York and Florida for how long now?

Uh, it's been a little more than a year now, so, um, I'm enjoying that. But it's definitely is work, you know, just the travel, I mean,

Yeah. So you have dual citizenship?

Yes, I have dual citizenship in a free state and a not free state <laugh>. Mm-hmm. <affirmative>. That's right.

What was it that inspired you to try to find a place to do surgery in Florida?

Well, it really was what happened during covid, during covid in New York State, they basically said, you know, you can't, you can't work, you know, we had a three month moratorium on so-called elective surgery, which when they first announced it, I thought they meant, you know, plastic surgery, because what we do is all elective as aesthetic surgeons. But no, they meant all surgery, you know, unless you were in a motor vehicle accident or gunshot or whatever, all surgeries were canceled. Hip replacements, uh, breast cancer treatment. So that was kind of scary because there are other people who need medical care. So I said, well, if we're gonna be in a state where a nonmedical person, meaning the governor, is gonna decide who can or cannot receive and deliver medical care, I wanna have an option where I have a license in an another state to work as a physician. And Florida was much more open to that than New York.

I was thinking about other times in history or in the history of plastic surgery where you were told that you could not do something. What came to mind was when they took breast implants off the market, were you are already operating when that happened, or was that before, before you started?

That was like in 91. So I just finished medical school. I was just finishing medical school. So I was only involved in that in the sense that once I went into practice, I had access to the silicone implants because I became an investigator for one of the studies. So I was very fortunate because I did have a lot of experience with silicone implants, including teardrop shaped implants, which other people in my, you know, time period really didn't get. But I was able to be an investigator for the studies. So that was, that was good for me. So the, the, they were still under study when I first started practice. So most plastic surgeons at that time didn't have access to silicone implant devices.

And did you continue to do studies after that one?

No, <laugh>, I did a couple with that one and then I stopped.

I thought you were part of the gummy bear.

Yes, I was. Yeah, I was part of, you know, three or four studies and then, then I, I'm not anymore, you know, the studies were concluded and so that was it.

So from the beginning of your career, safety was at the forefront for you, breast implant safety has been kind of back in, in the public consciousness lately because of breast implant illness. And I wonder what if you can share your thoughts on that situation with us?

Yeah, I mean, the good news is that everybody's really focused on safety in the plastic surgery community, the plastic surgeons and the patients as well. And I think we've learned a lot over the past, you know, six or seven years how to better communicate information to the patient so they feel like they have access to information. You know, it shouldn't be like a little closed club where only certain people know certain things. So with breast implant illness, I mean, my philosophy has been since I went into practice that although we don't have any, you know, hard data at all, <laugh>, that breast implant illness exists. My position has always been that everybody's immune system is different. And we don't know if there might not be a small number of patients, or maybe it's a significant number, but I think it's probably small that their immune system just doesn't really tolerate having a foreign material in it.

(16:10)
You know, and in this case we're talking about breast implants, but who knows, there might be people who have, you know, pacemakers or hip replacements that they're generally older when they have these procedures. So maybe if they don't feel well, it's not so obvious that they're not feeling well <laugh>. But that's always been my position. And when I first went into practice, I would say most plastic surgeons had sort of the opposite viewpoint, which was that, you know, we don't have any scientific proof that there is such a thing as breast implant illness. There are no specific studies or labs that can confirm that you do or don't have it. So we're gonna go with, it doesn't exist <laugh>. So that really was the sort of position of most plastic surgeons was that, you know, the patient is quote unquote crazy. Now, as time has gone on, I've had a patient who was a physician and she also had a known autoimmune disease that really flared very badly when she was pregnant.

(17:14)
And then it subsequently, um, resolved and years later she wanted to have very small breast implants. We did saline filled well, all the shell obviously have silicone, but the fill was with sailing and her labs were normal in terms of any type of inflammatory markers. And about two weeks after surgery, she told me that she was starting to have some of her symptoms that she had had years ago where she felt kind of foggy. She couldn't think clearly. Her vision was slightly fuzzy. And I said, well, we're taking these implants, you know, out which we did right away. And um, her labs were all basically normal except for her C-reactive protein, which is an inflammatory marker. It was very mildly elevated. I mean, if you saw this in any other situation, you wouldn't make anything of it. Her symptoms got better and her C-reactive protein became normal, it was zero.

(18:12)
So that's a case of a patient who's sort of prone to inflammation and she definitely reacted to the presence of a foreign body. So I always tell my patients, if you feel like you're not well, we work you up obviously to make sure that there is no diagnosable, you know, problem that could be treated like some type of inflammatory process or lupus, whatever it could be. And then if we wanna take them out, we'll take them out, we'll take out the capsule too. And there's probably a 50/50 chance that you're gonna feel better now, even if they feel better. It could be just that you feel better like a placebo effect because you have the implants out and so you think you feel better, but this patient still feels better. So it doesn't really matter why they feel better <laugh>. And as long as the patient goes in knowing that they may not feel better, which they do, they're, it, it helps 'em. I just had a patient two weeks ago, I saw her yesterday and she's like, I feel so much better. So good. And you could tell, you look at her face, you see her attitude, you know, she's smiling more. It's just, just, she's definitely a happier person. So I think she does feel better, and I don't really worry too much about whether or not it's actually physiological or if it's a placebo effect. It doesn't matter. So I'm glad we're having these discussions with patients and we're more open about it.

I'm glad that surgeons are listening too, because I don't think it was a good look to the public that they were all, there was a group that was very dismissive.

Yes, they were very adamant about it and would try to make people feel that they were, you know, not scientific and you're not going along with their mainstream thinking. So anytime somebody starts thinking a little bit outside the box in medicine or really in anything else, you know, you sustain a lot of criticism for that. The person that I trained with for breast surgery developed a tram flap, which was used to reconstruct a woman's breast after she had a mastectomy, you know, using her own tissue. And it was a very successful operation and really developed this whole, it was the foundation of a whole way of doing breast reconstruction. Now we have free flaps and if it's all using your own tissue, and it all started with Dr. Hartrampf and in the beginning they would have to take part of the rectus muscle, one of the sit up muscles to use as the blood supply to the skin.

(20:32)
You would basically take the tummy tuck skin and tissue and keep it attached to the muscle and move it up to the breast and that you could shape it and it would be a nice, uh, breast. And he would present at the meetings. This was in the eighties and, you know, the general surgeons would say, no, this is crazy. You're destroying the abdominal wall. You're gonna weaken it. The patient's gonna get hernias. I think he did over 800 cases and he had like four hernias, because it depends how you close the area where the muscle used to be, whether or not you're gonna get hernia. If you pay attention to the detail and close it in the, the proper abdominal layers, you're not gonna get a hernia. So, and he would, was widely criticized and, you know, took the beating, so to speak, and advanced, uh, the treatment methods and really helped, you know, thousands and probably hundreds of thousands of patients through all the people that he trained, you know, around the world to help all their women patients.

Still around?

No, he passed away a couple years ago. He was a great, great person.

Yeah, I was gonna say, I would love to interview him if he's still here.

Yeah.

Can you estimate how many patients you've had over the years in total? How many breast augmentations have you done? Or breast surgeries?

Yeah. It's hard to estimate. I, I mean, it's gotta be thousands, I don't know how many thousands. I'm not a person that does, you know, six cases a day because I like to pay a lot of attention to each individual patient. And I don't wanna have like a heavy schedule and you're worried about, you know, getting done and what time you're gonna finish. I don't like to work that way. So yeah, we'll do one or two patients a day, a couple days a week, and just nice and steady and that's what we do. <laugh>.

What's your weekly routine kinda look like? Is it the same in both places?

Pretty much, yeah. We usually have, like I said, I'll do surgery usually three days a week, sometimes four. And then we have, we'll either have one dedicated day in New York City for only patients. I mean, I definitely do that once a week in New York City. Then on Long Island, sometimes I'll do a full patient day where I'm just seeing follow ups and new consults, or sometimes I'll just be operating every day and then we'll see patients for follow up and new consults at the end of the surgical day. It just depends on, you know, mostly the, OR schedule. And then I like to do injections also, and we're gonna be introducing some new things into the practice with some cool peels and stuff that we found out about. And lately I've been doing bioidentical hormone replacement, which I think is super important for women and men. And, uh, we're growing that side of the practice as well. So keeps us busy.

Mm-hmm. <affirmative>, I know we said you were a dual citizen of New York and Florida. Where exactly are your New York offices and then where is the one in Florida?

Well, New York is on fifth Avenue in Manhattan, so that's on fifth and 94th Street right across from Central Park. It's a beautiful location. And then the office on Long Island is in a town called Quogue, which is, uh, an Indian name, Q U O G U E. And it's out in the, uh, area of the Hamptons. So it's open and sunny and usually beautiful except for February and March. <laugh> <laugh>. And, uh, yeah, it's, it's a totally different thing from the city, but everybody, you know, I love it out there. I love it in the city. Both places are great, but it's nice to get out of the city. Even for the patients, they like to go out there and have their surgery because it's just, you know, it's just a lot of sunlight and, you know, very cheerful, kind of casual vibe out there. So people like it. And a lot of times they'll come out day before or stay a couple days later or two, or they are friends that have houses out there. So it's a, it's a good place to be.

So is most of your New York surgery happening out in Quogue then?

A lot of it is. Mm-hmm. <affirmative>? Yeah, I would say probably 70%.

What's, so what do you do when you're in the car doing all this commuting? What's your favorite activity while you're doing windshield time?

I actually li I listen to things, you know, I listen to um, YouTube videos, but like, you know, long ones where somebody's talking about, lately I'm into listening to different priests on YouTube. There are these priests that do exorcisms and I'm listening to them. I find it very interesting. <laugh>, I listen to, you know, political shows, you know, talking about things like, uh, the people who are in favor of the great reset and uh, new world order. I listen to people who talk about the Federal Reserve and you know, the current banking system that we have. And I started doing all this during Covid cause I didn't have anything to do <laugh>, so I learned a lot during Covid. I listened to a lot of shows about Covid and the vaccine and I read a lot of books about that too. But there are certain people that I listen to, like Dr. Robert Malone, I listen to Robert F. Kennedy, a lot, because he's very familiar with the vaccines and how they're made and some of the problems that we have with vaccines. So that's what I do.

Yes, fluffy, light topics, very relaxing. <laugh>.

Yeah, I'm a Sagittarius. We always like to learn, so we're always interested in things. We're always learning new things. Everything's fascinating to us. That's just, we're just like that. We're like little kids in that way.

I have to know how everything works or I,

Yes.

Yeah, obsessed. So what procedures are your favorite? What do you love to do and and why do you love them?

Well, I love any breast procedure, any breast augmentation, reduction lift, revision of augmentation, correction of capsular contracture. I just love that it's very creative. You know, every patient is different. So every solution is different. It's not cookie cutter at all. I also love doing tummy tucks. Um, they're more a little bit more cookie cutter in terms of, you know, the surgery, but you really help women and they really feel a lot better after they have these done because they just don't feel like themselves. You know, usually after kids it could be weight loss too, but you know, they remember what they used to look like and they wanna get back to that. So it's very, very rewarding. And breast reductions, I would say are the most rewarding because it has the most dramatic impact on the patient's life in terms of their physical feeling. You know, that they don't have pain anymore in their shoulders and neck and back.

(27:32)
But also they just have less self-consciousness. They feel more confident in their clothes. They're not, you know, for young people, they're not drawing unnecessary attention. I mean, even for older people, but especially hard for teenage girls, you know, college aged girls to draw a lot of attention. They go to the beach, they're wearing an oversized shirt cause they don't wanna wear a bathing suit. I mean it just, I can't tell you how many pictures I have of, you know, right around prom. Sometimes they wanna get it done too. And you know, they show me their prom pictures and they're so happy and it's just really night and day. But it's true of all patients, of all ages. It doesn't matter if you're 20, 40, 60, even 70, it, it is a life-changing operation. So in terms of patient satisfaction, I would say breast reduction is probably number one. But for me I love doing all of them cuz they're all creative and they, you're helping all these people, every single one.

What can your perspective patient expect when they come to see you for the first time? And can they do that virtually or

mm-hmm. <affirmative>.

Yes they can?

Yeah, that was another, you know, overall Covid was horrible. But in addition to becoming more educated, it also opened up, you know, options for patients in terms of office visits. It wasn't something that we had really offered before. We would occasionally do it if somebody was like from California or Michigan or something. But yeah, they could do a Zoom consult or they could come in person. We usually take about an hour either way, no matter what the procedure is. I like people to really understand, you know, what's involved and sort of the pros and cons. And the longest consultation is most likely a breast augmentation patient because they're, seems so simple and it is in a way, but there's so much to know about implant choices and what's the pocket gonna be under, over the muscle. Where are we gonna make the incision? Might you need a revision surgery and why?

(29:31)
So there's a lot to go over with patients and I think we do a very good job of that because I really do spend the time with them on it. And I think other offices, you know, it's like 20 minutes in and you know, that's it. You can't explain everything, um, in 20 minutes. And that's one of the things that I'm hoping to achieve with our podcast series is to give another way for people to find out the information so they could pop it on in the car or listen to it. Because it's a lot of information that I give during the consultations and you can't really keep track of all of it, especially if it's the first time you've heard it. So it's nice for the patients to either listen to the podcast about, for example, let's say capsular contracture that can happen with breast implants or you know, how do we pick the right size and listen to that either before the appointment and or after the appointment. And I, I think you can absorb more information that way. Hearing it just one time. I don't know how much you can absorb. Maybe 60%, I'm just guessing. Yeah, yeah. So a lot of time. So definitely plan accordingly. <laugh>

On your podcast, this is actually one of the very first episodes that we will do is about the breast augmentation consultation. And our hope is that anyone who listens to that can come in already knowing most of the things that you're gonna say so that you can have a richer, deeper conversation in person.

Mm-hmm. <affirmative>.

So yeah.

Absolutely.

That's gonna be great. Where can we find more information about you?

Um, you can go to the website, uh, www, whatever it is, Pfeifer, d r p f e i f e r.com. And I used to have a breast, uh, revision site up, but we're not really using, using that one any. Yeah, I know you built it and it was like number one, but there's revision surgery patients in the galleries on the, on the main website too. And we're hopefully gonna be updating the website and adding some more areas about the bioidentical hormone especially. But the website has a lot of pictures and you can search by patient age or what cup size you want, especially for augmentation. That search feature is really helpful. But during the any consultation when people come in, we always encourage them to bring their own pictures of things that they think are pretty, whether it's tummy tuck, or breast reduction, or breast augmentation surgery, want to see the aesthetic sense of the patient. So they could get pictures off of my website or they could go on other people's websites as well.

And also your Instagram, which is,

Instagram. Yep. We post some things on Instagram too. We're gonna hopefully expand that a little bit. But yeah, there's things on Instagram and you can always call the office. I mean, we're always happy to talk to people and give them information. I mean, you don't have to necessarily come in for a full consultation. You can ask some, you know, basic questions to the staff. They'd be happy to answer it.

Who was on your team that we might encounter if we pick up the phone and call?

Okay. Well, in New York it's Maureen and Arlene. So those names sounds similar, but Maureen and Arlene. And then out in the Quogue office, Arlene also works out there. And then Kelly and Rafaella are, and we've had a team since, in Long Island, since 2011, and Maureen's been with me since, wow. She's been with me a long time. I think 2007, something like that. So we've had, our team has been in place for a long time and I'm very grateful for that. They're terrific. The patients love them, they love taking care of patients, and we're all on the same page when it, when it comes to our culture in the office with regards to how we treat and respect our patients.

That's great. You can't do it without them.

(33:17)
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