Let’s talk about breasts, baby. Dr. Jaime Schwartz on founding the Beverly Hills Breast Institute.
The Beverly Hills Breast Institute is described as a patient-first and comprehensive breast surgery center that combines the safest and most advanced aesthetic and reconstructive principles. intrigued by the idea of a center that focuses solely on breast surgery, I met with Dr. Jaime Schwartz, MD, FACS in his Rodeo Drive office to learn about his background and the vision behind the center he founded and his dedication to plastic surgery.
Dr. Schwartz graduated from Georgetown Medical School, where he trained extensively in breast cancer and genetics under a former president of the American Society of Plastic Surgeons who he says “based his whole world around breast cancer reconstruction.” With a residency at Georgetown and then a fellowship at the Cleveland Clinic, Dr. Schwartz did 7 years of training solely focused on plastic surgery (3000+ surgeries) as opposed to a 2 year specialization following general surgery training, which is more typical. A member of the American Society of Plastic Surgeons, he is the founder of the Beverly Hills Breast Institute.
Dr. Schwartz shares with me his expertise on breast cancer reconstruction and facing a cancer diagnosis, the new cohesive gel “gummy bear implants,” and what to look for in a plastic surgeon.
What led you to founding the Beverly Hills Breast Institute?
Dr. Schwartz: When I was in medical school I was exposed to breast cancer reconstruction very early on and that is kind of when I found plastic surgery. I was recruited out to California to build a breast cancer reconstructive program for a hospital system, and I did that for many years. What I learned was that breast cancer reconstruction, or even breast surgery in general, is not something that gets really focused on. It’s sort of a by-product of things that happen. My idea was to create somewhere where you can go and understand these things and have a comprehensive approach.
How closely do you work with oncologists? Do they give you recommendations for surgery?
Dr. Schwartz: Very closely, but I don’t recommend the oncological treatment. For breast cancer, you are typically part of a team and that is what I like to do. When you look at the patient in the center, we all have the recommendations for how we will go about doing things--If there will be radiation or chemotherapy or what size breast they will have, the chain of what their medical health is overall.
With the procedures that you do, which ones put you at risk of losing sensation in or even losing the nipple completely?
Dr. Schwartz: Depends on how much of the breast is being removed. Your skin and your nipple and your areola get blood supply and nerve supply from the breast tissue. If you have a mastectomy and that is all removed, you are going to be numb because you are losing the nerve supply. The other thing that you are at risk for then is complications and healing problems if the skin is not getting enough blood supply or oxygen. That is one of the complications we temper and deal with.
There are other ways to treat things, if someone is going to have a lumpectomy we can do something called an oncoplastic reconstruction. All that means is if a portion of your breast is being removed, I can do a breast reduction or a breast lift and almost fill that area in with breast tissue as if we were doing a regular breast reduction or lift. At that point, you should maintain all your sensation, but not necessarily 100%.
If you are having a mastectomy and your complete breast is removed, you can use your body’s tissues. You can use your stomach, your back, there are a lot of other things you can do to replace it which are more autologous or natural. The other thing you can do is fat grafting, we can remove the fat and put that into areas too. The most common reconstructions in the US are using expanders or implants because the other surgeries are usually reserved for when you have problems with healing or other things like that, that is how I do my practice.
For people facing a breast cancer diagnosis, what does the road ahead look like?
Dr. Schwartz: The truth is, the road ahead is going to be fine. The average person does extremely well, as long as you are diagnosed early that is the most important thing. If you are diagnosed early, your survival rate is really really high. In terms of reconstruction, there could be some bumps in the road, but ultimately you will get to where you want to be. It is a lot harder to reconstruct the breast than it is to augment it because somebody may have chemotherapy, radiation, and all these other things that get involved.
You are are a national trainer in the new cohesive gel or “gummy bear implants”-- what makes them unique?
Dr. Schwartz: We always had saline implants. In the early 2000′s silicone implants were taken off the market for cosmetic procedures and just used for reconstruction. 2 years ago we got approved for what is called the gummy bear or cohesive gel implant. Silicone can be in liquid or solid form; it’s all based on the molecular cross-linking. The cohesive gel is just more highly cross-linked in terms of their molecules.
If you took a gummy bear and bit the head off, it wouldn’t change shape at all. That’s what it is with these implants; if you cut or rupture the implant, it maintains that shape. Because of that, it is a little more complicated to use. It comes in a height a width and a projection, you have to really fit this to your body. You have a little more forgiveness with the roundness, but with this implant it has to fit perfectly so that’s a bit of a tradeoff. I tell people there is no perfect implant on the market, I educate people and then they understand. The cohesive gel seem to be more of a natural look, less fullness at the top more of the fullness is directed at the bottom. My older patients or those who have had children tend to gravitate for that. I do a lot of reconstructions for patients who have had bad plastic surgery—5, 10, 20 procedures, and when I am reconstructing breasts for them I tend to use these as a base for them. For my younger patients coming in before 25, they really tend to choose the round silicone implants, they are softer and more full at the top, for lack of a better word it’s a more “fun” implant.
Lifespan for implants?
Dr. Schwartz: I recommend that between 10-15 years you should start thinking about swapping them out. Studies show that after 10 years that is when the possibility of implant problems begin to happen. They are not lifetime devices. People do live them in long term, but I tell people that if you are my family member I would probably recommend that 15 years is about the right time. If you look at people when they are having breast surgery anyway, say you have a breast augmentation at 20, by 35 you will need them replaced and most likely by that time you have had children. At that point, your breasts may be sagging from breast feeding so you can switch the implant out and do a breast lift.
For people with bad surgeries in the past, what are the main things that have gone wrong? What should they look for in a plastic surgeon?
Dr. Schwartz: That’s the million dollar question. I think price is something—do that with your car or computer; don’t do that with your body. With a board certified plastic surgeon, you have a better chance of doing well.
In CA, we see people going to cosmetic surgeons. They have medical degrees, but they are not plastic surgeons—I did 7 years of just plastic surgery training. Some of these people take a cosmetic surgery course over the weekend and next thing you know they are advertising that they are a cosmetic surgeon. There is something about experience and time. For me to become a board-certified plastic surgeon I had to take a written exam and an oral exam where they reviewed a year’s worth of all my cases to make sure I was competent enough to proceed. I think that certification was one of the hardest things I ever achieved in my career.
On top of that, I think it’s a personal connection with people. There are some people who do a lot of sales pitches; we keep a normal straight practice, and if there are people who need help, we fix them. I let my patients talk to old patients of mine. Not that everything always goes right with your patients, but I am there for them and it’s more of a partnership instead of one surgery and we are done with things. I don’t perform a breast augmentation and never see someone again; I make sure people come back and see me yearly. I think the connection and the follow up is as important as everything else.
Dr. Jaime S. Schwartz, MD, FACS
Founder of the Beverly Hills Breast Institute
(310) 882-5454
http://www.beverlyhillsbreastinstitute.com
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