Meet Dr. Tracy Pfeifer

Speaker 1 (00:03):
Welcome to Kind of Beautiful with board certified plastic surgeon Dr. Tracy Pfeifer, the podcast for women seeking the very best of modern beauty.

Dr. Pfeifer (00:17):
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. Now 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 it 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. We went to, um, Haiti after the earthquake. A lot of the injuries, uh, after something like that required plastic surgery.

(01:11)
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 it 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 of 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.

(02:02)
So they think that, which I do too, <laugh> 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. 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, uh, 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 <laugh>, and if you're not being honest with me, you know, we could crash.

(02:49)
So that was interesting. Um, but we brought some things with us, but we still didn't have a lot and we were able to care for the patients in a way that made a positive outcome for them. 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, and 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, I mean there's, 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. 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. Yes, I have dual citizenship in a free state and a not free state <laugh>.

(04:08)
Well, it really was what happened during covid, during covid in New York State, they basically said, you know, 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 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, you know, 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 non medical 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 another state to work as a physician.

(05:06)
And Florida was much more open to that than New York. Well, uh, 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, air of the Hampton. So it's open and sunny and usually beautiful except for February and March <laugh>. And, uh, yeah, it's, it's a totally different thing from the city, but 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.

(05:56)
So people like it. A lot of times they'll come out day before or stay a couple days later too, or they have friends that have houses out there. So it's a, it's a good place to be. 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 know 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, you know, pretty good communication skills. So you know, you have to be a hard worker and 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.

(06:53)
But your patients are trusting you and you have to be available to them day and night 24/7, and you have to be comfortable with that. And I think we've learned a lot over the past, you know, six or seven years how to better communicate information to the patients 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.

(07:50)
You know, and in this case we're talking about breast implants, but who knows, there might be people who have 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. 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. Um, 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 and then had subsequently um, resolved and years later she wanted to have very small breast implants.

(09:01)
We did saline filled well, all the shells obviously have silicone, but the fill was with saline 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. 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.

(10:00)
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 prop 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, it helps 'em. I just had a patient two weeks ago, I saw her yesterday and she's like, I feel so much better.

(10:43)
So good. And you could tell you look at her face, you see her attitude, you know, she's smiling more. She's 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. 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.

(11:37)
Now we have free flaps and it's all using your own tissue. And it all started with Dr. Hartran. 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. 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, a nice, uh, breast. Um, and he would present at the meetings. This was in the eighties and you know, the general surgeons would say, you know, 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 when 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.

(12:48)
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, um, yeah, we'll do one or two patients a day, couple days a week and just nice and steady. And that's what we do. <laugh>, 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 matter. I definitely do that once a week in New York City. And 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.

(14:05)
Well, I love any breast procedure, breast augmentation, reduction lift, revision of augmentation, correction of capsule 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. 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.

(15:10)
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's 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.

(16:07)
You know, overall covid was horrible, but in addition to becoming more educated also opened up 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 our breast augmentation patient because there's seems so simple and it isn't 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? 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.

(17:05)
And I think other offices, you know, it's like 20 minutes in and that's it. You can't explain everything 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 capsule or 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 more information that way, hearing it just one time.

(17:53)
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, I 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 then 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. 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.

Speaker 1 (18:49):
To learn more, go to kind of beautiful podcast.com or follow Dr. Pfeifer on Instagram at Dr. Tracy Pfeifer. Spelled P F E I F E R. Links to learn more about Dr. Pfeifer and anything else mentioned on today's show are available in the show notes. The Kind of Beautiful podcast is a production of The Axis, t h e a x i s.io.