From Head-to-Toe to Just Breasts

My Journey From Jack of All Trades to Master of One

October 2024 | Vol. 68, No. 1
Written by Ted S. Eisenberg, DO, FACOS

During my third year at PCOM, I attended an ENT lecture that showed dramatic before and after photos of rhinoplasty. I realized that I liked the immediate gratification of seeing a significant change. During my internship, I discovered that my hands worked. When I started my general surgery residency, I already had a career in plastic and reconstructive surgery in mind. It was the one area of surgery that combined my longtime interests in design and architecture.

After I completed my surgery residency, I began two years of an AOA-approved plastic surgery training that was unfunded because an official AOA plastic surgery program did not yet exist. To pay my bills during this time, I moonlighted in the emergency room: I worked ten 12-hour shifts a month.

Starting Practice

On January 1, 1985, I started practice. I didn’t have an office of my own. Five established PCOM colleagues around the Philadelphia area generously let me use their office spaces and secretarial staff at no cost. I had privileges at four area hospitals spread out from Norristown to Langhorne to Juniata in the Near Northeast of Philadelphia.

My wife was pregnant with our first child, and I had the expectation that I was entering a lucrative profession. I was driven by the need to provide for my family. We made ends meet, but it wasn’t easy.

I did plastic surgery, from head to toe, including groundbreaking reconstruction with tissue expanders: to rebuild a nose lost to cancer and a new head of hair for a man whose scalp was scarred from shrapnel during the Korean War.

In April 1999, after 14-1/2 years in practice, I had to borrow $5,000 from my mother to pay the balance of my taxes. This was wrong. I am a plastic surgeon, for God's sake. I should have enough money to pay taxes. But at this time, reconstructive surgery reimbursements were getting smaller and smaller. At one point, I asked my congressman to intervene with Medicare so I could get paid for a breast reduction I had performed six months earlier.

In the intervening years, I learned some things about business. To supplement my practice, I became a provider for an out-of-state company that did plastic surgery referrals and financing. It was lucrative, and it worked well for a year until the company reneged on all its payments and left the city.

I became aware of a local surgeon who hired plastic surgeons to do cosmetic surgeries that he didn't want to do, such as breast augmentations. I thought this could be an opportunity to help supplement my practice income, so my wife and I met him and his wife for a dinner interview.

When we got home, we talked it over for hours and concluded that although my income could be guaranteed in this arrangement, I’d be happier working for myself. It would be an opportunity to develop my reputation.

During my stint with the referral/financing group, I had learned that I was good at breast augmentation and cosmetic breast surgery in general. I got to see immediate results. They advertised in Philadelphia, and I saw that it worked. I was ready to take a leap of faith and limit my practice to cosmetic breast surgery.

Subspecializing in Cosmetic Breast Surgery

On June 1, 1999, I told my staff about my new plan: No more general plastic and reconstructive surgery. Just breasts. They were stunned, but they realized I really meant it when later that day a woman called for liposuction, and I said no.

It was a scary plan. Could the practice survive economically with cosmetic breast surgery alone? I did have a safety net: I could always revert to my previous head-to-toe practice. I signed an advertising contract with a local radio station, and I got a line of credit – just in case. After three weeks of advertising, I did my first breast augmentation from a radio referral. I never touched that line of credit, and I never looked back.

I not only limited the scope of my practice, but I also decided to work exclusively at Nazareth Hospital in Northeast Philadelphia instead of running around from hospital to hospital as I had through the years. Nazareth is a small community hospital. It’s clean and well-organized. The staff has worked together for years and years, and it feels like a family.

Hospital and Surgical Advantages

The personnel in the SPU, Recovery Room and Operating Room got to know me, my needs, desires and protocol for my patients. So did the anesthesia team. The SPU nurses decided that one corner of the room provided the most space for me to maneuver around a patient for pre-op pictures. This has been “My spot” for the last 20 years or so.

These nurses know what I and the patients need. The patients are reassured when they have a smooth, seamless setup for their surgery. And it’s comforting to the patients when I say to them: “You’re in good hands with these fine angels.

Everybody's going to take good care of you.”

Everyone is familiar with my pre-op and surgical routine. This adds consistency to the results, which increases patient safety. And any deviation from the routine sticks out like a red flag. This efficiency cuts down on anesthesia time, which directly cuts down on postoperative nausea. Doing the same cosmetic breast surgery cases repeatedly makes it easier for the staff to cross-train each other – and adds depth to the players who are available to help.

I'm predictable. For example, OR supervisors can reliably schedule the cases because they know what time I’ll be finished. They can, with relative certainty, reassure patients and their families and give them a dependable discharge time.

Operative reports are easier to complete because only several templates are needed for the Dragon dictation and the Epic computer system. For example, a breast augmentation procedure might vary only in operative time, type of breast implants, and CCs used.

Since I’ve been doing just cosmetic breast surgery, my office staff and the hospital staff have become very versed in my needs, their needs and the patient needs. All of this contributes to each patient’s satisfaction and surgical results. 

Promoting the Practice

Years ago, I read a book about how to zig when everyone zags. The author suggested that it’s always best when you can say “The first and only.” Specializing in cosmetic breast surgery allowed me to say that I am “the first and only plastic surgeon to focus my practice solely on cosmetic breast surgery in the tristate area.” Coincidentally, I've heard my patients say, “I want to go to someone who specializes in just cosmetic breast surgery.”