Changing Shape
Half a century after the advent of the breast implant, Dr. Michael Stefan has become the master for helping women look and feel their best
by Bill Donahue

Fifty years have passed since the adoption of the breast implant for use in the augmentation and enlargement of the female breast. For more than two decades, Exton-based plastic surgeon Michael Stefan, M.D., has been one of the region’s foremost experts on how the breast implant and how it has shaped America’s perspective on beauty.

Certified by the American Board of Surgery and the American Board of Plastic Surgery, Dr. Stefan has performed countless breast-augmentation procedures throughout the years. He honed his artistic eye while earning a combined undergraduate degree in biology and art history from New York University, and then earned his doctorate from the Medical College of Pennsylvania. He further developed his skills by learning from world-class surgeons during a fellowship in aesthetic surgery and breast surgery at Georgetown University Medical Center, as well as from local mentors such as R. Barrett Noone, M.D., of Bryn Mawr-based Plastic & Reconstructive Surgery Associates. Dr. Stefan has since established himself as “the go-to guy” for primary breast implants and reoperative procedures, meaning surgeries needed to correct the form and function of the implant once it has reached the end of its useful life.

“I have had the privilege of working with some extremely talented people,” he says. “It was an honor working with world-class surgeons—people who have done fellowships around the world—and I was able to become competent in the use of implants and reconstructive breast surgery. I’ve gotten a reputation for reoperative breast surgery. It’s complicated, and it’s not a surgery for the uninitiated because you can actually worsen the entire equation.”

Although Dr. Stefan performs some reconstructive surgeries for women who have had mastectomies to treat breast cancer, most of the procedures he performs now are for purely aesthetic purposes. His office also performs other cosmetic procedures, such as facelifts, eyelid surgeries, fat transfer and liposuction. Regardless of the needs of his female patients, he always has the same goal: to enhance their appearance and, in the process, improve their self-image and self-confidence in the safest, most elegant manner possible.  

Q: Why do you think the breast implant has stood the test of time in the United States?
A: We all want to look our best. Breast augmentation continues to be among the top five procedures performed by plastic surgeons in the United States, and satisfaction rates are in the 90 percent range. Americans like larger breasts; we do far more augmentations per capita than in Europe or in other countries. These are all studies performed by the American Society of Aesthetic Plastic Surgery and the American Society of Plastic Surgeons, both of which I am a member.

How have breast implants changed over the years?
From 1992 to almost last year, we were able to use saline implants. It can, in the right hands, produce an absolutely beautiful result. In fact, the vast majority of implants I’ve done in the past 15 years are saline implants. Should there be a problem with that, they deflate, the saline is absorbed by the body and there’s an immediate obvious effect when that happens. It’s very easy to fix; you make an incision, take out the old implant and put in a new implant—very clean. What we have now is called highly cohesive implants, which are now available to us for both reconstructive and aesthetic reasons. It doesn’t leak, and it stays in the pocket the surgeon creates. We are trying to educate the public about highly cohesive implants, and we feel they are a quantum leap from the older implants. Should a problem occur, we can deal with that problem in a safe and effective manner.

Implants as defined by the U.S. Food and Drug Administration are devices, like a pacemaker or a hip replacement. In the majority of women who have had augmentation for reconstructive purposes—i.e., mastectomy for breast cancer—or for aesthetic purposes—i.e., small breasts that are not in proportion to the woman’s size and shape—these devices have a limited life span. I say the life span is 10 years, and that’s a conservative estimate. Let’s look at a woman who’s 24 who has breast implants. By 34 or 40, there’s a very high probability that she will need a second operation. In fact, a large study done by the Institute of Medicine, which is a branch of the government’s National Academy of Sciences, showed that the highest risk to patients who have implants is a second or third operation, not the implants themselves. We have proven definitively that implants are safe from every other perspective—i.e., they do not delay the detection of cancer, and they do not cause systemic disease such as connective tissue disease. Having said that, we have a group of patients who might have implant problems that require the implant’s removal.

What are some of the most common problems that could occur?

The most common is what we call capsular contracture. That’s where the body says, “What is this? It’s not part of me.” The body responds by trying to isolate it with scar tissue, and as that continues it will create pain for the patient. Those are indications for removal and, most likely, re-augmentation with a state-of-the-art implant. If older silicone implants leaked or had a violation of the capsule, it resulted in the movement of the liquid into the chest area, which required a thorough and sometimes extremely difficult operation to remove all the liquid and then recreate a healthy pocket for replantation of a new-generation implant. Rippling is another common problem. With rippling, the body follows the profile of the implant, so you can see the waving form of the implant; it looks very unnatural. You can put in a number of products that are xenographic, meaning they are taken from another source, such as a bovine source, and then try to put a camouflaging layer over that. I don’t really like to do that; I prefer to remove the old implants and readjust them.

I’m happy to be considered the superstar of reoperative implants. What I find remarkable is that a significant number of patients do not know that we can handle these problems in a fairly efficient manner and you do not have to live with a compromised aesthetic or result for the next 20 years.

Tell me about your “cycle of care” you have adopted to ensure patient safety.
The cycle of care for our patients is something we make a priority in our practice. We offer almost a concierge service for all our patients so they can have peace of mind, and we can have peace of mind, knowing that we’re following these results on a long-term basis. On my patients, when I do breast surgery, I see them once a year as a rule of our practice and the culture of safety in our practice to make sure what we’ve done is satisfactory and durable. We do everything at a state-certified ambulatory surgery center with highly qualified nursing staff, anesthesia provided by a board-certified physician, and that is the cycle of safety that starts with the preoperative interview and ends with an annual evaluation. I work at Lankenau Hospital of Main Line Health, which is an excellent hospital, and Limerick Surgery Center of Phoenixville Hospital, which is also superb.  

What does the future of the breast implant look like?

I think implants are safe, but I believe what is going to happen in the next decade is that structural fat grafting will take over implantable devices. In this procedure we use the patient’s fat to shape the breast. Presently we can use this procedure to increase the breast by only a cup size, but over time I think we will be able to do augmentations completely without structural devices.

Michael Stefan, M.D., Plastic Surgeon
The Commons at Oaklands
730 W. Lincoln Highway
Exton, PA 19341
610-873-7200 |

Photograph by Todd Rothstein