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Response to Real Self Review

PLEASE READ!! Choose surgeon wisely: Awful experience (22 yo, Breast Reduction lift w/implant & Rhinoplasty) – Miami, FL
Where to begin…In August of 2015 I decided to have breast reduction surgery along with a rhinoplasty. I was 20 years old at the time and had 36DD saggy breasts, and had a small bump on the bridge of my nose. I decided to go with Dr. Hochstein because he had some of the best pictures online and his reviews on sites like this were all positive, and patients seemed to be content with their results. This surgery was a big deal to me. I had never been ill, never had any injuries or surgeries prior and was about to undergo a massive surgery that would forever change my life.

Right off the bat, during my first consultation, Dr. Hochstein was very distant and almost robotic in nature. I undressed, he assessed my breasts from at least 3 feet, and after perhaps 30 seconds stepped out to present me with his solution to my problems. He essentially just mentioned that I needed a breast reduction with a lift, and an implant would be wise and he would also reduce the size of the areola. All I needed from this step was to proceed with scheduling and payment, and bring in a picture of my ideal breasts and nose on the day of surgery.

Fast-foward a month or so, and it was surgery day. I was nervous and anxious, as anyone would be under the circumstances, and Dr. Hochstein did nothing to comfort me. He simply walked into the pre-op room, FOR THE FIRST TIME, physically touched my breast, to mark up incision sites, and was gone after 5 minutes. At no point did he reassure me that all was going to be fine. Fast forward, I went into surgery, came out, and I was sent out the door. He didn’t go see me after anesthesia wore off, or even tell my parents that the surgery went well.

The day after surgery, I had to go back to the office to remove the surgical dressing from my breasts, and so that he could remove the gauze that was stuffed inside my nose. As you can imagine, I was uncomfortable and in pain, and the nurse did not take this into consideration when removing the surgical dressing (she wasn’t gentle). To make matters worse, the doctor finally walked in to remove the gauze from the nose. He instructed me to lie straight on my back, and instead of assisting me, (because I was very sore and in extreme pain), he was almost rushing me as I was trying to lower myself without the use of my arms (post-op instructions) to help me lie on my back. He then, proceeded to literally RIP the gauze out of my nose, without any warning that it was going to be very painful. As you can imagine, I left that day in a lot of discomfort.

Seven days later, I had to return to the office to remove the casting from my nose. The removal wasn’t painful, and I have to say that I am truly content with my rhinoplasty results. That same day however, I asked the doctor a question about the appearance of my breasts. My breasts were very cone-ish with virtually no shape, and almost looked like pecs. I respectfully asked him if this was normal, and he flat out said that he didn’t understand my question. Instead of just further reassuring me that, this is expected a few days and weeks post op and that my implants will fall into place overtime, he just blatantly acted like he couldn’t see what I was seeing and that my breasts weren’t oddly shaped.

A few weeks pass, and my breasts were very irritated and warm, (turns out I was allergic to the surgical tape, to my discovery), and I was told not to come in, to send the pictures to the doctor. Per usual, the Dr. didn’t see anything wrong with my pictures, and I was not told to come in so that he could further assess the situation.

A week after that, I noticed a strange odor coming from my surgical tape. I realized that the incisions around BOTH my areolas had opened. One areola in particular, even had some breast tissue exposed. I once again contacted the office, was told to send the picture to the doctor and he would decide what to do. Once again, EVERYTHING was great and just to wash it multiple times a day etc.

Overtime, more incision sites opened up and I formed Keloids.

I do not blame Dr. H for the keloids that I formed or for the fact that my incisions opened. I understand that this could all be because the implant dropped too quickly, and I know that everyone’s body reacts differently, especially when a foreign object is placed. My problem with Dr. H is how he treats these matters and his patients.

I went to every post op check-up, and every time I asked him if it was normal that one breast was much larger than the other, that the ends of my incisions were lifted as if someone was pulling on them, that if it was ok that my nipples were placed too up, or that if there was anything I could do to help reduce the keloids that were developing.

EVERY SINGLE TIME I was treated as if I was unreasonably questioning his work of art, because after all, he is the “boob god”. He was condescending and would consistently tell me that there was nothing wrong. That he couldn’t see what I was seeing, as if I was blindly reaching these conclusions, to the point of trying to make me feel as if I was delusional. I’m assuming his approach is to repeatedly tell his patients that all is great, so that they can start to believe it as well. I’m not sure if perhaps Dr. Hochstein is the one that is deranged, but I am fully capable of assessing what is wrong with my body, beyond what is supposed to occur naturally vs something that is a result of the surgery. As a doctor and as one of “the best” he should be capable of holding himself accountable for his mistakes, or at least provide some sort of remedy to alleviate the keloids at least. There is nothing he can do now about lowering the placement of my nipples which are way too high, but he could’ve suggested something for the very noticeable difference in size of the breasts.

Every visit, I was told to give it a couple of months…well it is now a year and half later, and I have to undergo surgery once more (with another Dr.) to correct everything that went wrong with Dr. H. After various consultations with many doctors, I was told that Dr. H should have never even put an implant in the first place because I had more than enough breast tissue to work with, secondly, he removed WAY too much of my natural breast tissue. I am now left with implants that outweighs my breast tissue, and thus my breasts are sagging once again (and have been sagging since 6 months post op). Apart from this, based on how my muscle contracts, the implants have been pushed out and is no longer inside the sac under the muscle.

In conclusion, I had a horrible experience before, during, and after my surgery with Dr. Hochstein. His office is truly a surgical factory, where patients are just another number, another check in his bank account, and he has no care or consideration for the patients and their concerns before or after the surgeon . He’s not approachable, not comforting, almost programmed in speech, and has a superiority complex, that far outweighs any doctoral degree that he may have up on his wall. He comes off cold, rude and tries to be so formal and distant in something that is intensely personal, so personal that his hands will literally be molding your body. Dr. Hochstein may have a lot of medical knowledge and thousands of surgeries as experience, but he has to learn about person to person contact and interaction. A doctors bedside manner is crucial, especially when a patient is paying >$10k. You are paying for his expertise, his time, and his effort into achieving your desired outcome. To be treated as someone that is merely taking up his time, and is ludicrous in even asking him a question about his work of art, is not acceptable.

Although he was successful in fixing my nose, and even if he were successful in correcting some of my breast deformities, his approach to patient care and his bedside manner heavily negate any positive surgical outcome.

Please do your research, and consult with MANY doctors before setting your mind on just one, especially Dr. Hochstein.

Dr. Hochstein’s Response:

When reading a review like this I had to ask myself could these things really be true. It had been a while and I had no clear memory of this patient as apparently she never made me aware of how unhappy she was so I went back and reviewed the chart.

Based on my review I learned that the things she mentioned in the review were untrue but I would never ask anyone to take my word for it. I would like to explain what happened and will use the postoperative pictures to explain how the healing from the surgery should and did occur.

Let’s start from the beginning. I do understand that surgery is life changing and important. The way I approach my consultations is to be as professional as possible. It is not a time for joking. People come to me for straight answers and my recommendations based on over 22,000 breast implant surgeries. It is that experience that brings patients from all over the world for my advice. I take this responsibility very seriously. If you want a best friend I am not your surgeon but if you are looking for the best consistent results than you are in the right place.

Based on this case I recommended a breast lift with implants and a rhinoplasty (refer to pictures 7/15). On the day of surgery I personally speak to and mark my patients. I also take the time to explain the marks in front of a mirror. Writing that I did not specifically say “everything was going to be fine” seems a bit unfair. I assume that people choose me for my track record (0 malpractice suits and 0 penalties by the board of medicine) but I can assure that if she had asked I would have done more to reassure her, it’s simply that most people don’t request it. I do not visit patients in the recovery room routinely but I do call every patient the night of the surgery to check on them as I did in this case.

The next day this patient’s characterization could not be any less true. First, I place my hand on the patients back to gently support them as they lay back and the packing is gently, slowly, and smoothly removed. Ripping it out would have created potential damage and is something I have never nor would I ever do. The fact that she wrote this was my first clue that what was to follow would likely not be accurate. Fortunately the pictures will tell the full story. I routinely tell patients that the breasts will change over the next several months and never look good in the beginning so for her to say that I thought they looked normal from day 1 is not true.

The first picture post operative was roughly a month later is very clear. There is no rash or unusual redness as the person alleges. There is a small opening at the left areola which is consistent with a spitting stitch which is very common. There was no rash, there was no infection, and the wounds did not open. My advice of keeping everything clean without any further treatment was the correct diagnosis and treatment plan.

The rest of the review is just as accurate as the beginning. She showed up for only two other post op visits and actually skipped most of the appointments she had. I do not tell my patients that “everything is great all the time” but what I do tell them is that there are timelines to healing and breast evaluation.

The last set of pictures are the 3 month pictures as the patient did not show up for the latest post op visits and I will now give my assessment which was identical to the assessment I gave the patient. The scars: there are no keloids. On the contrary for 3 months they look terrific since the color and thinning of the scars can take 2 years.

Nipple position: exactly where they should be and symmetric (note the spitting stitch opening has healed and now there is not a sign that there was ever an issue. There is some mild stretching of the skin at the lower breasts and would likely need to be tightened which is certainly not unreasonable considering the amount of excess skin she had starting out but it is too early to do so. She had some minor dog ears at the outer parts of the breasts but at 3 months is likely to resolve on its own but if present at 6 months(not likely) it would have been corrected. She has a size asymmetry but at 3 months it is too early to tell and I would need to evaluate at 6 months to see if a revision there would be necessary. If there would have been an asymmetry at the 6 month mark (again not unreasonable considering how asymmetric her breasts were to begin) I would have performed the revision at no charge (written policy).

The remainders of the review are technique comments and I will address them. Using an implant is certainly optional but always gives a better result. Saying that she had enough breast tissue to work with simply shows a lack of understanding of breast surgery. Although she had plenty of breast tissue, it was mostly hanging down to the abdominal area. It cannot simply be repositioned. The only long term solution is removal and replacement with an implant. Any other option would have resulted in a terrible sag within a year of surgery. The implant itself was relatively small (only 339cc). Had there been a less sag, I would have removed less tissue. I tell all patients with implants to do no chest exercises and the last pictures I have show the implant pockets to be in perfect location. The only way they could have shifted is if the patient did not follow my recommendations.

It is true that I am serious about my work but I am there to answer any question at any time. This patient’s description about how I treat patients is as accurate as the rest of her review. Fortunately in this case the pictures tell a different story.

Leonard M Hochstein MD

real-self

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Leonard M. Hochstein M.D.
Address: 585 NW 161st Street, Miami, Florida 33169
(Miami Metro)
Telephone: (305) 931-3338
Fax: (305) 931-3324

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