Talking with a Plastic Surgeon About Breast Reductions | Pelvis Party

Welcome back to the Pelvis Party! Today, Dr. Mahsa Smoot, a plastic surgeon at Olmsted Medical Center is back again to talk with Britt and Becky about common concerns and questions about breast reductions and Becky shares her personal experience with the procedure.

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Transcript

SPEAKER_01 0:00

Um, I just say that because I want to encourage women that if you've ever thought about this, it is worth a call. It is worth a phone call just to see, just to know if you're a candidate. You do you owe it to yourself to feel the very best way that you can. And there are a lot of things that you cannot do to change the size of your breasts. Um, and so I I just again, this surgery changed my life.

SPEAKER_00 0:37

Welcome back to the Pelvis Party. I'm Britt, today's host of our episode, and I am joined by Dr. Mafasmoot and Becky. And today we're talking about a few things within the realm of plastic surgery. So let's start at the beginning. What made you go into plastic surgery in the first place?

SPEAKER_02 0:56

Mentorship. Um, as I was going through my residency, one of the rotations that I selected, actually before my residency, when I was still in medical school, one of the rotations I selected was in plastic surgery. And honestly, the main reason I chose the rotation is because it was close to my parents. I went to medical school in Australia. I wanted to come back and be a little bit closer to my parents, at least for a few months before going back to Australia. And this rotation was in Arizona. And although I was assigned to the program director for that plastic surgery program, one of his colleagues, who was a young plastic surgeon in private practice, kind of took me under his wing. He was very much into teaching, very enthusiastic. Um, and he saw it as an opportunity to kind of show a medical student what plastic surgery is about. And like most people, I thought of plastic surgery, I thought of it as what you see it in the media. You know, I thought it was mostly aesthetic surgery, mostly elective cosmetic stuff. Didn't really have a good sense of what the specialty was about. And so he took me around, introduced me to his colleagues, kind of showed me the other side of plastic surgery, and introduced me to a plastic surgeon who was working at the same hospital, who at the time I did not know, but is very world-renowned for facial reconstruction and nasal reconstruction. And he let me hang out with this plastic surgeon for a few days. And that kind of opened my eyes to the possibilities and the breadth of the specialty. And that's where it started. That's where I was like, wow, all of this is plastic surgery, reconstructive surgery is plastic surgery, pediatric surgery is plastic surgery, cosmetic surgery. And that kind of piqued my interest. The the diversity, the the breadth of the practice, everything that you can do. I think um partly because of my background in general surgery. My my first residency was in general surgery. I'm very comfortable with body, and hence, uh, and also because I'm a woman, I I tend to do a lot of breast, whether aesthetic breast or breast reconstruction, um, abdomen, abdominal wall reconstruction, um, post-pregnancy changes, uh, tummy tucks, whatnot. Um, it's an area of the human body that I'm very, very comfortable with. And I also trained as a craniofacial surgeon, and so I'm also very comfortable with head and neck, face, scalp reconstruction, and things like that. So I find myself, some of what you end up doing is essentially the needs of the geographic area and the practice you end up working at. I am in community practice, and hence I find myself doing a fair bit of uh reconstruction after skin cancer removal, aesthetic surgery, eyelid surgery for people who have difficulty seeing once eyelids get droopy, breast reconstruction, breast reduction, abdominal wall reconstruction, all of those things.

SPEAKER_00 4:05

We are so excited to have you today, and we're gonna dive deep into a couple of those topics and hear some real patient experience. How did you land in Rochester then? It sounds like you've had quite the experience traveling around, which is amazing, but why Rochester?

SPEAKER_02 4:20

Uh, Mayo Clinic. Uh, as I was looking for opportunities in residency, um, uh one of my last rotations in medical school was at the Mayo Clinic in Scottsdale, Arizona. And um the program director in general surgery there kind of uh suggested that I consider the Mayo Clinic in Rochester because they were more open to taking foreign medical graduates or they had more spots available. Um and that's how I ended up matching into the um initially it was what they call the preliminary general surgery program. And eventually from the preliminary, I was able to um match into the categorical program, which is the the contract five-year program in general surgery. So I ended up in Rochester mainly because of the the Mayo Clinic and the opportunities it provided in terms of training.

SPEAKER_00 5:10

Well, let's get into the topic for today, was which is breast reductions. And we have Becky, our very own co-host, who is here to help us understand what her story with a breast reduction was like, and then obviously our expert to weigh in on the process together.

SPEAKER_01 5:26

Becky, not only the expert, but my surgeon. Yeah, so it's interesting being in the hot seat. Usually I'm in the hosting role, so roles are reversed today. So it's it's I'm gonna I'm gonna try and dial in my inner guest. Um, but you know, Dr. Smoot and I uh have met prior to my breast reduction surgery, and I had been into the department for this, that, and the other thing. And actually, one of the fun things that I remember is um the first time I saw Dr. Smoot, she came in and she's like, I know you. And she knew the website, and she said something, you said something so kind, and you made me cry. You made me cry. And you gave me a tissue, you're like, oh, don't cry. That was so nice of you.

SPEAKER_02 6:12

So I told me I was a little starstruck.

SPEAKER_01 6:16

She told me she was starstruck, and I was like, What? This is crazy. So it's um, it's been, you know, a relationship since then, and I think that's really important. And something that's really um, I think so wonderful about OMC is that you're able to develop relationships with the people that care for you. Um, and so it was really comfortable when um that really it was this past spring. I just said, why am I living like this? Um, I need to do something about this. I had really large breasts, and so I just dialed into the department and I said, you know, I want to just see if this is if this is even an option for me. And the reason why is because I had already had a breast reduction. I had one in my 20s, and life happens, right? Life happens, you have kids, you gain weight, you lose weight, you, you know, all a measure of things, and my breasts had grown back, which they can do. You can have more tissue, and you know, these you I and I was basically back at the size that I started, and I was miserable because my life had changed.

SPEAKER_00 7:23

Yeah, my life had things like this. But what does that mean?

SPEAKER_01 7:26

Yeah, it was there was the they were so heavy. They're so heavy. It affects your self-esteem, it affects your profile, it affects how clothes fit, it affects not only that, but it affects how you move. Um, we're active, we we travel, we are outside, we we hike and we enjoy the outdoors, and having a heavy weight on your front, it can be debilitating. And so it was time. And so then that's when I came in to talk to Dr. Smoot about what do we call them, a secondary uh a second surgery.

SPEAKER_00 8:06

So posture, the weight of breasts in the front. What are the medical aspects of that, Dr. Smoot, that you look at when you are having a consult with a patient?

SPEAKER_02 8:15

A lot of women don't realize that chronic upper back pain, chronic neck pain, shoulder pain, grooving from bra straps that dig into your shoulders, sometimes even numbness and tingling in the fingers could all be related to a disproportionately large chest. Um, heavy breasts, heavy and pendulous breasts can contribute to all of those problems. And sometimes a breast reduction can really make a huge impact in terms of quality of life. Because if your back pain improves, if you can't, if you have a better posture, if you don't have straps digging into your shoulders, then you can move better. You're more comfortable being active, you're more comfortable participating in activities of daily living. You it's much easier to find clothes that fit properly.

SPEAKER_01 9:03

All of those things were certainly my experience, especially chronic upper shoulder, back, neck pain, headaches. Um it was just all associated. I think you I think when you have heavy breasts, you you start to normalize the things that you experience. And you just say, well, this is what happens because I have this. Um, and you don't actually realize the things that mount and build to affect your quality of life. And that was certainly true the second time around as much as it was the first. My first surgery was completely life-changing. And I would say the same for the second because you experience that relief all over again.

SPEAKER_00 9:47

Was there a moment that you realized that, Becky, or was it a culmination of things or just waiting long enough?

SPEAKER_01 9:54

I think the idea if I'm being truthful with myself, is that the idea of a second surgery felt a little indulgent. If I'm being truthful, you have this once, it affects everyone around you that you have to be cared for. It's a it's a choice, it's not a necessity. Um and having an again was almost like, who does that? Right? Who who has such a major reconstruction um cosmetic surgery twice? Um, so I really had to dig deep and do a little soul searching to truly say to myself, there's actually a reason that this can be medically necessary. Like this is not just about cosmetics. This is not indulgent. This is going to not only affect you, but everyone around you. I can care for people more. I can live my life with my people more in ways that mean something to me. Um, and so I don't even really remember. I had a friend who had had her breast reduction, and she came to me last year talking to me about, you know, how my experience was. I'm like, oh my gosh, it was, you know, 19 years ago, 20 years ago now, and just talking to her as she recovered, I was like, I can do this again. I can do this. And I remember just one day I woke up and I'm like, that's it. I'm calling doing it. And then the process went really fast.

SPEAKER_02 11:31

To be honest with you, a lot of women who have a breast reduction when they're young, um, 18, 19, sometimes even younger than 18, end up needing another breast procedure at some point in their life because there's so much life that you have yet to live, and so many milestones that you haven't reached yet, that it's inevitable that your body will change. Yeah. And sometimes, as you said yourself, this was your personal experience. It doesn't apply to everyone. But often, as you go through those milestones, you realize, like, oh wait, things have changed again and they're heavy again.

SPEAKER_01 12:02

And you know, and I don't I don't think I knew that when I had my first surgery. I really didn't know. I just knew that I needed to change my life, and the only way that I was gonna be able to do this was by the surgery. I had done everything that insurance had wanted me to do to try beforehand.

SPEAKER_00 12:24

Becky, you said something earlier that struck me in that you said it's a choice. You felt it was indulgent this time around. Um, and it wasn't medical necessity, but I think all surgeries are probably a choice. Yeah. And if things symptoms were worsening and things were getting to a point where you noticed you had to do something about it, you took it back into your own hands. And that's what the show is all about, of course.

SPEAKER_01 12:50

Never settle.

SPEAKER_00 12:51

Yeah. So maybe let's hear from Dr. Smoo on what made you a good candidate for surgery, and then we could talk generally about patients, what might be um qualifications for cancer.

SPEAKER_02 13:02

Well, and you've kind of without realizing it, you've kind of listed all of what I would consider criteria for medical necessity. Um you had had your first surgery when you were very young, and then obviously life happened. Um you had kids, um, you went through other stages in life, gained, lost weight. Usually um, a woman who a woman is a good candidate for a breast reduction, a woman like because can have a breast reduction if they have symptoms of chronic upper back pain. I typically say if the back pain, if you picture where your bra strap is, if the back pain is at or above the bra strap, and if it's been there for more than six months and it's there most days of the week, regardless of whether you are doing something physical or not, if it if you tend to notice it throughout the day and you either put up with it or you just say, Oh, I'll just take some Tylenol's ibuprofen, or if you find yourself doing things like using massagers, stretching exercises, seeing the chiropractor, using heating pads, patches, roll-ons, things like that to make yourself feel better, we can improve on that back pain. So women who live with chronic upper back pain, shoulder pain, potentially neck pain, and have done those things, or at least some of those things, to try to relieve the pain, at least you can say that they have tried non-surgical measures prior to considering surgery. Some of these women, because of the size of their breasts and the weight of their breasts, also find themselves having skin irritation, skin irritation that can happen in between the breasts or underneath the breasts. And it's a sensitive topic. It's not something that you discuss over coffee with friends. So often these women don't even mention it to their primary care provider, but they're very creative in finding ways to take care of it. So when they come to see me, they may not even mention it to me until we pry it out of them and we ask them, okay, so tell me, is there like moisture that holds up under your breasts? Yeah. Does it ever get red? Does it ever get itchy? What do you do for that? Do you and they're like, uh, you know, I just put some powder. Okay, which powders? Yes. And honestly, at this point, I I've done this enough that I can list off like the products that are available over the counter. Yes. And it's anything.

SPEAKER_01 15:19

Something called bust dust. Yes. Yes.

SPEAKER_02 15:22

Bust dust, uh, um, butt paste, uh, barrier creams, diaper rash ointments, um, antibiotic ointments, uh, cloth, hairdryers, and the list goes on and on. They don't have to try everything, but if they've had those issues and they've tried a few things and they continue to have the issue, then maybe we have a case. Yep.

SPEAKER_00 15:46

In a case, what do you mean by that? Case we deem it medically necessary.

SPEAKER_02 15:51

Yes, everything has to be prior authorized through an insurance company. What that means is that once a person comes to me and they tell me that they're interested in having a breast reduction because they want to improve their quality of life, then we have to prove to the insurance that this is medically necessary. And we prove it. I mean, insurance companies have their own policies, and some of them list the criteria for the procedure in the policies, while others are a little bit more vague. But you essentially have to prove that this surgery will actually solve some of these problems. So you have to list what the problems are, how long those problems have been there, what the person has tried in order to make the problems go away. And then you put all of this together and you send it off to the insurance with a few other pieces of information and you wait for them to tell you whether they think it will be considered medically necessary and covered by insurance to do the breast reduction. Now, there are a couple of other pieces to this. Whenever you do a breast reduction under insurance coverage, uh your hands are tied in certain ways. In other words, like women will come to you and be like, Well, can you change my breasts from my current cup size to this cup size? And I always tell them, look, when I work with insurance, I don't get to pick. And honestly, neither do you. Yep. Because insurance predetermines how much breast tissue I have to remove. In or in other words, they determine what they consider medically necessary, and they actually put a number to it. That number depends on the woman's height and weight. Okay. It's a mathematical equation. It's a mathematical equation that actually ironically was devised by a plastic surgeon back in the late 70s, early 80s. And a lot of insurance companies have adopted a version of it's not always the same equation, not always the same scale, but they've adopted a version of this scale that is always based on the person's height and weight. And so in the office, we are able to see which insurance policy the person has. Is it spelled out which scale they use? We'll calculate it, and then we also have to send that off. And so part of the consultation is actually setting realistic expectations, making sure that the person is going into this with eyes wide open. Because although I've done this enough that I can give you a ballpark of where I think we will end up in terms of cup size once we do a breast reduction, I can't promise you a cup size.

SPEAKER_00 18:18

You may not go from an F to a B. Not necessarily.

SPEAKER_02 18:22

Not necessarily. That is actually a more to be honest with you, that is a more feasible scenario than going from a D to a C. Yeah. Yep. Because insurance puts a minimum. You can always remove more once you've had a conversation. I've had women who've come in and said, oh no, please, I don't, I want to be smaller. I want to be that would be me. As small as possible, or I don't want to be any larger than a B cup, if you can. And then you know that potentially you could remove more than what insured wants you to remove, and they'll still cover it. I cannot remove less than what insurance wants me to remove. Yeah. So when women come in and say, I am a D and I just want a little bit of a reduction and a lift, and I don't want to be any smaller than a I I talked with a lot of women who are like, Oh yeah, I really considered that, but I don't think I'd ever be covered by insurance.

SPEAKER_01 19:16

I've heard horror stories and these sorts of things. And um I have actually two opposite sides of the spectrum that happened with me when I was in my early 20s and I wanted to um consider the surgery. It wasn't very common. And um I went to my insurance company and they denied me. And the reason that they denied me was um weight. I think at the time I weighed maybe 200 pounds and they wanted me to lose 20 pounds before they would consider me a candidate. Um, they needed me to prove more about my um by my back pain. Um, I mean, when I had my brush, I was a, I let's call it a 38H. I mean, I was large as a young woman. Um, and it kept on repeatedly getting denied. And the um care provider I worked with was furious about this and actually worked with me to create a case to take to the Secretary of State and the um attorney general to say this is unfair. This is deemed medically necessary, and I was able to work with the facility and my insurance company and change it. And so that is one end of the spectrum. The other end of the spectrum is I walk into Dr. Smoot's office one day in April, talk with the um wonderful business um business administrator in plastics. Um, she is she is wonderful. She went to bat for me and called me back and, like, good news, you're covered. When would you like to schedule surgery? And I think four weeks later, I had surgery. There was, it was, it was so night and day different. And I bring up this antidote to say that insurance has come a long way in understanding and recognizing the medical necessity and um of these sorts of procedures and understanding that helping women have this procedure will prevent a lot of other things happening down the line, like back pain, which is a much more expensive thing to cover, and things like physical therapy and this sort of thing. So um, I just say that because I want to encourage women that if you've ever thought about this, it is worth a call. It is worth a phone call just to see, just to know if you're a candidate. You you owe it to yourself to feel the very best way that you can. And there are a lot of things that you cannot do to change the size of your breasts. Um, and so I I just again, this surgery changed my life. Also, Dr. Smoot is an incredible surgeon, which I haven't been. Able to like say during this entire episode, but my surgery was flawless, it was beautiful. I am incredibly grateful and incredibly happy with my results. And my um, I'm gonna cry. My entire um recovery was amazing. And I just again, it's uh it's a life-changing surgery, enough to make me like cry about it several months later.

SPEAKER_00 22:23

Um, but yeah, so that thing because I think there's something very unique about Dr. Schmoot's approach. Um, as much as you can, you try not to use drains, and yes, that helps with the recovery process, as I understand it.

SPEAKER_02 22:36

I think it's just less painful. Um drains are painful. Um when I use drains, patients always complained about the drains.

SPEAKER_00 22:44

Um and I every not every listener is gonna maybe know what that is or why it's used.

SPEAKER_02 22:48

Um surgical drains are tubes, and part of the tube is in the area where you've done the surgery, so it's inside, and the rest of the tube comes out. And the purpose of the drain is to wick away any excess fluid that is produced after surgery to prevent any of this fluid from becoming a collection that then could potentially get infected. So the the tubing goes inside and then it comes out through a little opening in your skin, and it goes to a little collection device that often looks like a silicone grenade. And drains are used in many different specialties in surgery for many different purposes, but really the main purpose is to wick away fluid and to prevent potentially a collection that may then lead to an infection. They can stay in anywhere from one day to several weeks. Again, it really depends on the surgery, the specialty who's doing it, all of that.

SPEAKER_00 23:42

The painful part is when you take them out?

SPEAKER_02 23:44

They're just painful to have in. They're just painful to have in. I've had um, you know, I was trained, um, and I still use drains for certain procedures, because for some procedures you have to. Um, but I was trained to use drains in breast reduction. Um, and I think a lot of the plastic surgeons in my generation were trained to use drains in breast reduction and the ones before. I think now the tide is starting to change, and there are many of us who don't use them anymore for certain procedures, and studies have shown that especially in breast reduction, drains don't really add much. They don't prevent infection, they don't prevent bleeding, they do cause discomfort. I think the simple fact that you have this tube that constantly yanks on your skin can pinch, can burn, can irritate. Inevitably, we're human. It's gonna get tugged while you're trying to take a shower or get dressed, and it adds to the misery.

SPEAKER_01 24:33

I've had a uh procedure with drains and without drains, and I can just far and away say that a drainless operation surgery is it was freeing. I mean, it truly was. The drains are painful anyway you move, they're tugging on you. Imagine sleeping at night. You this was again 20 years ago, and I had to measure every day the fluid that came out of me. That is gross, you know. And so um, just having having a drain-free procedure was incredible. It truly, truly was.

SPEAKER_00 25:12

Is there anything that was surprising to you, Becky, about the recovery process?

SPEAKER_01 25:17

Um, yes, I and I want to preface this by every patient is different. Okay. So my personal experience with recovery, um, I had a remarkable recovery. Um, I was feeling amazing by day five, six, seven. I went in um for my post op, and they're like, you are looking great. I don't know, I was healing very well. One thing that I think is really that was incredibly beneficial to me as a patient that Dr. Smoot just incorporates into her breast reductions is OT and lymphatic drainage massage that you go to Olmstead Medical Center PT or OT. And I started that about 10, seven to 10 days after surgery, and you are with a specially trained shout out, Emily, um, therapist who massages your incisions and it moves all of the lymph and all of the fluid away from your scars, away and and it flows with your natural lymphatic system and it helps you heal. And the difference between when I had my first surgery and this is remarkable. My scars are flat, flat. You cannot differentiate my scars, my incisions from my skin. Are they red? Yes, of course, they're scars. That's gonna fade over time. It doesn't bother me, but they are flat. And I credit Dr. Smoot and her incredible skill and Emily at OT. I went to a lymphatic massage. I was, it was just great.

SPEAKER_00 26:58

Did you have the scar popping like when you do the it's like the most satisfying thing on because I I have a scar that I had to do the massage on and it was like pop pop milk, but I would feel gratifying. I loved it.

SPEAKER_01 27:09

I would feel I didn't have any of that, but I would I did have You can come work in our office anytime. I had a couple of times where I'd pop a stitch and I'd be like, I just popped a stitch. Yeah, is that I didn't have to do it myself, but I would just be like, Oh, I'm healing and I'm healing great, you know. But they give they your office just equips people so well. Like when you see this or this, you do this, you go home with so much information and you feel so equipped. And I knew what to wear, I knew what not to wear, I knew what I could do, what I couldn't do. If it looks like this, this is what it could be. Sending pictures over my like it was just it was it was just an incredible, I felt incredibly cared for. Yeah, team. Truly amazing.

SPEAKER_00 27:55

Yes. Yep. Well, on that note, we're going to end today's episode, although I have a feeling we could go on for a lot. For a long time. An honor, Dr. Smoot. Yes, thank you. Thank you for your thank you for sharing. Well, it's been great to be able to share another part of my own MC journey. This episode was brought to you by Olmsted Medical Center. Like and follow us on YouTube at Pelvis Party or wherever you get your podcast, and head over to social media and follow us there as well.