Today we're meeting with Dr. Masri.
Doctor Masri is a board-certified
plastic surgeon who has been practicing medicine in South Florida for almost 20
years.
His surgical skills are derived from his comprehensive training in both
general and plastic surgery.
He has a rare distinction of holding dual
certifications from both the American Board of Plastic Surgery and the
American Board of Surgery.
He is also a fellow of the American College of Surgeons.
Dr. Masri thank you very much for joining us on the program today.
Thank you very much for having me.
Well, we're gonna talk today about breast
reduction and more in general the general common practices of breast
reduction.
First of all I'm sure our audience has
some questions about your history and just start with you know how many breast
reductions do you typically do in a week and how many of you done over your career?
I would say the breast reduction procedure is something that we, it's
probably one of the most popular procedures of our practice over the
years.
I've had extensive experience with breast reduction extending from my
residency on to now and my professional practice.
I would say in a regular week
we could probably do 4 breast reductions pretty easily but for the
most part I would say the range of breast reductions really it just depends
on everything from the time of the year - you know what's coming in the door, but
most cases is about anywhere from 25 to a hundred breast reductions a year and
over my experience I've probably done over a thousand.
And Dr. Masri, who would be a typical candidate for a breast reduction and
what makes somebody a good candidate for that and obviously are there some people
that just it wouldn't work for them.
You could elaborate on that as well.
Well, most people who present for breast reductions are people who are usually
symptomatic.
Large breasts can create a lot
of discomfort pain typically around the shoulders, around the neck; it's also
responsible for a lot of irritation underneath the skin on the lower parts
of the breast; the requirement to wear very constricting tight bras is also a
problem with women with large breasts; so by and large most women who present with
complaints of large breasts have other associated symptoms and in most cases
it's not all just the cosmetic consideration it's more of a functional consideration.
And what's the recovery like?
Recovery from breasts reduction surgery is I think relatively
straightforward.
Most women experience a
little discomfort immediately postoperatively but the recovery is in
most cases about a week.
And what's the general goal of breast reduction?
You know, what are you trying to accomplish, and I should also mention a
common question that comes in is would a bra still be required immediately or
even long-term?
I think the the the goal of breast reduction surgery is to
alleviate some of the symptomatology related to large breasts.
In the breast
reduction procedure we remove skin and breast tissue to decrease the volume of
the breast, and by decreasing the volume of the breast we're also able to improve
the shape of the breast and improve the location and the relationship of the
nipple areolar complex to the relationship of that to the breast itself.
Now by doing this procedure we effectively lift the breast so we
lift the breast, we're improving shape of the breast and also improving the
projection of the breast.
So these are all the the goals of the procedure that
really bras are used to emulate, bras are used to create all of those
characteristics of a breast; so having the breast reduction procedure doesn't
necessarily mean that you can go without a bra, but I think that in most cases the
supportive features necessary how or that bras are used for are and somewhat
eliminated from having a breast reduction.
Now, a lot of variables are
necessary to decide whether or not you still need a bra or you would still need
to wear a bra after a reduction and I think that's primarily just a matter of
personal preference and it's also related to a lot of the amount of breast
tissue that's been removed; the size reduction essentially related to the procedure.
So Doctor Masri do you have to do this in a hospital and or where do
you perform this surgery?
It really depends, a lot of factors are considered;
the near overall medical condition is a very important consideration; there are
breast reductions that can be done or performed in an office setting without a
problem; however most people who present with for breast reduction surgery really
in my opinion require a hospital setting only in the sense that it has to be done
under general anesthesia; in doing so general anesthesia
some people postoperatively have problems related to nausea vomiting they
may have some discomfort that's just not alleviated with simple oral medications
may require some IV medication soap; in some cases again we take this on the
case-by-case basis people may require overnight hospitalization
but most of our procedures are done in the hospital.
I think that there is a
certain safety index related to having procedures performed in the hospital;
typically procedures that require removing large amounts of tissue and
that may or may not be uncomfortable postoperatively.
And so now that we're in a hospital what about it covering the cost, I mean
will insurance cover the procedure?
In most cases breast reduction surgery is
covered by insurance.
Now, this depends on the insurance companies and the policies
related to this coverage.
However based on the symptomatology of
patients presenting for this procedure, insurance companies, there are
criteria related to medical necessity which insurance companies do request and
obviously people with symptoms related to large pendulous breasts do qualify as
medical necessity.
The authorization process is something that we have a lot
of experience in, but insurance changes how every month insurance companies make
new decisions but we work with patients and insurance companies to try to make
sure that if your policy does provide coverage for this procedure that we
definitely do it through the insurance.
So, Doctor Masri getting to maybe a
little bit more about shape and time so if if there's weight gain or weight loss
what will happen to the shape and size of the breast will it actually grow
and shrink according to, you know, personal shape of the body?
Well yes it will, as we age our breast volume gets replaced, our breast tissue gets
replaced with fatty tissue and that fatty tissue is best
definitely sensitive to the the effects of weight loss and
weight gain.
So, for example, a woman with large breasts in her 40s, who has gained
a lot of weight, will find that weight distribution is probably going to
go, you know, to a certain percentage in her breasts.
Now, in the same patient with
weight loss she'll probably see a significant weight loss from her breasts
as well; that I really believe that it in it's more of an age-related phenomenon
and certainly the issues related to weight loss and weight gain do play in
the cosmesis of a breast reduction postoperatively.
Okay, so what about situations where a patient plans to have children and they want to
nurse a baby; what happens after the procedure in a situation like that?
That's a very common question and the way that I answer that question is more
related to the fact that when you're doing this procedure you're not
affecting the ducts on the nipple areola complex that provide milk to the baby.
Now, you're reducing the volume of breast tissue that ultimately leads into those
ducts that provide the milk to the baby, but the real issue is that
functionally you should be able to breastfeed, however in some cases you are
unable to produce enough milk to satisfy the baby.
There have been studies to show
that women overall who have any type of breast procedure whether it's a
reduction, whether it's an augmentation, or whether it's just a breast lift,
statistically, and they've done studies on this, just choose not to, for personal
reasons, breastfeed, but it doesn't necessarily mean that you can't
physiologically breastfeed.
And for the screening purposes of breast
cancer for example is it more difficult to detect masses after a procedure like this?
The procedure is, in most cases, done on women over the age of 35.
Now, certainly,
there's a younger population who have breast reductions;
however for women who are closer to the age of 40 we always request a
preoperative screening mammogram.
The recommendations depending on your
personal family issues, or your personal history of any breast elements,
usually dictates this, but in most cases we request that you have a screening
mammogram if you're around the age of 40 just to have a baseline.
Now, if for
whatever reason after surgery there's a question of palpable masses or something
suspicious on mammogram, there's always a baseline or there's always a reference
from that preoperative screening mammogram.
Now, just having a breast
reduction in and of itself does not mean that there is a possibility of changing
the architecture of the breast such that a mass is not detectable by radiographic
studies.
What it does mean is only that if there is anything suspicious on
mammogram that in this day and age radiologists and breast surgeons are
very aggressive about performing additional studies but that's whether
you had a breast reduction where you had any or or nothing done, it's just in
in this day and age, if there are suspicious findings on a breast exam
that they can be evaluated in a number of different ways, so it shouldn't be a concern.
That clarifies that point very well.
So what about risks, what kinds of things can go wrong, and what are some of the
pre-emptive strap of the preparing steps in order to reduce let's say for the
risk of an infection or what have you?
Can you maybe elaborate a bit on that?
Yes I think those are very important considerations and that's why
preoperatively we really assess your past medical history, your past surgical
history, some complications typically occur with people who are not basically
at their their peak medical status I would say that the biggest concerns for
me are people who smoke.
Smokers run a higher risk of developing wound
infections, they run a higher risk of what we call wound dehiscence, where the
kin that we brought together opens up a little bit;
there's also considerations related to the nipple areolar complex: smokers have
a higher incidence of what we call necrosis, which that nipple areolar
complex, the tissue of that nipple nipple areolar complex, which is so dependent on
blood supply from some certain elements of the breast tissue, are compromised and
those are big considerations; but in terms of wound healing we watch for
people who are diabetics, or poorly controlled diabetics;
normal diabetes with good control is really not a contraindication to having
the surgery; the biggest contraindication I would say is smoking, and we really
encourage people who come in for evaluation to stop smoking for at least
six weeks prior to surgery; otherwise from the full range of young women
requesting breast reduction and surgery to older women just tired of carrying
around the weight, we do a careful analysis and of course we make sure that
we are in contact with their primary doctors
their internal medicines, to medicine doctor, just to make sure that
there's nothing that we have to be concerned about, overly concerned
about, in terms of recovery.
Now, aside from issues relative the potential
infections there are always risks about and I wouldn't say that these are risks
but there are always considerations about how well people scar and the areas
in which they scar; sometimes women may are tend to develop what we call
hypertrophic scarring which is scarring it's a little spread or more spread
than it was following the surgery and sometimes there are women who are
predisposed to what we call keloid scarring which are very raised and
painful and can be painful; these scars are problematic but there are certain
things that we can do to try to prevent and postoperatively we can try to treat
them using different modalities.
The one thing that I do want to mention, and this
is a question that's very common, when young women present to the offices:
Does the procedure affect sensation to my nipple areola complex and will that
be altered?
And the answer to that question is a straight up - Yes, maybe.
However, that change in sensation usually resolves or comes back to a baseline
anywhere from six months to a year after surgery if it happens./ I would say in my
experience that I've seen that in probably about 10 to 15 percent of women
I have a situation where they experience insensate nipple swallowing surgery but
in most cases that returns it may not if it does happen again it's a rare
occurrence but if it does happen it may not return to a hundred percent but
maybe to about 80 percent.
Got it.
So kind of summaring up here
look a little bit at some some of the obviously the fears that people have
what does this procedure doesn't meet reasonable expectations and I mean
reasonable I mean you know what someone would normally see in a person's
inconsistencies in their body for example you know for example what if one
breast is slightly higher or larger than the other; what do you have to
say about that?
There are always procedures that we can do to treat
issues related to asymmetry postoperatively.
In a lot of cases it's
very difficult to gauge how well the tissues are going to readjust to their
new positions how well patients are going to scar following the procedures
but I think more importantly it really needs to be evaluated or issues, really
a potential asymmetry, potential aesthetically displeasing scars, all of
those issues are something that we address about six months to a year after
surgery.
But those are definitely issues that can be addressed and in most cases
they can be addressed with very minor revisions.
I would say that 85% of
situations like that or something that can be done under local anesthesia in
the office and really have a little to no downtime.
I think one of
the big concerns is if I have a procedure and it's not to my liking,
what can be done about it, in
terms of more in terms of volume.
I find that women who have very large breasts
are very eager to have very small breasts.
But it's a very important
consideration with a woman who's had large breasts for you know 20 years of
her life to all of a sudden wake up one day and
not be able to see that she has the same type of volume or breast tissue that she
had before.
So I think it's very important that we counsel our clients
very carefully on what it is that the breast reduction is going to accomplish.
Overall, it's very important to understand as well that in all of
plastic surgery, every procedure that we do, from facelifts and neck lifts the
tummy tucks, from liposuction, studies have shown, and these aren't our
studies but these are actual scientific studies that have been published, in all
of plastic surgery, breast reduction procedures provide the highest
satisfaction ratings to people who have them; and and that really goes without
saying when you see a woman who's complained so long for having neck pain,
back pain, shoulder pain, irritating bra strap injuries, superficial skin
infections related to these large pendulous breasts, those people following
breast reduction surgery are very very happy to get rid of a lot of these
problems, and it becomes a situation that it's not only a functional
improvement in their lifestyles, but they're always very very happy with an
aesthetic improvement of their of their their breasts and the way that they're
able to wear their clothes better and they're able to find clothes that fit;
that's a very common phrase.
that after breast reduction is that - oh wow now I
can buy clothes that fit so now I'm going to spend a lot more money than I
thought I was initially (laugh) so, it but it's a
I think breast reduction surgery and
I've seen it just based on the number of breast reductions I've been involved
with over the years it is the it is the most satisfying and
rewarding procedure not only for myself but for
the patients who have the procedure.
So, kind of in summary is there anything
that a patient needs to do, or needs to know to prepare for this, and maybe as a closing
comment maybe offer
your suggestions to would-be patient.
I think preparation for breast reduction isn't something that happens overnight I
think that there's a lot of psychological preparation involved and
again that relates back to what I mentioned previously about the fact that
here you're looking at yourself a certain way, you're buying clothes a
certain way, you're buying bras a certain way, and then the next day that's
completely changed.
Most people who come into the office for a breast reduction
procedure trying to find out more information about breast reduction
procedures already know from somebody who's had it done before
a relative of a friend who had who's had it done before.
So they kind of know of
the experience.
I think the important thing in terms of preparation is when
when you're discussing possible breast reduction
with your doctor you want to make sure that it's something that you're really
looking to.
I don't want to say looking to improve your life but you want to
make sure that it's something that you've decided that there's no other way
to deal with your large breast issue.
Now what do I mean by that?
Well it's
certainly we talked about how weight loss and weight gain affect your work,
your breasts.
If you're looking to have a breast reduction to lose weight
certainly you are going to lose weight from the procedure but if you come in
with large breasts and you've progressively gained weight over the
last five years one of my comments is as typically well how would your breasts
look if you lost 10 20 pounds do they look any different?
And often times I see somebody who looks at me and says - well, you know what, I
don't know!
That could be something so there is no replacement for a
good balanced diet, diet and exercise and if if you are in if you are and you're
I'm not gonna say your best health but if you were in a healthy situation and
you still have a large symptomatic breasts then it's definitely something
to consider.
Well doctor Masri as always it's great having you on the show
explaining and demystifying a lot of the topics related to cosmetic surgery.
Thank
you once again for for joining us today.
Thank you very much for having me, I
appreciate the opportunity.
Không có nhận xét nào:
Đăng nhận xét