Speaker 3 (00:07):
You are listening to The La Jolla Cosmetic Podcast.

Monique Ramsey (00:14):
Welcome everyone to The La Jolla Cosmetic Podcast. I'm your hostess, Monique Ramsey, and today I have the pleasure of welcoming back to the podcast, Dr. John Smoot. Welcome Dr. Smoot.

Dr. Smoot (00:26):
Thank you. Glad to be here.

Monique Ramsey (00:28):
So today we want to talk about breast reductions and lifts and kind of what is the normal age and story of a woman who wants to do a reduction and or a lift?

Dr. Smoot (00:42):
Well, the age can vary from probably 16 to 70. There's really no set age. We tend not to do reductions or lifts on those under 18 except in extreme circumstances. But generally we want a woman to be pretty much their adult height, weight and maturation. And beyond that, it's kind of up to the patient.

Monique Ramsey (01:06):
And are the main common complaints of this person mostly just that they're so large that clothes don't fit or heaviness of it, or what do you kind of hear?

Dr. Smoot (01:19):
Well, it's basically a combination of all those things. The most common thing is they're just so big. I don't fit in my clothes, I'm embarrassed, I can't exercise. They're painful. That's usually the biggest reasons they come in. They just can't function well in their normal life, everyday life.

Monique Ramsey (01:38):
So how do you achieve shifting that volume to improve the appearance of a breast?

Dr. Smoot (01:46):
Well, the breast reduction is just exactly what it sounds like. It's removing unwanted tissue, but doing that, not only does that remove the weight and size, but it also does a lift. So typically breasts do sag when they're this big, so it's not necessarily changing the footprint of the breast, but it's changing where the tissue hangs and making it so it sits over that footprint of the breast. It's not like we can take the tissue and take it from down below and push it up on top.

Monique Ramsey (02:15):
So is there anything that prevents someone from being a good candidate for this procedure?

Dr. Smoot (02:22):
Well, there could be. I mean, it just depends on the general health, but we tend not to want to do it on girls that are under 18 just because they don't, I don't think they fully matured, nor do I think they understand the consequences of doing this procedure because there are consequences to doing a breast lift and mostly it's immigrant riding nursing because if you do have a breast reduction, not necessarily a lift, but a breast reduction that could affect their ability to nurse later on.

Monique Ramsey (02:49):
Is it because the ducks involved the milk ducks?

Dr. Smoot (02:54):
No, no. It's the volume of breast tissue. We were actually removing breast tissue. Now we do leave some breast tissue depending on the technique that's used, but it's usually not sufficient enough to generate enough milk production.

Monique Ramsey (03:06):
Oh, I see, I see. Okay. So if you could walk us through where are the incisions made and are they ever something that's a variation or is it pretty much a standard thing?

Dr. Smoot (03:18):
No, there's several ways to do a breast reduction. I mean, it's kind of like having ice cream. Some people like vanilla, some like chocolate, some like a mixture. The typical classical way of doing it, it's called an inferior pedicle, where the incisions look like an anchor go around the nipple from the nipple down to the fold underneath the breast that where we and the breast tissue was inferior. Pedicle is based inferiorly, so we can move it upward. There's also way with the superior technique where your blood supply comes in from the top rather than the bottom. Notice some other variance of that with a no mound reduction, sometimes with a AJ or an L incision. But it depends on the patient, it depends on their volume distribution and what one is trained to do and most comfortable to do.

Monique Ramsey (04:06):
Now, is there something that makes scars harder or easier to heal in that post-op time?

Dr. Smoot (04:15):
Well, it has to depend on how tight you pull the tissues, how thin the flaps are. Typically, if we see a healing issue, it's always in the same place. It's right at the bottom of the breast where the vertical and the horizontal incision meet. That's where things are the tightest. That's where the least amount of circulation and occasionally that tissue breaks down. It takes a little delayed healing. But that's typically where we see it.

Monique Ramsey (04:37):
Now, if a woman in thinking about her breast being a lot larger and it's going to get smaller, does the areolar also get smaller or is that something that you talk about first with them?

Dr. Smoot (04:52):
Well, it just kind of depends on what they want. I tell patients, well, I can leave them half dollar size, quarter size or dime size. What you want. You look at the overall proportions of their body, their shoulders, their width of their chest, so something that looks proportionate on them, and that's the operative word when doing this type of procedure. It's not that I'm going to take X amount of grams out and you're going to be a CD or B, whatever. It's to look at your proportion, something that looks best on you and your body. So taking so much out of one person does not mean that's what you do on another.

Monique Ramsey (05:26):
Okay. And generally how long is somebody under anesthesia for this?

Dr. Smoot (05:32):
Well, it can vary depending on the surgeon, but for me it's about two, two and a half hours.

Monique Ramsey (05:37):
So not too long and then no,

Dr. Smoot (05:39):
It's not bad at all.

Monique Ramsey (05:39):
They can go home the same day,

Dr. Smoot (05:41):
Same day. We usually see 'em back the next day. If everything looks good, I'll see 'em in a week. And then typically I see 'em at six to eight weeks.

Monique Ramsey (05:50):
And when are they able to maybe go? It probably depends on what they do for work, but I was going to say if they're delivering packages and they're lifting, that's not

Dr. Smoot (06:00):
What's their recovery in other words.

Monique Ramsey (06:02):
Yeah,

Dr. Smoot (06:03):
The recovery is, I tell patient recovery is about two weeks now. When I say recovery, meaning during two weeks there's no running, lifting, heavy objects, sexual activity, working out, pushing, pulling things, picking up kids because what you really want to prevent is any pulling the wound apart or getting bleeding. Those are the two things that can cause problems in that time period.

Monique Ramsey (06:25):
So then after two weeks they might be cleared to do more depending.

Dr. Smoot (06:30):
Usually I clear 'em about two weeks, maybe it's four to six weeks before they're back in each gym lifting weights again.

Monique Ramsey (06:35):
Okay. And then what do your patients say once they come in for that one day or one week post-op? What is sort of the consensus from the patients?

Dr. Smoot (06:46):
Well, okay, it varies. Typically it is, I'm just glad the weight's gone and this is the main reason you're doing this, that the weight's gone. They don't feel so heavy. They seem to fit better in their clothes. Occasionally, someone who's had very large breasts for a very long time, you do this and they look down and they go, what have I done? Because they're not used to seeing their breasts that small or that size. I almost always say, yes, you are smaller, but it's going to be fine. And usually I never have a problem with that.

Monique Ramsey (07:23):
Have you ever had somebody who had a breast reduction and then later wanted more fullness and got implants?

Dr. Smoot (07:29):
Yes.

Monique Ramsey (07:30):
Really,

Dr. Smoot (07:30):
Because Oh yeah. Well see what happens is we do this surgery based on where you are in your life at the time. But let's say 10, 15 years later a child weight loss, weight gain, the breasts are going to change. And what typically happens is we get older, we tend to lose volume. The skin gets stretchier and they'll come back and say, well, when you did, I look good. But now they've kind of, I need some more volume. And not very often it's not. Most women don't want to come back and have their breast enlarged again, but there are occasionally the few that do want to be fuller. Again,

Monique Ramsey (08:05):
I remember Dr. Olesen had a patient, she was so happy over the moon breast reduction, and she was in her early eighties and he said to her, what made you finally decide to do this? You've lived your whole life with the size that you were. And she said, yeah, my husband, he didn't want me to have surgery. He didn't want them smaller. So he had passed on and she was going to do it for herself, and it was really, really sweet and she was so happy

Dr. Smoot (08:34):
Of all my patients. My breast reduction patients are usually my happiest because they're so happy to get rid of the weight, the size, the shape, and to exchange those for the scars is usually a good exchange for them.

Monique Ramsey (08:48):
I think people are always worried about scars for every procedure we do, and it is a trade off, like you say. So that's a trade off. Most of them are thrilled to make. So how long though, most scars when they're new pinky red and then to fully heal, about how long do you tell people to expect to wait?

Dr. Smoot (09:12):
Well, when you say heal, there's different variations of that. Usually by two weeks they're healed well enough. They can be doing most of their regular activities. But a healing scar takes six months to a year to what we call fully mature. For the first few months, they may be firm red, slightly visible, but usually in time they do fade. They soften and end up being white lines. Now, not everybody heals like that. Some people are more hyper reactive and they get very red raised what we call hypertrophic scars. Sometimes you get a keloid, which is somewhat rare, but that's where scars look very thick and heavy. We like to have patients for the first six months use scar creams, gels, things like that, or silicone taping to help minimize their scarring.

Monique Ramsey (09:58):
That was going to be my next question, so you beat me to it, how they take care of their incisions. So you go over that with them as they go through. Now, are there certain brass that they can't wear or certain post-op garments that you want them to use?

Dr. Smoot (10:16):
Well, in the first couple of weeks, yeah, we don't want to put anything special, but it doesn't matter. Whatever they're comfortable in wearing, they can wear wire, they can wear pushups. It just depends on what they're comfortable wearing.

Monique Ramsey (10:27):
And then in that first few weeks after surgery, I'm assuming with breast surgery, if you have one of those people who sleeps on their stomach, do you try to have 'em not pushing on that area?

Dr. Smoot (10:38):
Oh, absolutely. I just say you can sleep on your side, sleep on your back, but don't sleep on your stomach.

Monique Ramsey (10:44):
I had a chiropractor when I was a teenager get me out of that habit and he's like, do you want to know why your neck hurts? Because you're sleeping on your stomach. So luckily I haven't done it since then, but. So you're going from whatever size to a much smaller size. Is there a lot of pain involved? Is you're taking away a lot of tissue? Is this a painful procedure?

Dr. Smoot (11:07):
It's not terribly painful, but there's some discomfort. I won't negate that, but it's not excessive. It's not like doing an augmentation where you're cutting and moving the muscle, that's much more painful. But there is seasonal pain, which is true, but it's not bad. Usually by 10, 14 days, they're pretty much functioning quite well.

Monique Ramsey (11:26):
Okay. Now I'm going to take you into a realm that I don't know if you'll know the answer, but this is the one thing that people always ask, is insurance going to cover my breast reduction? And so how can you speak to that question and what's sort of the best way to think about that?

Dr. Smoot (11:45):
Well, I used to do a lot of these on insurance, but insurance companies essentially don't want to pay for this. And so they've made it very difficult to get authorization because they've changed their algorithms for this. Now you have to be a certain height, certain weight, if you're too heavy, you can't get it. You need to lose weight. They want a certain amount of grams to be removed. And sometimes that doesn't behoove a good cosmetic result. So I don't like necessarily having to meet a number to have a breast reduction. I want them to look proportionate. And that's why the way I approach this is a little differently, not determining, I want to make you a cup size. I want to make you look proportionate to your body. I mean, we don't want to do a mastectomy per se, because you have to be down to a certain size. But I want them to say, as a young woman, you want to still look good in your clothes. You still want to have some volume and shape, and that's what I focus on, not necessarily the amount of I have to take out.

Monique Ramsey (12:47):
That makes sense. So can they ever get reimbursement though, or is it sort of off the table?

Dr. Smoot (12:54):
Well, I don't deal with the insurance anymore.

Monique Ramsey (12:56):
Yeah, okay.

Dr. Smoot (12:56):
It's simply if they want someone who wants to focus on the cosmetic side of this and not the weight side of it, that's usually what we do. There's a lot of good surgeons out there can do this on insurance. But again, my experience in the past has been getting those approved through insurance are very difficult. I mean, you have to be absolutely huge breaths with very life altering problems.

Monique Ramsey (13:21):
Interesting. And like you said, I think having that good cosmetic result, not being dictated by some third party about how much you have to take away, let's leave you with what you're going to be happy with. So our website has kind of the price range for breast reduction anywhere from $12,500 to $14,500. And so I would assume that, I think about one in three is the number of patients who decide to do financing for their surgery. We do a lot of patient financing. And so even though that might feel like a big number, it can be a relatively lower monthly payment. There's some interest-free plans. And so just for the audience to know that there are ways to get your surgery now, pay as you go afterwards. So would you say there's a typical, I know you said people could be any age, but do you sort of see people at a certain age that most often after they've had kids or before? Or is there no rhyme or reason?

Dr. Smoot (14:27):
It varies. I mean, I see a few young women in their early twenties or late teens. It just said, I like to compete athletically. I, I see some women who've had kids and their breasts just got bigger and they don't want these large, heavy, breasts anymore. And the other ladies, I've had these all my life and I'm tired of it. I just want to get it done. So there's really no specific age group that I see it in.

Monique Ramsey (14:54):
Is it something that the younger you do it, the easier it is to heal?

Dr. Smoot (15:01):
Yes and no. From a technical standpoint, it's a lot easier to work on a younger breast than is an older breast just because of the nature of the tissues. But the older we get, the better we heal in reference to the scars. Scars tend to heal better. There's going to be less red, but that's not, that's just a generalization. It doesn't apply to everybody.

Monique Ramsey (15:21):
Okay. So how many times, if you have somebody who wants to have surgery with you, but let's say they don't live in the San Diego area, do you find that patients will travel for this and then when they do that you have sort of a protocol for them while they're here?

Dr. Smoot (15:39):
Yes. It is pretty simple. We like to come a couple of days before their surgery, especially if they're flying or driving a long way. We could see them the day before the surgery, can be performed on the next day. I like to have them here about a week to 10 days to make sure that they aren't going to have any healing issues. If that's fine, they can leave. Usually when we see healing issues, it occurs at about two or three weeks when we have some breakdown, sometimes we have to deal with and teach 'em how to take care of it. But once they get out 10, 14 days, they're pretty much healed. They can go about their regular activities. I allow them to start doing activities as they tolerate after two weeks.

Monique Ramsey (16:16):
So in that case, for the traveling patient, do they do a Zoom consult with you first and then sort of book going after that?

Dr. Smoot (16:24):
Yes. Either way. I mean, doing the Zoom, I can say, yeah, you definitely need this, or maybe you want to think carefully about doing this at this time. But with a Zoom, I can get some idea of what we're dealing with. What I can't tell is how soft or how dense the tissues are and what technique I would probably use until I actually see them. But that can be decided on the day before surgery.

Monique Ramsey (16:48):
Okay. And what advice would you give to a person who's thinking maybe this is what I want. What would you say to them?

Dr. Smoot (16:58):
Well, think about how it's affecting your personal life. Mostly the young adults that come in, or young, I mean those in their twenties. It's just that they're so miserable and now nothing fits. And the embarrassment of getting clothes to fit people, staring at their boobs and stuff like that. It basically comes down when it's worth the cost, the hassle of the inconvenience for that kind of result. If that's what you're at that point in your life, great, let's do it. Well, no, I want to have kids. I want to wait. I want to lose more weight. That's fine too. There's no set time or no set pattern, except they have to really want it. What I don't want is, well, my boyfriend or my husband wants me to have this. No, that's not a good reason to have this done. That's rare that that happens. Most people come in and most women are saying, yeah, I'm ready. I want it done, enough of this.

Monique Ramsey (17:52):
Is there any waiting period prior to surgery that they have to, I don't know, once they see you to wait prior to having it done?

Dr. Smoot (18:01):
No. Just enough time to do their pre-op evaluation and make sure any lab work has to be done. It doesn't take long to get them prepared for this, but they have to be healthy, first of all. That's kind of stating the obvious, but that's what we want.

Monique Ramsey (18:15):
Right. Yeah. And I think most people, they're not going to want to have a procedure when they're not feeling great, healthy. But are there certain medical conditions where you might say, we might need to check with an outside specialist?

Dr. Smoot (18:31):
Well, if they're diabetic, they've got renal failure, renal problems, they're medically not in good condition. Heart conditions, a lot of times patients come in with other conditions that we have to have clearance from their other doctors before we do an elective procedure because these aren't life or death procedures. They're cosmetic and we don't want to increase the burden or cause more problems by doing a surgery they're not ready to have done yet.

Monique Ramsey (18:57):
Okay. Well, this was really interesting. Thank you for lending your expertise with us today. And is there anything that we might not have touched on that you wanted to say?

Dr. Smoot (19:09):
I don't think so. That's pretty thorough. But I think that the bottom line is this is something you need to want to do, and it's something that can be done at any age. There's no restrictions on that, but I think that it has to be for the reason of literally reducing, getting the weight off and just feeling better about your life. And if you're at that point in your life, then it's something would greatly benefit you.

Monique Ramsey (19:36):
Yeah. All right. Well, thanks for coming in and sharing that. And for people in our audience, if you're listening today, please drop us a review, subscribe. We'd love to see any questions you have. We'll answer them. And you can go on our website and you can find all kinds of great information about recovery time about, you can see before and afters, which is I think, a really helpful way, especially with breasts. Well, anything but breasts, especially because you can kind of find maybe somebody who's shaped similar to you and sort of see them before in them after their surgery. So there's a lot of great tools on there, and we invite you to check those out. And thanks again for coming and joining us today, Dr. Smoot.

Dr. Smoot (20:22):
You're welcome. Hope we can do this again someday.

Monique Ramsey (20:25):
Alrighty. Well have a wonderful weekend.

Dr. Smoot (20:27):
Okay. Well, thank you, Monique. I hope that a lot of people listen to it. I mean, this is not exactly one of those fancy dancey procedures, but it's out there enough that I think we can sure help a lot of young women.

Monique Ramsey (20:38):
Absolutely. Alrighty, thank you.

Speaker 3 (20:45):
Take a screenshot of this episode with your phone and show it at your consultation or appointment or mention the promo code PODCAST to receive $25 off any service or product of $50 or more at La Jolla Cosmetic. La Jolla Cosmetic is located just off the I-5 San Diego Freeway in the XiMed Building on the Scripps Memorial Hospital campus. To learn more, go to lj csc.com or follow the team on Instagram at lj csc. The La Jolla Cosmetic Podcast is a production of The Axis T-H-E-A-X-I-S.io.