Monique Ramsey (00:02):
Welcome everyone to The La Jolla Cosmetic Podcast. I'm your hostess, Monique Ramsey. So women face societal pressures from left and right. I mean, we're seeing all these images on Instagram and these perfect lives, perfect models on TV and on magazines, and everybody talks about body positivity and that that's key. And we should own our wrinkles or own our imperfect bodies. And I think that's true to some extent, but at the same time, you want to feel comfortable in the body you're in, and if there's something about your body that's really bothering you, honestly, you can take ownership of that and you can fix it. And so we're going to talk today about some cosmetic procedures for ladies that are a great option and a confidence boost. And so today I'm joined by Dr. Diana Breister. She's a board certified plastic surgeon who knows all there is to know about the female body and is a top choice for mommy makeovers. And we're going to dive into what those procedures are. So welcome back to the podcast, Dr. Breister.

Dr. Breister (01:13):
Hi, good morning. Thanks for having me, pleasure.

Monique Ramsey (01:14):
Yeah. So what are some of the societal pressures that you see that women face when it comes to their appearance?

Dr. Breister (01:24):
Well, you know the usual, there's a lot of young girls now that are so heavily influenced by all the influencers and all the makeup tutorials. The younger girls, I see some of them coming in with a little bit of unrealistic things at such an early age. So the 25 year olds, I think, and 30 year olds or such are going to be probably more pressured to do fillers and things like that and starting Botox early. So many of them will turn to more of the nonsurgical type procedures. And I think it comes from society, but I also do really believe it comes from the woman internally. Many of my patients, or if not all, are doing it for them. They're not really doing it for anyone else. Now, there have been a handful of women that are reentering the workplace or have to get jobs, and there's a lot of younger people in jobs. So sometimes there's that pressure that women will feel some kind of ageism, that they're a little older. But for the most part I find it's internal. It's coming from the woman who just really wants from their heart, wants to feel better about themselves.

Monique Ramsey (02:36):
And I think it's really hard with those mixed messages of body positivity and own it. And then it's like, well, but if I'm not feeling good owning it, then can I own something different? And is that okay? And your point is really good, we have to do it for us, not because somebody else is telling us to do it or telling us not to do it. That's almost equally

Dr. Breister (03:01):
An equal message.

Monique Ramsey (03:02):
Yeah. So getting into body type stuff, we see just as much on Instagram or social media, and I think that the Kardashians for this, that it's like this is the perfect body type. Well, perfect body types change, and I think it's sort of dangerous in a way to sort of say, oh, this is the body shape of the hour or of the year, and I want to have that body shape. And so do you have a lot of patients who are thinking, oh, this is my body shape and wanting to keep up with the style?

Dr. Breister (03:43):
The trends do influence us, and I do see women coming in at different times wanting different things, but mainly I think it's age too. I see a lot of women that in their earlier years they had breast implants and then 20 years later they don't want those anymore. They're too big for them, they've changed their body, their body has changed, and so they want those out. So there are societal trends, but there's also age changes that change us within ourselves that can oftentimes influence decisions. And I don't think there's anything wrong with that too. I don't think a woman should necessarily shame themselves like, oh, I see a lot like, oh, I don't know what I was thinking when I got these. I said, well, you were young and you wanted it at that time. There's nothing wrong with that. There's nothing wrong with having wanted them at that time, and now 15 years later you're different. So we evolve and change as people.

Monique Ramsey (04:46):
And in terms of the body procedures, like women in their twenties and thirties, what are the things that they're sort of bothered by versus the women in their fifties and sixties?

Dr. Breister (04:59):
So the twenties and thirties are going to be, I see a lot of breast augmentations. I see some liposuctioning, that would be probably the two main things. As we get into the forties and fifties or even late thirties, the woman has had possibly some kids by that time. So then we're talking more of a mommy makeover. Sometimes the stomach muscles get stretched out. So there are tummy tucks that come about usually, usually after children, but not necessarily. And at that point too, a lot of times one will need a mastopexy in addition to that augmentation. So lifting of that breast tissue might be necessary after having the kids and the body really going through changes. So it's gravity changes our skin, sunshine ages our skin, and kids can change our body a lot.

Monique Ramsey (05:52):
Looking at society over time, one of this ideal body types that doesn't seem to go out of style very much is sort of that hourglass shape and that snatched waist, which I just hate that term so much, but it does sort of explain it. So what are some of the treatments that you can do to give more shape, especially if somebody's sort of straight up and down?

Dr. Breister (06:18):
So that is actually honestly a pretty difficult problem to address. If someone doesn't necessarily have a really tiny waist and they're more that straight, it's going to be difficult to make a really dramatic change. However small changes can be made, and that can be done with some targeted liposuction done right around the middle of the waist. When we do our tummy tuck procedure, when we tighten those muscles, we can snatch in those muscles to help create more of a waistline. So I'm always very honest and realistic with women. If they want the waist, we focus on that waist, but the structure of the body can sometimes be very difficult to change. So we can do it with liposuction and maybe tummy tuck just to help achieve that. And then sometimes the fat transfers in the hips or buttock area can help to curve out below that waistline.

Monique Ramsey (07:19):
And in terms of how much body procedures make a difference, what are some of the things that you hear from your patients after they've done it, after they're coming back for their post-op visits or their follow-up visits? Tell us about maybe some things you hear about the impact for them.

Dr. Breister (07:39):
Oh wow. Well, the impacts are usually quite dramatic. Usually the women have been hating and disliking a part of their body, say the C-section scar or the hanging skin that they see, and they've been thinking about this every day for years and years. So once that that problem is resolved or taken care of, that is almost like a euphoric feeling when they can look down and see their flat tummy and wear all the clothes they like to see. I think one of the most common sentiments I hear is, wow, I should have done this sooner. They realize that they can get through it and what a dramatic change that is for them. So it's really powerful and exciting to see them afterwards. And as I tell them, it does take a lot of courage to make those steps. So once the procedure is done and they get through it, they feel a tremendous sense of accomplishment.

Monique Ramsey (08:44):
I think you're right on the money on that. Once you finally, you may want it in your head for a long time, making the jump to make the phone call and then making the jump to have the consultation and get it on the books. That can be one of those things that hold people back.

Dr. Breister (09:02):
Yeah, and everyone needs a little encouragement with that. And so I always try to give my patients a lot of credit just for coming in, just for making that phone call. That can be a huge step. There is something about plastic surgery, and I think we've talked about it before. There's a certain stigma, there's a certain, it's expensive, it's elective. Should I be doing this? I don't know. There are these, I don't know if there's societal or our own internal things that kind of tell us, no, maybe not. Or maybe this is just frivolous or maybe this is just vanity. So a lot of those things prevent someone just from making a phone call. So I really encourage people just to just at least make the phone call and get a consultation.

Monique Ramsey (09:51):
Yeah. Then you know what you're looking at. And what would you say before we move on to, I have a few breast questions, but the body with the body, and you mentioned ozempic and all the different skinny shots, which now we're offering, if somebody's thinking about making a change to their body, but they're not quite at their ideal weight, how does that, I guess let's say a patient is 20 pounds overweight, 25, and they just can't get the last off, but they really want the mommy makeover. How do you work with them and talk about is it really that bad to just have the surgery when you're not at your right weight?

Dr. Breister (10:28):
Well, it really depends on the amount of weight that the person is struggling with. There is a tremendous benefit from being closer to your goal weight, and that is, I really encourage that to be as close as possible because number one, the surgery will be safer just right out the gate. We have a lot of science back that heavier people have higher incidences of complications. So number one, just for health reasons, it's great. Number two, you're going to get much closer to that result that's going to last you. Okay. I mean, I understand it's hard to lose weight. It's very hard. And prior to this weight loss, skinny shot, I would say I understand it's hard to lose the weight. So if you can't lose it, I'm not going to put those kinds of pressures on people. You can't have the surgery till you lose the weight. So many times, I would say, do the best. You can lose five pounds and we'll do it. But now I'm really encouraging the women to at least get the consultation about the skinny shots, see if it might work for them, because we all know, let's face it, when you're globally 10, 15 pounds lighter everywhere, that's powerful in and of itself.

Monique Ramsey (11:59):
Very much, yeah.

Dr. Breister (12:00):
Very, very much so. I am a very strong advocate for these shots.

Monique Ramsey (12:08):
So for in breast, in the breast land, we've got breast augmentation using implants, we have breast lift, sometimes people have a lift with an implant, and then there's a breast reduction. And so are there any ages that are kind of specific to any of those procedures or are they sort of nicely distributed across all the ages?

Dr. Breister (12:33):
Well, I would say that there is a distribution. Obviously now younger girls, women are not going to be needing the lifts quite as much as the older, obviously, because after childbirth and kids and things like that, that can change our breasts. So mainly the younger ones are really getting the augmentations. Now, that's not to say there are many young women, 18, 19, 20, that have extremely large breasts. So we're doing reductions in that group of women, and I'm very supportive of an 18-year-old getting a breast reduction because that is really impactful for them. Everything they do, their activity, their running, their self-image. So that's a fantastic surgery. But that spans also all ages. There are women that approach me in their fifties or sixties and say, I've wanted to do this my whole life, and once they do it once again, why didn't I do this earlier? And then the lifts can really span all ages too, because sometimes genetically you breasts have a bit more of a droop, whether you have aged or not. That's just the way God created your breasts. So that is, we can see all of those procedures really at all ages.

Monique Ramsey (13:55):
And is skin quality, I hear that word kind of used, oh, skin, she has bad skin quality or she's great skin quality. What does that mean? And is there anything we can do about it if we're born with bad skin quality?

Dr. Breister (14:10):
Well, that is a good question. Skin quality, obviously as we're younger, is going to be more robust. There's more collagen. It's got a lot more elasticity, and the tissues are definitely better than when we are in our fifties and sixties. But that is another thing that's very genetic. We are kind of made with a certain composition of our skin. So really there's not much we can do influencing that other than obviously protect our skin from the sun and moisturize our skin as much as possible.

Monique Ramsey (14:49):
And when you're like, I'm thinking about breast reductions, breast lifts, there's a fair amount of scars that are created to create that lift, to take away that excess. Absolutely. And that's something that I think women get a little bit hung up on, like, oh, I don't want the scars. So what kinds of things do you do to help them heal the best?

Dr. Breister (15:12):
Yeah, so number one, that perception, what I have found is someone's perception of a scar or an incision is very different amongst all of us. One person's idea of a bad scar is different than another person's idea of a bad scar. So I always like to try to see where is this person coming from? Number one, because they may say, oh, you're recommending a lift. Well, I have horrible scarring. And I say, well, how do you know that? Well, and they'll show me a little scar in their abdomen or something. And guess what? The scar is really not that horrible. It's actually a pretty good scar. But what that tells me is that this person really hates scars and their tolerance for scars are very low. So I say, that's actually a pretty good scar, but let's really look at that because if you are going to be bothered by that on such an extreme level, we really need to consider it.

(16:10):
So that's number one. Many of the reduction patients, however, are just like, I don't care about scars. I don't mind them. I could care less. So there's a whole range of what people's perceptions are and how they feel about that. And we try to show them some realistic incisions and scarring at various stages of healing. Here's three months, here's six months. Most of the time everyone's scars by a year or more are going to be pretty faded, and we can help with that by monitoring the scars very closely. Adding a silicone tape over the scars is very, very helpful. There are some lasers that can help take out the redness of the scars. So there are ways that we can absolutely help influence them. So we just try to reassure people that we will do everything in our power to make those scars fade as quickly and as well as they can, so.

Monique Ramsey (17:14):
Yeah, it's always a trade off and it's for somebody with a breast reduction, it's a scar or it's being able to actually buy clothes that fit and buy certain kinds of shirts, that button up or a different kind of bra and

Dr. Breister (17:30):
Life changing stuff we're talking about.

Monique Ramsey (17:31):
Life changing. Exactly. And I have somebody very close to me who recently had a breast reduction with you, and she is so happy. And she said, why didn't I do this sooner? And to your point, and it was like, but life gets in the way.

Dr. Breister (17:49):
It's just things happen and we don't really think it's possible or it's not that, whatever the reasons are. But once it happens and it's really not that big of a deal, I mean, it's obviously a deal, but it's not. I think we sometimes make things bigger in our minds then they actually are. That's so true. And once it's done, you're like, wow, this is not that bad. I didn't even, it just kind

Monique Ramsey (18:16):
Why did I wait 50 years to do it?

Dr. Breister (18:18):
Yeah. Wow. This is amazing.

Monique Ramsey (18:21):
Well, and I remember way back when I started at the surgery center of a girl who was maybe 18, had came in and very tall, skinny girl, but her breasts were ginormous and she had a breast reduction, and that girl was the happiest girl because she was going to be going off to college. And she just looked strange before, and it wasn't anything she could do other than have it fixed. And I've never seen anybody so happy in my whole life.

Dr. Breister (18:50):
It's a great surgery.

Monique Ramsey (18:52):
Now let's get in, we're going to go down the body. And having children is a beautiful thing we love, but it can leave some changes in our intimate areas that make us feel a little bit insecure when we're having relations with our significant others or even just wearing certain kinds of clothes. So tell us a little bit about procedures that can help us get our groove back if after childbirth, or even if just God gave us a little too much skin down there.

Dr. Breister (19:25):
So number one, the labiaplasty is a wonderful option for women's anatomy, that they're either unhappy with the length of their labia menorah or maybe even the labia majora. So number one, though, really it's genetics. So the childbirth obviously can change the internal structures, if you will, but that labia is usually God-given. A woman will, once they hit puberty, they develop breast, but they also, that tissue will take on what it's going to be. And there's just obviously millions of different anatomy, and it's all normal really, but it's bothersome to a lot of women. So the labiaplasty is fantastic. It trims the excess tissue from the area. It doesn't take very long. It heals up very fast. So that too is one of my favorite procedures. Some of the happiest patients, it really is also, I would say life-changing in a different way. It's more of an internal feeling of how they feel about themselves, how their confidence with their body just really skyrockets After that, they just feel so much more comfortable and better about themselves. So that is something I highly encourage women if it's bothering them to just make the call, come talk, see what it's all about, and then possibly do it.

Monique Ramsey (21:01):
And two other little things in that area. Let's talk, you mentioned it a little bit, c-section scars. So a lot of women have C-sections and then they get this weird scar or a shelf, or it gets really tight and constricted and sort of strange looking. Is that something you can fix? I am assuming?

Dr. Breister (21:22):
Yeah, absolutely. Now, a lot of the times, the tummy tuck is going to address that, but if someone doesn't necessarily need a full tummy tuck, even the C-section scar alone can be completely revised. That can be cut out and the tissue can be kind of sculpted around it. So to get rid of that shelf, if you will, or an unsightly scar, so everyone heals differently, the OBGYNs sew those up differently. And so yeah, they can be problematic, but there is a pretty simple fix for that.

Monique Ramsey (21:57):
And then another little area is that sort of fullness that you can get in the

Dr. Breister (22:03):
Oh, in the mons.

Monique Ramsey (22:04):
The mons. Okay. The mons pubis, right?

Dr. Breister (22:06):
We call that the mons pubis. Right.

Monique Ramsey (22:08):
Okay. So tell us a little bit about that and how to address that.

Dr. Breister (22:11):
We all put on weight in different areas, and sometimes that area can just get puffy. It can show and close. And that's really upsetting for a woman when you put on a tighter outfit and you see a bulge in that area. So that easily can be liposuction. So that's a really good option for that area. Sometimes it does require a little skin excision as well, if it's a problem of bulk and extra skin. So it may require a little bit of sewing and cutting as well. But liposuction is going to be our first line solution for that problematic area of the mons.

Monique Ramsey (22:50):
And that's something that I think if we're thinking about liposuction, we're not necessarily knowing that that is an area that can be, you're thinking about your hip bulges or this irregular shape you have, and then it's like, oh, you can do that too. Well, let's do it.

Dr. Breister (23:07):
I can add it on. Sure. Yeah.

Monique Ramsey (23:09):
Yeah. Because I think while we want to be confident outwardly also we want to be comfortable inside. And when we're presenting, when we're nude

Dr. Breister (23:21):
Yeah, yeah.

Monique Ramsey (23:21):
Or barely clothed, do you still want to have that same confidence?

Dr. Breister (23:24):
Yeah. That's an area that can be very problematic for a woman when their yoga pants on or a slim fitting dress with that bulge that just really kills it.

Monique Ramsey (23:35):
And there's not anything you can really do other than.

Dr. Breister (23:38):
No, you can't target weight loss in certain areas. You just can. Unfortunately, I wish we could, but the body's not going to listen to that.

Monique Ramsey (23:47):
So anything else that we might've missed that you want to talk about?

Dr. Breister (23:51):
I mean, my general message is something's bothering you, think about it. Fixing it sometimes it's simpler than you think. So you are worth it. You're worth investing that energy and resources into making yourself feel better. I think it's really important to honor yourself and put yourself first. You deserve it. You are certainly entitled to feel good about yourself. There's nothing wrong or vain about you for wanting to look good or feel good. So that's really my main message. And the other thing that I find is as women age and get older and older, even in their seventies or plus, there seems to be this, well, I'm this old, so this shouldn't bother me. Well, that doesn't really make sense. At 70, we're still going to want to feel good just because the number says 70 or 75, it doesn't matter. We still want to look in the mirror and feel good about ourselves. So wanting to feel good has no age limit. I just encourage women to really honor themselves and it's okay to want to feel good.

Monique Ramsey (25:09):
Yeah, hear hear to that. And I remember a patient of Dr. Oleson's years ago, and she was in her early eighties, and she was very healthy and she wanted a breast reduction. And he said, can I ask why you've waited so long? And it was her husband who didn't want her to get it, and he passed away.

Dr. Breister (25:31):
There you go.

Monique Ramsey (25:32):
He passed away. He was no longer there to influence her. And she said, I did it for me and I did it, and I've always wanted it. And she was so happy and she was healthy enough to have the surgery. And so like you say, that really has no age limit for feeling good.

Dr. Breister (25:47):
No, there's no age limit. Exactly. Exactly.

Monique Ramsey (25:51):
Okay. So we'll put in our show notes, some links to some of the procedures we've talked about, and now we have over three years of podcasts, which is like 155 episodes. And so we've talked about a lot of things in more depth. And so we'll put some links to previous podcasts about some of these topics. And then I also wanted to, when we were talking about the Skinny Shot, there's a podcast that is so great because I'm on Ozempic and I've lost 48 pounds or something.

Dr. Breister (26:24):
It's amazing, right?

Monique Ramsey (26:25):
It is. But there's a podcast called Less of You, which is really interesting, little double entendre, but it's the Less of You podcast, and it's two people on the journey of ozempic kind of at different times. One had already been using it for about a year the other and had lost 80 pounds or 70 or something, and the other was just starting. And they're friends and they're just really real and talking about their journey with that. So I would encourage people who, if you're thinking about it and you're a little bit on the fence, it's just another

Dr. Breister (27:00):
Information. Resources, yeah.

Monique Ramsey (27:01):
Yeah, it's a resource to sort of hear real people talking about it in a very real way. And we have a lot of happy patients who have been doing it and we're trying to feature them on social media, but I think that it sort of ties into some of the body stuff that we're talking about. And so I just wanted to throw that out there. Alright, well thank you Dr. Breister. This was so fun.

Dr. Breister (27:21):
Yeah, thanks Monique.

Monique Ramsey (27:22):
Again, we'll have everything in the show notes and all the links you need, and we'll see you all on the next one. Thanks.

Dr. Breister (27:28):
Alright, bye. Thank you for having me.

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