Am I too old for breast reduction surgery? [Dan Zegzula, MD, Portland]

Dr. Zegzula (00:00):
Dan Zegzula. I'm a plastic surgeon, Portland, Oregon at the Portland Plastic Surgery Group.

Eva Sheie (00:07):
What's the usual age and story of someone who comes to you looking for breast reduction?

Dr. Zegzula (00:12):
I used to say it was either going to be the young ladies, late teens or early twenties that just developed large breasts. And then there were the post mommy patients whose breasts were quite heavy after nursing and potentially some weight gain after pregnancy. But I'm now seeing a third wave of patients, and these are patients in their late fifties and into their sixties. And I've even done a couple of patients in the last year, in their early seventies who are finally getting around to having their breast reduction. And I always ask them what took so long? And it's usually they were thinking about everybody else but themselves, right? They had a husband to take care of, they had their family to take care of, they never thought they would really get it done, and then something inside them, or maybe they had a friend and they finally come in and say, you know what? I think I want to do this. And they are equally ecstatic about having that operation done. They feel so much better afterwards. But I chide them gently like You should have been in to see me 10 or 20 years ago. And they, yeah, I know, but I'm glad I got it done.

Eva Sheie (01:21):
How commonly do they also ask for a lift? Is that just part of the deal?

Dr. Zegzula (01:25):
Yeah, many times they'll say, and you are going to do a lift too. And I always have to explain to them that every breast reduction includes a lift. It would be funny if we made breasts smaller, but they stayed droopy. That would be a sad result. So yes, every breast reduction has a lift.

Eva Sheie (01:44):
But they're smaller.

Dr. Zegzula (01:45):
But for the cosmetic patients, of course, they want the better shape and the higher breasts, and they're not droopy looking. But even those patients have less weight and their backs and necks. Some of them, it's so liberating that they can buy a bra off the rack that some of these patients have always had to have specialty brass. So just being able to go to the store and find a bra easily makes them very happy.

Eva Sheie (02:09):
Is there anything that prevents someone from being able to have breast reduction?

Dr. Zegzula (02:14):
Well, one big, no-no is being a smoker. I have a very, very strong rule about not doing breast reductions on patients who are actively smoking. That puts you at high risk for wound healing problems. But specifically, the blood supply to the nipple is very tenuous in smokers. And they have a higher incidence of having a bad complication called ischemic necrosis, which is where there's not enough blood supply to keep the nipple alive, and then the nipple can actually die. And that's a hard thing to go through. A lot of wound care, a lot of revisions, and then it's just never going to be perfect again. And so hard, fast rule about non-smoking. The second rule is there's some evidence showing that after a certain BMI that it becomes riskier to do a breast reduction. But I'm pretty liberal with that. Depending on the patient's age and her other medical issues, I can pretty confidently do a breast reduction on patients with a BMI, even up to 34, 36. But heavier patients do carry a higher risk for wound healing complications as well.

Eva Sheie (03:19):
If I had a breast reduction and then lost weight, what would happen?

Dr. Zegzula (03:23):
Yeah, 10, 15 pounds, nothing would really happen. You would still be happy. The breast would still have a good shape. But patients who lose more 20, 30, 40 pounds, then they tend to be a little bit less happy with the shape and the fullness of their breasts. So sometimes at that point you could just do a lift and make it a little bit better. Or on occasion, they'll come back and they'll put an implant in. I guess there's also potential for fat grafting, but sometimes you just have to add volume back to the breasts. It's better, I tell my patients it's ideal to do your surgery when you're at the body weight that you want to be, but not everybody gets there. So I tell 'em, it's not a rule, it's just if you lose weight, we might have to make an adjustment. And I've had to do that a couple of times. Not a lot, but a few.

Eva Sheie (04:04):
They're still probably pretty happy, cuz now they

Dr. Zegzula (04:06):
Oh yes. Very happy.

Eva Sheie (04:08):
On this podcast, we bring you directly to the doctors who are where before meets after. Links to our guest's website and contact info are in your show notes. Follow us on Instagram @wherebeforemeetsafter. Where Before Meets After is a production of The Axis, the podcast agency for Aesthetics, theaxis.io.