What really happens during breast reduction surgery [Kyle Baltrusch, MD, Portland]

Dr. Baltrusch (00:00):
My name is Kyle Baltrusch. I'm a plastic surgeon in Portland, Oregon.

Eva Sheie (00:04):
In terms of how long the surgery takes in the or, what does a day of surgery look like for a breast reduction patient?

Dr. Baltrusch (00:11):
We start operations at 8:30 at some places or eight. And so we have patients come in an hour before their operations, so say 6:30, they go to the pre-op bay with a friend or loved one. They talk to anesthesia, they get an IV placed by nursing, and then we roll into the OR. The operation itself isn't probably around two and a half to three hours, and then patient's in recovery with us for an hour or so as well. So I would say it's probably a half day.

Eva Sheie (00:38):
In your surgery center, do you work with the same anesthesia team all the time? Are they the same people over and over?

Dr. Baltrusch (00:43):
Yeah, so these operations we do outside the hospital settings because they're day procedures. We do them at surgery centers. We work at two main surgery centers, our own Bridgeview and then Northwest Surgical Center. And yes, we work with the same nurses, the same anesthesiologists, day in and day out, so that is a great aspect of the surgery centers.

Eva Sheie (01:03):
What are the benefits we might not normally think of you working with the same people every day?

Dr. Baltrusch (01:09):
I think we learn how the team flows, how our anesthesia providers like to do things. The nurses, our scrub nurses, our scrub techs know how we like to do the operations so they know what instruments we want and what to expect. We all have little variations in techniques, and so they know our operations very well. And then as far as recovery, we're kind of on a first name basis. We know each other, so I would say the anesthesiologists and the nurses feel very comfortable calling us if they have questions preoperatively or postoperatively. And so it's much tighter group.

Eva Sheie (01:45):
I know I was surprised at one point to find out the anesthesiologist stays in there with the patient the entire time. They never leave.

Dr. Baltrusch (01:54):
True.

Eva Sheie (01:54):
Do you think people

Dr. Baltrusch (01:55):
Right, same as the surgeon?

Eva Sheie (01:57):
Yeah. Both of you are there the whole time. It's not set it and forget it. Bye anesthesia. See you later.

Dr. Baltrusch (02:02):
Yes.

Eva Sheie (02:02):
Does that happen in the hospital or is it kind of the same everywhere?

Dr. Baltrusch (02:06):
Yeah, same everywhere. So certainly, I mean, occasionally we all need breaks or anesthesia, if it's at a hospital, they may have

Eva Sheie (02:13):
Cannot go to the bathroom.

Dr. Baltrusch (02:13):
residents. And so yeah, I mean, even another anesthesiologist will come in and give them a break to run to the bathroom or grab something to drink. And so that's not necessarily the case with the surgeons, but at the hospital settings, they have residents that depending on their level, can also run rooms under the guidance of anesthesiologists. The surgery centers that we work at are just the anesthesiologists or CRNAs, and so they're in the rooms the whole time.

Eva Sheie (02:41):
I had another anesthesia question, oh, people are often really afraid of anesthesia. Do you find that happens with your patients too, that it comes up pretty often?

Dr. Baltrusch (02:52):
It does come up pretty often, whether that be patients who are anesthesia naive or who have had multiple operations. Our anesthesiologists at these centers do call the patients the night before and talk them through their plan, ask them about their medications and let them know if they need to hold anything. But I do talk to my patients about the blocks that they do and that at these surgery centers, it's not a true endotracheal intubation. Certainly IV sedation, but they do laryngeal masks and so they occlude the airway, but there isn't a tube that is going through the vocal cords. But I'm not an anesthesiologist, and so I can't go into great detail of agents or what's being used or what to expect. And I haven't even had surgery myself, so I can't tell them first hand experience of that. And so I just tell them that the anesthesiologist is going to call them the night before surgery and certainly ask them any questions that they have. But oftentimes it's more the anxiety. And so patients do receive an anxiolytic if needed, preoperatively after we do markings to help them feel a little bit more comfortable and relaxed going into the operating room.

Eva Sheie (03:58):
I think you're painting a picture for me of a lot of people who do their jobs really well. That's kind of what I see when you describe it.

Dr. Baltrusch (04:06):
I think we do our jobs pretty well.

Eva Sheie (04:07):
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.