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Scott Webb (Host): Breast reduction surgery is a life-changing surgery that involves about three hours of surgery and minimal recovery time immediately after the surgery, though it will take longer to fully heal. My guest today wants women to know that they don't have to suffer any longer. And I'm joined today by Dr. Jamie Ranieri. She's a Board Certified Plastic and Reconstructive Surgeon with Franciscan Health. This is the Franciscan Health Doc Pod. I'm Scott Webb. So Doctor, thanks so much for your time today. We're talking about breast reduction surgery, and I got a whole bunch of questions for you. So as we get rolling here, why do patients pursue breast reduction surgery?

Jaime Ranieri, MD (Guest): Most patients have had large breasts for most of their lives and many start experiencing symptoms early in their teenage years when breast development first starts. Most patients complain of neck, shoulder, back pain, and even breast pain itself. Symptoms can include rashes, soreness underneath or between the breasts, some trap moisture, under or between the breasts. They often complain of their large breasts interfering with daily activities, exercise, and sometimes work depending on what they do for a living.

Host: And so when we think about who's a good candidate, let's talk about are they younger, older, is there an age limit? Can, can you sort of paint a bit of a picture for us?

Dr. Ranieri: There's no specific age requirement for breast reduction surgery. Extreme ages either really young or advanced age are considered on a case by case basis. The caveat being you must be healthy enough to undergo general anesthetic. And again, most women are candidates for breast reduction, if they're healthy.

And as I previously mentioned, can tolerate general anesthesia. If you are young and your breasts are still growing, oftentimes I may advise you to wait till your breast growth has stopped or slowed down. And that age varies among individuals. So often times I can see girls as young as 14 or 15, and I've seen women into their seventies or mid seventies that are desiring breast reduction.

So I kind of take those kind of teenagers and over 70 kind of a case by case basis. My usual patient is more in childbearing ages, you know, 20 to mid 50s. And again, if you're healthy enough, if you've recently had a baby, I recommend waiting till close to about one year postpartum, when your breast size have returned to your pre pregnancy size and sometimes longer if you've been breastfeeding for an extended period of time.

And probably the one medical thing that sometimes is a contraindication or something that I won't do surgery on you for, if you are an, a blood thinner that you can't come off for surgery, which in that age group is very rare, but that is one thing that sometimes will preclude you from being a surgical candidate.

Host: Yeah, I see what you mean. And I guess I'm wondering a surgery like this, is this a surgery for life? You know, I've talked to doctors about hip and knee replacements and things, and we think about, well, you may need another hip at some point. Does that breast reduction surgery last for life?

Dr. Ranieri: It really does. I mean, I tell patients, especially if they're very young, when they have surgery, the breasts are very dynamic parts of your body and everyone's breasts are a little bit different, meaning that, you know, they're very hormonally dependent. So some people, when they gain weight, even when they're pregnant, their breasts can get very big. Sometimes they gets smaller. So it varies among individuals, but generally if you know, your breasts have stopped growing, your weight is relatively stable. You should not need another breast reduction in life. Patients that, again, gain a ton of weight. I mean not tend to 20 pounds, but 50 to a hundred pounds after breast reduction, sometimes they will need a secondary breast reduction, or if someone who in their teenage year who had very large breasts and had a breast reduction, but then as life goes on, you know, they have a couple kids, so they gained some weight. Sometimes those, a small percentage will need another breast reduction, but generally it is a one-shot operation. And the results and your improvement will be lifelong.

Host: Yeah, I hear what you're saying. There could be some exceptions, but generally it's a one-stop shopping a one-time deal, which is probably good for patients. So let's talk about the surgery in general. Are there different ways, different approaches and maybe just take us through this.

Dr. Ranieri: So a breast reduction is an outpatient procedure. So like many things in this world, most things are being done and you get to go home afterwards. And breast reduction is definitely one of those surgeries. But it is about a three hour operation. It is under general anesthetic. I always tell patients a five minute surgery or a three hour operation will feel exactly the same cause you be completely asleep during the operation. Basically when you wake up, you just wearing a bra and fluffy dressings. All the sutures are underneath the skin and absorbable. So no sutures need to be taken out.

As part of the operation, we do reposition the nipple and not only reduce the breast tissue, but we actually lift the breasts. So there is multiple incisions, most of which are in places that are, once they heal will be difficult to see. But you know, there's a lot of incisions. So the process of kind of taking the breast apart, removing the excess tissue and then putting back the breasts together to make it a, an aesthetically nice breast, that takes about three hours. As I mentioned before, you come out with a bra on and just some fluffy dressings. We do use tapes on your incisions that really helped the scars, which are nice and protect the incisions over the the first couple of weeks. When you come back and see me the next day in the office, we take the bra off. Make sure everything's okay. And then after that you can actually shower. You're gonna be in a sports bra for about two weeks after surgery except when you're taking a shower or washing it.

And most patients are very comfortable in the support bra, it provides support during the healing process. And a lot of the discomfort after a breast reduction is really from swelling. So the more you can minimize that swelling with supportive, bras, the better you're gonna feel. At the two weeks we take the tapes off.

And then at that point, you are on restrictions for another two weeks afterwards. The activity restrictions after it really has to do with lifting. So we don't want you lifting more than about eight pounds, which is in layman's terms about a gallon of milk. Those of you that have young children at home, you won't be able to lift your babies or baby carriers, strollers that type of thing for about three weeks after surgery, you'll be able to hug your children, but not lift them like you normally would.

And once you're healed, you know, and after that three weeks, we basically release you to full activity. The final results, meaning that the aesthetics, as far as the breast shape, the symmetry, the breast softness, the scar maturation can take up to a year. Most patients are very happy within just first couple of months.

Basically when you wake up from surgery, you will notice a difference in your back neck and shoulder pain, which is pretty exciting for me. It's one of my favorite surgeries to do, just because it's one of those surgeries where it's instant gratification for patients and they feel better immediately. But as far as the final results, as far as how good your breasts are gonna look, is at a year and that's really when the scars fade the most as far as everything looks good and you know, everything softened and the shape is the best it's going to be. But most patients previously mentioned are really happy within a couple months of surgery.

Host: Yeah, I was going to ask you about outcomes. It sounds like it's fairly minimal quote, unquote recovery time, may take as much as a year, you know, for the scars to fully fade or as much as they're going to fade and so on, but it sounds like a lot of happy patients.

Dr. Ranieri: Very happy patients. As I said, it's like one of my favorite surgeries to do, just because patients are so appreciative. And so many patients don't even know this is an option. They've been carrying around the large breasts, do breast reductions. Take off 10 pounds off patient's breasts. It's like they've been carrying a small child around on their chest for 20 years of their life.

It's really fulfilling surgery and patients really are very happy afterwards. Yeah. And then recovery really. I mean, as far as going back to work and a lot of patients, especially in this kind of post COVID hybrid, or a lot of patients are working from home. Some patients are back on the computer within a couple of days.

Usually, you know, especially for extremely large breasts, if it's something you have an occupation where you are expected to go into the office for eight hours a day, that's more usually about a two weeks before I want you to go back to the office. But patients that have the option to work at home a couple of days, or kind of work remotely, usually, they can go back to work within a week. So it's really a minimal recovery time.

Host: Yeah, and I got kind of hung up. You said 10 pounds. That just kind of slide by there. I guess I had no idea that some women are carrying around that much extra weight that can be removed. That's amazing.

Dr. Ranieri: Yeah, it's impressive. And those patients still have plenty of breast tissue afterwards. So a lot of, patients are concerned that, you know, they want smaller breasts, but they're worried about the aesthetics of it or how much breast tissue they're going to have. They're going to look abnormal and most patients after surgery, even with that amount of breast tissue removed, most patients just look like they lost weight. Their friends or family members would look at them and say, no, she looks great. I don't know what's different, but you know, their immediate family members are obviously know, but your neighbors are going to think, you look good.

They're not going to know what you did to achieve those results. And then some patients that are a little overweight when they have the surgery, the goal is for them to feel better so they can exercise and, you know, be healthier lifestyle overall, is the breasts are kind of deterring them from doing that.

Host: Yeah, you can see how they would be a deterrent and right. Like folks probably look at them and think, well, something's different. I can't quite figure out what it is. Like if you've done your job, you know, appropriately and well, folks will probably just go something's different. I'm just not sure what it is, right?

Dr. Ranieri: Exactly. Exactly. She looks great, but I don't know what exactly she did. And what's her secret?

Host: That's awesome. Always the elephant in the room with this kind of thing is insurance. Does insurance generally cover this type of surgery?

Dr. Ranieri: They actually do. Every now and then we'll come across an insurance plan where it's a non-covered procedure. That's really, I'd say less than 5% of insurance plans. So what insurance looks at to determine eligibility, so three different things. The first thing they do at the, as far as they want to make sure that I'm removing enough breast tissue to make it medically necessary. They want to make sure is it a plastic surgeon. I'm not doing a cosmetic breast lift or something that someone is doing just to improve the appearance. There's gotta be a functional problem. So the first thing to look at is what's called a body surface area. So you take your patient's weight and the height divide that number.

And that body surface area correlates with how much breast tissue I have to remove to make it medically necessary. Most patients who come in, they meet that, and then some it's really not, usually not an issue. The second thing they look at is, and we know you have large breasts are what symptoms you're having related to your large breasts.

So yeah, we go through a series of questions at the consultation, as far as asking what back, neck, shoulder pain, shoulder grooving, rashes, numbness in your hand from the bra being too tight on your shoulder. So we document all that. Everything doesn't have to be positive, but what is positive we document.

And then the third thing I look at, like, we know you have these symptoms, you know, you have large breasts, but what have you tried short of breast reduction, meaning are you wearing a supportive bra? What do you use for your rash? Do you take anything for your back pain, neck pain, shoulder pain. So we document all that. They want to know also seen if you've seen a physical therapist or a chiropractor or a massage therapist to help with your back pain.

Again, you don't have to do all of it, but what you have done, we document in the note, we send that off to the insurance company. We also take pictures of your breasts. Obviously there's no face on the pictures, but as I say, a picture's worth a thousand words, so pictures and measurements, as well as my note saying, I believe this surgery to be medically necessary.

We submit it to the insurance. Usually it takes about three weeks to hear back. Once you hear back from the insurance company, we basically get you scheduled for surgery. Another question that comes up with the insurance, if they approve it, will they approve all of it or some of it, or your fee or the anesthesia fee.

And typically providing you met your deductible and every insurance plan's a little different from that standpoint, it is a covered procedure. So that means they will pay for my fee, the facility fee and the anesthesia fee, as well as a post-op care.

Host: Yeah, as you say, as long as it's medically necessary and you can document and prove it in pictures and your word and all of that, so good to know. Cause I'm sure that would be one of the, you know, the questions that folks would have. Now, if that 5% that isn't covered, can you give us a ballpark of what the cost would be?

Dr. Ranieri: The cost is generally between six and $7,000. And that range kind of depends how big your breasts are, because what comes into that fee, it's not only my fee, which is standard, whether your breasts are large or really large, it's still the same fee for me. The second thing is the facility fee, which is unchanged based on the size of your breast.

And the third thing which varies a little bit is the time that it takes me to do the surgery. And I do a lot of breast reduction. So I'm pretty quick, but as far as sometimes depending on how big your breasts are, sometimes if your incisions are longer, sometimes it takes a little bit longer. So that's why the kind of range as far as extra anesthesia time. But we also, if you're a self-pay for breast reduction, we always want to have the pathologist look at it.

So whether it's insurance or cosmetic, we always send the breast tissue just to make sure that everything's okay. We do require a mammogram if you're approximately age 40, so someone's 39 now, who's never had a mammogram. I typically recommend I get a mammogram, but we do have a mammogram before surgery.

In addition, we do send all the breast tissue that we remove to the pathologist to review, just to make sure there's no cancer, or anything abnormal within the tissue. So that generates an additional like $500 charge for pathology. Which insurance should normally pay for, but if you're paying all out of pockets, that's like the six or $7,000 comes into, but that does include all your post-op care. You know, it's kind of one check upfront, but everything is included with that price.

Host: Well, this has been really informational today. And you had mentioned earlier about just sort of getting the word out that there's a lot of women that just don't know that this is an option and they suffer, you know, carrying that extra weight around. So maybe, as we wrap up here, what would be your final thoughts and takeaways and your encouragement, words of encouragement to try to let women know that this is an option?

It may be something they have to save for, as you say, if your insurance wouldn't pay for it, but in most cases, 95%, it would be paid for. So what do you want women most to know about breast reduction?

Dr. Ranieri: I would just say, if you've been struggling with large breasts your whole life and you didn't even know it was an option, please come in for a consultation. It will change your life. If you have a friend or family member that you know struggles with this and get the word out because it is such a fulfilling operation. And it really would change, your or your friend's life by having this done. And it's really the minimal recovery, and it'll change as far as your back, neck, shoulder pain. You'll feel great afterwards.

Host: Yeah, it really does sound like a life-changer. So Doctor, thanks so much for your time today. You stay well.

Dr. Ranieri: Okay. Thank you so much.

Host: And to learn more about breast reduction, visit Franciscanhealth.org and search breast cosmetic surgery. And if you found this podcast helpful, please share it on your social channels and be sure to check out the full podcast library for additional topics of interest. This is the Franciscan Health Doc Pod. I'm Scott Webb. Stay well, and we'll talk again next time.