Paul A. Critelli, MD

By Avery Niles

Published:& Oct. 16, 2023 at 12:46 PM CDT

ATHENS, Texas (KLTV) - Roughly one out of eight women in the U.S. will develop invasive breast cancer in the course of their life.

Melisa Collum was working at the UT Health Athens hospital as a registered nurse when she felt a lump in her left breast.

"We were up on the floor one day and my PCP happened to be up there, Dr. Swartwood, and some of the nurse's kind of let the cat out of the bag. So he made me come see him that day, and sure enough he sent me over to the breast center and I had multiple masses," Collum said.

Collum was diagnosed with an aggressive form of breast cancer called HER2+. She immediately started chemotherapy treatments.

"After my first treatment I didn't have my port in yet. I was up on the floor and Dr Doorman happened to be up there doing rounds and I grabbed him and kind of pulled him to the side and told him what was going on. He and I had a really long talk that day. Within two weeks, he had my port in," Collum said.

After six rounds of chemo and 12 rounds of Herceptin, general surgeon Dr. Doorman and plastic surgeon Dr. Critelli preformed a bilateral mastectomy with reconstruction.

"And when Dr. Doorman called me with my pathologies back from my sentinel nodes, it was the best day," Collum said.

At a follow-up appointment after surgery, Collum saw there was no nurse at the office.

"And as we were walking out, the office manager said, ‘are you looking for a job?' and I was like ‘no I work at the hospital' and we just laughed it off. And a few days later is when Dr. Doorman called me," Collum said.

She is now the registered nurse at the office and a nurse navigator for Patients'd. Robert Doorman said Collum is able to connect with patients in a special way.

"She'll spend hours on the phone with them, and she will laugh with them, and she will cry with them, and she will be there to hold their hands even when they are in appointments outside of this office," Doorman said.

Collum said her own cancer journey has led her to where she needs to be.

"I think they trust me because they know what I've been through," Collum said.

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What is Breast Reduction Surgery?

Breast reduction surgery is a surgical procedure that removes fat, breast tissue and skin from the breast. This reduces breast cup size and weight, while at the same time lifting, reshaping and repositioning the nipple/areolar complex to a more youthful position.

While there is a large population of women that may want to augment their breast size by adding volume, there is an equally large number of women that want to reduce the size and weight of their breasts.

Reasons one may consider breast reduction surgery

1. Breast reduction can decrease pain and improve posture.

Large breasts lead to tension and stress in your shoulders, back and neck. For most women, this begins shortly after puberty or pregnancy and tends to progress or worsen with time. Chronic pain and discomfort often lead to avoidance of exercise and athletic activities which leads to weight gain and decreased core strength, which further exacerbates the pain.

Not only do women who have large breasts deal with the above-mentioned pains from the heaviness of the breasts, but the breasts also can cause women to hunch over, leading to poor posture. The weight of large, heavy breasts can, over time, cause a curvature of the spine. This often leads to neck, back and shoulder pain. Removing excess breast tissue will decrease the tension on your neck, shoulders and upper back, improving posture and discomfort.

2. Breast reduction can improve mobility and exercise abilities.

When you have large breasts causing pain and discomfort, it becomes difficult to remain active and physically fit. Having larger breasts and the associated heaviness on your chest brings multiple challenges regarding exercising, sports and physical activity.

There are many exercises, especially cardio, that require more vigorous movements that are difficult to accomplish with large, heavy breasts. Finding appropriate supportive bras is also a challenge. As a result, most refrain from these sorts of exercises to avoid pain and discomfort. This is a common reason for women to undergo a breast reduction because smaller breasts will make it easier and more comfortable to be active.

3. Breast reduction can increase confidence and self-esteem.

Many women, especially young women, feel uncomfortable having large breasts and report low self-esteem due to large breasts. This is very common with teens who feel awkward when playing sports or swimming. Large breasts also may be a source of unwanted attention while out in public or with friends. Reducing breast size to a more normal or proportionate size can allow you to be more comfortable in public and with normal activities, which will increase your confidence and self-image.

From a practical standpoint, large breasts also can make it difficult to find appealing clothing. After a breast reduction, your body will be more proportionate, and clothing will be easier to shop for and your clothing options will increase as most clothing brands market to “normal” size breasts.

4. Breast reduction can reduce sagginess and provide a lift to the breasts.

With time and pregnancy, breasts unfortunately and inevitably age and sag. If you have larger breasts, this is often more drastic and noticeable.

Larger breasts have more tissue and fat, which results in more weight and an increased risk to sag sooner than smaller breasts. Breast reduction not only removes excess skin and breast tissue to get you to an ideal cup size, it also lifts and repositions the breast tissue and nipple on the chest wall to a more youthful position. This lift will make your breasts appear perkier with improved medial cleavage and place the nipple at the most projecting point of the breast.

5. Breast reduction can fix asymmetry in the breast.

Breast asymmetry is very common. In fact, most women have mild asymmetries between their breasts, whether it is with the size, shape or nipple position. Sometimes, this asymmetry can be more significant and a source of discomfort or low self-esteem. Breast reduction surgery often is used to correct and improve these asymmetries.

6. Breast reduction can assist with better sleep.

Lastly, breast reduction surgery can assist with a better night's sleep. Having larger breasts can make finding a comfortable sleeping position difficult, as well as having the pressure from heavy breasts making it hard to completely relax. Breast reduction surgery can eliminate this issue and make it easier to comfortably lay in bed without the added weight and pressure of large breasts.

7. Does insurance cover breast reduction surgery?

Because large breasts, or macromastia, commonly lead to chronic pain, issues with posture and social issues, it is often considered medically necessary and may be covered by your health insurance plan. The first step is to contact your insurance company or have our office help you to determine coverage of breast reduction surgery. Occasionally there is a policy exclusion and our office can help you determine out-of-pocket expenses.

8. Is breast reduction surgery right for me?

Breast reduction surgery is a common, well-tolerated procedure that relieves pain and discomfort associated with large breasts to give you back your life. Don’t let your best life pass you by. Discuss with a board-certified plastic surgeon to determine if a breast reduction is right for you.

Information provided by board-certified plastic and reconstructive surgeon, Paul A. Critelli, MD, at the UT Health North Campus Tyler. For more information or to schedule an appointment, call 903-877-7826 or visit uthealthnorth.com/services/plastic-surgery.

Many women of, all ages, contemplate changing the size and or shape of their breasts. This may be to improve perceived beauty, femininity, sexuality or improve body proportions or correct asymmetries. The decision to have a breast augmentation is a very personal decision that only you can make for yourself. It’s about what you want and your quality of life.

When should I get my breast augmentation?

There is no perfect time to have a breast augmentation. Many women have been told to wait until they are done having children and done breastfeeding to take the plunge, but that doesn’t mean you have to wait. It’s entirely up to you. But there are a few things you will want to consider.

Effects of pregnancy

During and after pregnancy, your breasts will grow with breast milk. Pregnancy enlarges the breast gland and stretches the skin envelope, but after breastfeeding is finished, the gland shrinks to a smaller size, but the skin envelope stays larger. This means your breasts won’t be as perky and may sag more than before pregnancy.

Breast augmentation before babies?

First and foremost, it’s safe to have breast augmentation before becoming pregnant and perfectly safe to breastfeed with implants. Your implants will not harm your baby in any way. A small number of patients may have trouble with breastfeeding after augmentation and this can vary slightly with the size of the implant and how they are put in, so make sure to talk with your surgeon about your future breastfeeding goals.

It’s tough to predict how pregnancy and breastfeeding will affect each woman’s breasts. Some women experience significant changes in shape and size, while others experience almost no difference (the latter being uncommon). For patients who have had a breast augmentation before pregnancy, you may experience breast sagging, where the breast tissue overhangs the implant after pregnancy. Smaller breasted women tend to see fewer changes than large breasted women. The common treatment for this “sagging” or ptosis is a procedure called a mastopexy or breast lift. Because this requires another surgery and longer scars, many surgeons will suggest waiting on your breast augmentation if you plan to become pregnant in the near future.

The solution!

For patients who are concerned about the stretching of the breast skin envelope and want to limit the future need of a breast lift, either, to avoid a bigger surgery or the scars associated with it (usually an inverted T or anchor pattern), but still get their ideal breasts now, I recommend breast augmentation with a saline implant. Saline implants offer one clear advantage to younger patients, they can be deflated prior to or during pregnancy without the need for surgery. Deflating the implants will minimize, and often eliminate any additional stretching of the breast skin envelope. After pregnancy and breastfeeding, the implants can be replaced with a simple procedure requiring no additional scars and with similar pre-pregnancy results.

Saline implants may offer you a way to have the breasts you always wanted now and avoid common issues later. However, if you don’t like the idea of having multiple surgeries, you should probably wait to have your breast augmentation until after having kids. Always consult a board-certified plastic surgeon to discuss questions and concerns. They will be able to sort out your options and develop the best plan for you as an individual.
 

Information provided by Paul A. Critelli, MD, at the UT Health North Campus Tyler. For more information or to schedule an appointment, call 903-877-7826 or visit uthealthnorth.com/services/plastic-surgery.