Episode 6 – Breast Reduction with patient Yullia Beteramia

Wendy Squires (00:10):

Welcome. My name is Wendy Squires, and I’ve been a journalist for more than 30 years, specializing in women’s health issues, which is why I have the great honor of introducing highly respected breast doctor and surgeon, Dr. Nicole Yap.

            She’s an expert in oncoplastic, which involves removing cancers with pleasing aesthetic results for patients. Training in both plastic and general surgery, Dr. Yap’s breast techniques were refined whilst working at the European Institute of Oncology in Milan at the Royal College of Surgeons in London, and working with world renowned experts in Paris and Lyon. Amongst her many accolades, Dr. Yap is the former deputy chair of the Royal Australasian College of Surgeons, and it’s representative on the Cancer Council Victoria, Medical and Scientific Committee. She’s also Pink Hope expert advisor and vice president of Medico-Legal Society of Victoria.

            Today I’m with Dr. Yap and Yullia Beteramia, who is one of Dr. Yap’s patients. And you’ve undergo on a breast reduction-

Yullia Beteramia (00:10):

Yes.

Wendy Squires (01:14):

I understand. I’d like to talk to you about this, even before we get to Dr. Yap’s procedure, because I think a lot of young women feel very uncomfortable having large breasts when they’re very young. Can you tell us a bit about your experience?

Yullia Beteramia (01:29):

Once I hit puberty, it was overnight. I developed breasts and everybody else around me were flat chested or very small, so it made me feel very awkward and uncomfortable in my skin.

Wendy Squires (01:48):

Can I ask you what size you were?

Yullia Beteramia (01:50):

When I hit puberty, I went to a size C, but then I was just getting bigger and bigger. And finally I got to a size F in my late teens and thank God it stopped growing then. But by that time, I was just so unhappy with my body image. It’s affected me until today, until I finally got the surgery too.

Wendy Squires (02:15):

Did you look into having a breast reduction back then when you were a teenager?

Yullia Beteramia (02:19):

I did. There wasn’t a lot of information available at that time online. And what was there, was very frightening for a young girl. I didn’t really have anyone I could speak to about it. My parents were very supportive of me, but they didn’t understand these things. So I just put it to the back of my mind. I was like, “This is what you’ve been born with, you just have to deal with it. And maybe once you get older, you’ll become more comfortable with your body and you can just accept it.” But that never happened.

            And finally, I decided to have another look at breast reduction and it was still frightening. And that’s when I came across information about another procedure, a liposuction procedure called scarless breast reduction. And I thought that’s perfect. It sounds exactly what I’m looking for. And I spoke to a few cosmetic physicians who did that procedure, but there was a lot of unanswered questions. I wasn’t really sure that I would be getting the results that I wanted. That’s when I spoke to my GP and asked his advice. And it was he who directed me to see Dr Yap, because she is obviously a qualified surgeon. And he said, “Before you decide to do something drastic…” Because it is drastic, any type of surgery like that is drastic, “Speak to someone who actually knows what they’re talking about.” Then I spoke to Dr. Yap, because obviously she’s qualified in this field and she was able to advise me about what I should do.

Wendy Squires (04:04):

Dr. Yap, liposuction on the breast, is this a new procedure? What does that entail?

Dr Nicole Yap (04:09):

Liposuction anywhere in the body has been around for a long time, because it’s a quick fix, but it does not address the skin envelope. So it removes volume. And I think in someone like Yullia, who has basically not that much fatty tissue, but more glandular, I would not be suggesting that because lipo means fat suction means removing fat by sucking it out, and then no one addresses the enlarged skin envelope. So you end up with flat, less volume, floppy breasts. Why would someone in their thirties want flat floppy breasts? I don’t know. I certainly wouldn’t. Yullia doesn’t want it. You have to address, like in all breast reduction, the main surgical procedure is removing volume, but also removing the excess skin.

Wendy Squires (05:08):

Yes, of course.

Dr Nicole Yap (05:09):

And unfortunately that does require an incision, because geometrically you can’t do it any other way.

Wendy Squires (05:15):

So can you tell me actually, what a breast reduction operation entails?

Dr Nicole Yap (05:19):

Yes.

Wendy Squires (05:20):

Because it isn’t just removing fat. It’s actually restructuring the breasts, isn’t it?

Dr Nicole Yap (05:23):

Yes. So, it entails removing volume, so whether that’s fat and or glandular tissue. Glandular tissue being breast tissue, and you can remove it anywhere on the breast. But I like to maintain the vascular supply of the nipple areola at all times. So I will do that. I don’t cut the nipple areola off. I don’t care how large the breasts are. I don’t need to, because I’ve maintained that blood supply. And then I’ll remove the excess skin. And because we don’t want any incisions on the upper aspect of the breast, we make them in the lower aspect, so they hidden, because the breast folds in like this. So the incision also allows for the nipple areola to move up because when you have large breasts, they’re down dropped below and you want them back to where they originally should be. So the incision is around the areola margin. So you can hide it within the margin, in the crease under here, which nobody sees unless you’re going to be lying topless so that everyone can see underneath.

Wendy Squires (06:29):

Standing on your head.

Dr Nicole Yap (06:29):

Yes. Because by that stage, I would’ve lifted the breast. All the tissue that is remaining is lifted. So you have perky breasts at the end, nipples in the right spot, and most of the incisions hidden in the crease underneath the breast around the areola, and a fine line running from the areola margin down. So that has to be there because I have to bring in skin from where I’ve removed the excess skin. So it’s one fine line, which in effect, when you’re standing there looking at yourself because the breast is rounded underneath, most of that’s hidden.

Yullia Beteramia (07:03):

Yes.

Dr Nicole Yap (07:03):

Yes.

Wendy Squires (07:05):

Is that one of the things you were frightened of in the beginning, was things like the nipple being removed and all those scary things?

Yullia Beteramia (07:13):

Yes. It was… When I was younger, the only type of breast reduction I knew about was the four… They did the cross, so you’d have… And I was like, “Oh my God, all that scarring.” I was just scared about what it would look like afterwards. I didn’t want to trade one body image issue for another body image issue. But I’ve been really happy… Surprisingly happy with the results.

Dr Nicole Yap (07:39):

Surprisingly?

Yullia Beteramia (07:40):

Sorry. I knew Dr. Yap would do a fantastic job, but there’s still always that worry in your mind that things aren’t going to work out right, and it’s not going to look good and you’re going to have all these issues. But yes, I’ve actually recovered much better than I thought I would, and Dr. Yap and her team were amazing. So I think it’s just about getting over those hurdles in your own mind, when you’re going through [crosstalk 00:08:09].

Wendy Squires (08:08):

It’s not even just the aesthetic though is it, with large breasts? Because I know I suffer severe neck and back pain. You were suffering that as well.

Yullia Beteramia (08:14):

Yes. I still have to visit the chiropractor every two weeks. It’s something that people I don’t think, really understand how debilitating it can be. Especially women would look at me and be like, “Oh my God, you’ve got amazing breasts. I’m going to Thailand so I can get breasts like that.” And I’m like, “You don’t know what it’s like.”

Wendy Squires (08:35):

I’m exactly the same way. Everyone says, “Oh, you should be lucky or proud.”

Yullia Beteramia (08:38):

No.

Wendy Squires (08:39):

And it’s, “You don’t understand. They are so, so painful.”

Yullia Beteramia (08:41):

Yes.

Wendy Squires (08:42):

So how is all of that? Has that been alleviated?

Yullia Beteramia (08:44):

It has, yes. It’s much better. It’s obviously, because it was years of pain and muscle-

Wendy Squires (08:52):

Weight.

Yullia Beteramia (08:52):

And spinal… Exactly. So I’m still getting treatment for my back. But immediately afterwards, I just felt so much… My posture is better, I just feel better.

Wendy Squires (09:03):

I have to say, you’ve got beautiful breasts.

Yullia Beteramia (09:03):

Thank you.

Wendy Squires (09:05):

They look like the right shape and size for your body.

Yullia Beteramia (09:07):

Yes.

Wendy Squires (09:07):

You’ve done a gorgeous job as usual. What would you say to anyone who’s suffering from really large breasts and are in pain?

Yullia Beteramia (09:17):

Speak to a medical professional, someone that you trust. Your GP. And don’t be afraid to get a second, third, even fourth opinion. Take the time to do the research. It can be frightening, but you have to ask yourself whether you can continue living the way you are with the pain, with the discomfort, or whether you can imagine a better life for yourself afterwards.

Wendy Squires (09:52):

A lighter life.

Yullia Beteramia (09:52):

Yes.

Wendy Squires (09:52):

You’ve done a beautiful job. You should be very proud.

Dr Nicole Yap (09:52):

Thank you.

Wendy Squires (09:54):

You look wonderful, Yullia. Congratulations.

Yullia Beteramia (09:54):

Thank you.

Wendy Squires (09:57):

You’ve done another great job. Congratulations to you as well. And thank you for coming in.

Yullia Beteramia (10:01):

Thank you.

Dr Nicole Yap (10:02):

Thanks.