Ask the Doctors

Dear Doctor: I'm not one for cosmetic surgery nor have I ever had money for such things, but now that I'm 61, I have more than the usual saggy breasts that come with age. Is corrective surgery unwise at my age? If I had thought forward to how the sagging would get progressively worse, I believe I would have tried something at an earlier age.

Dear Reader: It's unclear whether you're considering a breast reduction, a breast lift, breast augmentation or some combination of the three. Each is a major surgery that would, through different approaches, address the issue of sagging breasts. In a breast reduction, fat, tissue and skin are removed to achieve the desired breast size. If the reason for seeking breast reduction surgery is back or neck pain, insurance may cover some or all of the cost. In an augmentation, the size of the breasts is increased with implants made of saline or silicone. While all implants are made to be long-lasting, in reality they have finite life spans. It's possible that sometime in the future, implants may need to be replaced or removed. In a breast lift, underlying tissues are lifted and reshaped, and excess tissue and skin are removed. The specific surgical technique is determined by breast size and shape, the degree of sagging, skin elasticity and nipple position.

In general, people are considered to be candidates for elective surgery if they are in good health, are physically fit, don't smoke and -- this is equally important -- have realistic expectations. When it comes to age, there's a bit of nuance in the findings from various studies. Older age in and of itself is not considered to be a risk factor for physical complications during or after surgery. What matters more are frailty, cognitive impairment and, as we mentioned earlier, smoking. Both frailty and cognitive impairment are associated with being older, so in that regard age can be a factor.

A condition known as post-operative cognitive dysfunction, which we discussed in a previous column, has been linked to surgery and the use of general anesthesia in older individuals. In this condition, short- and long-term memory, mood and consciousness are negatively affected following surgery. Once again, research suggests that risk factors for this include poor physical health, as well as existing problems with memory or cognition.

Elective surgery is a personal decision that, in our opinion, is best made with input from your primary care physician, your surgeon and, if you wish, your closest friends or family members. This will help keep your own wishes and well-being front and center and will keep extraneous (and unhelpful) noise to a minimum.

If you do decide to move forward, start with research. Make a list of potential surgeons and learn about their backgrounds and ratings. Meet with your top candidates so you can ask every question you have. Request before-and-after photos of patients who are willing to speak with you. And check out the American College of Surgeons' program called Strong for Surgery, which focuses on how to prepare yourself physically and mentally for the best outcome.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o Media Relations, UCLA Health, 924 Westwood Blvd., Suite 350, Los Angeles, CA, 90095. Owing to the volume of mail, personal replies cannot be provided.)

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