Is Breast Reduction Right for You?

Large breasts affect nearly 1 million American women, but there is help available.

From the WebMD Archives

Extremely large breasts have been linked to a number of physical complaints including back aches, neck pain, and numbness in the fingers in hands. They have also been implicated in migraine headaches, known to cause shortness of breath, and have prevented women from doing everything from aerobic exercise to picking up their children, to sitting at a desk.

Experts estimate extremely large breasts affects nearly 1 million women nationwide.

"Sometimes a woman with very large breasts will know instinctively that the extra weight on her chest is causing the problems but just as often she doesn't recognize the connection and sometimes that can lead to years of unnecessary suffering," says Bethannie Snodgrass, MD, a plastic surgeon and author of the new book, When Less Is More: The Complete Guide for Women Considering Breast Reduction Surgery.

This, says Snodgrass, can be particularly true for women who have never had a professional bra fitting and may believe their breasts are smaller than they are.

"There are women who are literally squeezing their breasts into a D or DD cup and when they get measured they discover they are really an F or even a G cup," says Snodgrass. And that, she adds, is often their first clue that at least some of their health problems may be related to their breast size.

Breast Size and Your Symptoms

While doctors aren't sure of all of the links between breast size and health complaints, they do know that many problems arise from changes in the normal anatomical structure caused by the excess weight on the chest.

"As women get older and heavier, their shoulders naturally roll forward, which in turn puts compression in the thoracic outlet -- the area where the ribs, shoulder blades, and nerves come through a rather narrow triangle," says Snodgrass.

That rolling forward, she says, combined with the changes in the anatomic space in the back, compresses nerve fibers enough to cause the pain.

"The larger your breasts are, the more you will pull forward, and the more compression occurs -- and over time that is going to lead to some significant discomfort," says Snodgrass.

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Additionally, doctors say many women with large breasts also experience shortness of breath, as well as headaches and shoulder pain, all stemming from the excess weight on their chest.

"Some gals will also have numbness in their arms, and paresthesias (nerve tingling) from the weight on the shoulders pulling on nerves behind the collar bone," says Mark Jewell, MD, president of the American Society for Aesthetic Plastic Surgery (ASAPS).

By the end of the day, says Jewell, the pressure on the shoulders from the bra straps alone can be a significant source of pain.

Breast Reduction Surgery: A Remedy That Works

While physical therapy, ergonomic changes, and even pain medication are often a woman's first line of defense, doctors agree that the only sure way to alleviate symptoms is with breast reduction surgery.

"Large breasts pose a clear and recognizable health problem and nothing works better than surgery: not losing weight, not physical therapy, not pain medication," says Jewell.

And women seem to agree. In studies published in the journal Plastic and Reconstructive Surgery a group of Swedish doctors wrote that women who had the surgery reported significant improvement in all areas of pain and discomfort.

According to the ASAPS, in 2004 more than 144,000 breast reduction surgeries were performed in the U.S. alone -- an increase of more than 200% since 1997.

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How It Works

The operation itself can be performed in a variety of different ways but all techniques have the same goal: Removal of a pound or more of tissue and fat cells from each breast, and then cutting away the resulting excess skin. While in some instances the nipple must also be removed and repositioned, doctors say this procedure has become increasingly rare.

And while the surgery can take up to three hours and always requires general anesthesia, doctors say it is a safe procedure with a fast recovery.

"Since all we are doing is taking out skin and superficial tissue, and not moving any muscles or organs, there is little danger and very little postoperative pain," says Michael Zenn, MD, an associate professor of plastic surgery at Duke University Medical Center.

Indeed, Zenn reports that most women experience only a mild discomfort for a day or two after surgery, and most go back to work within a week. In two weeks he says you can be back to all normal activity, including gym workouts.

"Women are always surprised at how little pain is associated with this surgery. They always expect much more than what it causes," Zenn tells WebMD.

Scarring

While breast reduction surgery is designed to relieve physical complaints, doctors say that aesthetics also play a role.

While good shape and contour are almost always achieved, doctors say the one problem that can't be avoided is scarring.

"There is always some scarring, it is always visible and it is always permanent," says Snodgrass.

That said, it's important to note that the degree to which it occurs is highly personal and different for each woman.

"In general people have different scarring potential. Even within each person the body can scar differently depending on the area, so some women can scar far less than others," says Zenn.

Women with a history of keloids for example (a complication of excessive scar tissue that is most prevalent in blacks and Asians) are frequently dissuaded from having the surgery because scarring might be excessive.

However, Snodgrass says that most women aren't bothered by the potential for scarring.

"The statistics show that well over 90% of women are not only glad they did it, but they would do it again and they would recommend it to someone else," says Snodgrass.

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More Pros Than Cons

In addition to the external scars, scarring inside the breast also occurs. And for many years doctors were concerned this might interfere with the accuracy of a mammogram -- and in doing so increase the risk of breast cancer.

Now, however, improvements in imaging techniques have made it easier to tell scar tissue from disease. Moreover, new research reveals that women who have breast reduction surgery actually have a reduced risk of breast cancer.

Reporting in the journal Plastic and Reconstructive Surgery, author Leroy Young, MD, writes that based on the results of six observational studies conducted in the U.S., Canada, Denmark, and Sweden, women who have this operation are at lower risk for this disease.

"We are not recommending this as a way to reduce your risks, but it is good to know that the operation has this added benefit," says Snodgrass.

Although far less serious but still of significant concern to some is a condition called "nipple numbness" -- a lack of sensitivity and a decrease in sexual response that can sometimes occur as a result of the surgery.

"The operation itself is designed to preserve nerve supply and sensation but there are variations in personal anatomy that you can't account for," says Zenn.

However, Snodgrass reminds us that just as often a woman may experience nipple numbness as a sheer result of her breast size and she may gain breast sensitivity after surgery.

"It can go either way but truthfully, most women are so delighted with the advantages of this surgery overall, nipple numbness is usually not a major issue," she says.

Finally, if you're thinking of breast feeding after breast reduction surgery, doctors say it's possible, as long as your nipple was not removed and repositioned.

That said, doctors also caution that there can be a significant reduction in milk supply after breast reduction surgery, and some women may find they can't breast feed at all.

"If a woman is totally committed to breast feeding her children, then I always suggest she put off the breast reduction surgery until after her childbearing is completed," says Snodgrass.

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Paying the Piper: What You Should Know

According to ASAPS the average cost of a breast reduction surgery in the U.S. is close to $6,000 and it can be significantly higher depending on where you live.

"One of the reasons this operation is so underutilized is that very often insurance companies post barriers that keep women from getting help," says Jewell.

Of those companies who do cover the surgery, Jewell says some require so much tissue to be removed that it leaves some women with a near mastectomy result.

"In the last several years some companies have increased the amount of necessary tissue removal by 150%, which for some women would leave them with almost no breast tissue at all," says Jewell.

Other companies, he says, have written breast reduction surgery out of their coverage completely.

"This is an important women's health issue that needs to be addressed but instead it's being dealt with by a variety of tactics designed to shift the cost to the patient," says Jewell.

Snodgrass says that any woman considering breast reduction surgery should check her insurance policy concerning coverage, and then discuss her specific operation with a plastic surgeon, to access the amount of tissue that must be removed to relieve symptoms.

Says Snodgrass: "No one likes fee surprises so it's always best to know before you have the surgery what your out-of-pocket costs will be."

WebMD Feature Reviewed by Louise Chang, MD on November 23, 2005

Sources

Published Nov. 28, 2005.

SOURCES: Bethannie Snodgrass, MD, FACS, plastic surgeon in private practice, Toledo, Ohio; author, When Less Is More: The Complete Guide For Women Considering Breast Reduction Surgery. Michael Zenn, MD, associate professor plastic surgery, Duke University Medical Center, N.C. Mark Jewell, MD, president, American Society for Aesthetic Plastic Surgery; plastic surgeon in private practice, Eugene, Ore. Young, L, Plastic and Reconstructive Surgery, June 2004. Blomqvist, L. Plastic and Reconstructive Surgery, October 2000.
© 2005 WebMD, Inc. All rights reserved.

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