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Female breast reduction: When less is more


One of the most commonly requested and most predictably successful plastic surgery procedures is female breast reduction. Many women suffer from symptoms caused by the weight of their breasts. Unfortunately, non-surgical treatments often provide little or no relief.

The medical term for large breasts is macromastia, and when large breasts cause pain and other physical problems the condition is called symptomatic macromastia. Heavy breasts can cause disturbances in multiple body systems. Furthermore, the impact of macromastia can contribute to obesity by reducing a woman's exercise capacity. The symptoms of macromastia can include chronic neck, back, and shoulder pain; chest wall pain; headaches; poor posture; shoulder grooving; numbness and tingling of the hands; shortness of breath, sleep disturbances, rashes under and between the breasts and in the bra strap grooves, and low exercise tolerance. These symptoms may be similar to those of neck arthritis or disk problems, thoracic outlet syndrome, migraine headaches, sleep apnea, and a variety of other conditions. However, for most patients the diagnosis of symptomatic macromastia is straightforward and does not require much if any testing.

Can the symptoms of heavy breasts be treated without surgery? Mild occasional symptoms may be relieved by anti-inflammatory medications, heat packs, massage, chiropractic, physical therapy, etc. Unfortunately, for women with more severe and persistent symptoms, such treatments rarely provide permanent relief. The low success rate of non-surgical therapies for these patients has been well-documented in the medical literature. What about support bras? Good bra support is not always beneficial, as it can aggravate neck, chest wall, and shoulder symptoms. Does weight loss help? While often desirable for health reasons, weight loss has been repeatedly shown not to be effective treatment for symptoms related to heavy breasts. It's all about gravity. A large breast becomes progressively longer and heavier due to the effects of gravity, not because the breast skin stretches like a yo-yo but because it increases in volume. Breast skin is heavy, contributes significantly to total breast weight, and any increase in breast skin volume is permanent, i.e. not reversible with weight loss.

Breast reduction surgery, also called reduction mammaplasty, is a highly effective treatment for symptomatic macromastia because it deals directly with the cause of the symptoms. Numerous medical studies have documented the benefits of breast reduction surgery for women with symptoms related to excessive breast weight. These benefits include improved physical functioning, pain relief, improved skeletal stability, improved lung function, improved quality of sleep, reduced headaches, and improved breast visualization on mammography. Patient satisfaction rates after breast reduction are very high, and it is the rare patient who will not experience significant relief of her symptoms after surgery.

Breast reduction surgery is a standard part of plastic surgery training, although plastic surgeons do not all have equal experience performing the surgery. Some surgeons send their patients home the day of surgery, while others prefer their patients stay overnight in a hospital or short-stay facility. In either case, patients typically will have surgery with a general anesthetic. Incision care after surgery is not difficult, although minor delays in healing are common. Most patients can resume full activities within six weeks, but final breast shape will not be apparent for many months. Women should be aware that all breast operations cause scarring that can affect a radiologist's interpretation of a future mammogram and may require further evaluation.

One of the biggest challenges for many women contemplating breast reduction surgery is obtaining insurance coverage of the surgery. Stay tuned for that discussion in a future post.

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