When Breasts Become a Burden

Courtesy of Coastal Carolina Medical Center

or far too long, Marie had come to think of her large breasts as a pain. Her neck and upper back ached from the constant burden, and her bra straps had engraved deep grooves in her shoulders. Her doctor agreed that she was a good candidate for breast reduction surgery.

Breast reduction, or reduction mammaplasty, involves removing fat, glandular tissue and skin from the breasts in order to make them smaller and lighter. Unlike its sister procedure – breast enhancement – which is nearly always performed for cosmetic reasons, reduction mammaplasty is frequently chosen by women who have suffered physical discomfort or outright pain. About 100,000 procedures are performed each year and, according to the American Society of Plastic Surgeons, it ranks high in patient satisfaction.

A recent review of 29 studies involving more than 4,000 patients concluded that breast reduction surgery significantly decreased back, neck and shoulder pain, headache, breast pain and numbness and pain of the hands. [Mayo Clinic Proceedings, May, 2001]

“Some women choose breast reduction surgery for primarily cosmetic reasons,” shares Dr. Frederick Weniger, a plastic surgeon who recently joined the medical staff at Coastal Carolina Medical Center. “Some of my patients decide to have this surgery because their breasts make them feel self conscious or because they desire better shaped breasts and a more pleasingly proportioned body that is easier to fit in clothes.”

Reduction mammaplasty is a two- to four-hour operation that is nearly always performed under general anesthesia.

Risks include those of any operation under general anesthesia, including bleeding, infection and reaction to the anesthetic. Heavy smokers and persons with diabetes have a particularly high risk of complications, and overweight women are usually encouraged to lose weight first.

There are several techniques; the most common involves an anchor-shaped incision that goes around each areola (the pigmented area surrounding the nipple), then downward, and finally following the natural curve of the crease underneath the breast. After removing excess tissue and then moving the nipple and areola into their desired position, the surgeon brings the skin from both sides down and around the areola, shaping the contour of the new breast. If the nipples and areola have to be completely removed and re-positioned, the patient may experience a permanent loss of sensation. In rare instances the blood supply might be cut off, causing the nipple tissue to die, but in such cases the nipple and areola can usually be reconstructed using skin grafts from other parts of the body.

“It may take a year for the breasts to achieve their final position and size and even then they may fluctuate with hormonal changes and weight, states Dr. Weniger. “Generally speaking, however, the change in body image–and the burden on the neck, shoulders and back–is virtually immediate.”

For selected patients, notably those with excessively fatty breasts, liposuction can be used as an outpatient alternative to traditional surgery. The risk is much less than that of surgery, and there’s minimal scarring and virtually no loss of nipple sensation. One study of 250 women undergoing liposuction found that 197 were quite pleased with the results with no scarring or irregular placement. In fact, recovery was two to four days compared with an average of six weeks for mammaplasty.

There is no evidence that either surgery or liposuction increases the risk of breast cancer. Instead, one study found a reduced risk of not only breast cancer but lung cancer, cervical cancer and non-colorectal digestive cancers for a six and one-half year period after breast reduction surgery–perhaps in part because of an improved lifestyle.

Because they look on it as primarily cosmetic, many insurance carriers refuse to cover reduction surgery or provide coverage only if a certain amount of tissue is removed. Women like Marie argue that the procedure is not for looks but for comfort and relief of pain. “My only regret,” she said, “is that I didn’t have it done sooner.”

Breast Reduction: Did You Know…
Proportion More Important than Weight

Some insurance companies provide coverage for breast reduction surgery only if a significant amount of breast tissue is removed or the woman is more than 10 percent above ideal weight. Authors of a recent study, however, wrote that breast size in relation to body proportion is often a crucial factor in determining whether a woman experiences back, neck, shoulder, or breast pain. The meta-analysis, reviewing 29 studies involving more than 4,000 patients, found that breast reduction resulted in significant improvement of back and neck symptoms and quality of life. “In this study, ample data support the claim that this is a procedure of health benefit to the patients involved,” the authors wrote.

Liposuction Gets Results

Women with a high volume of fat in their breasts may benefit from liposuction, a less invasive alternative to traditional breast reduction surgery. Liposuction has a lower risk of complications and results in minimal scarring. A Dutch cosmetic surgeon using liposuction reported a 46 percent mean reduction in breast volume with clear elevation of breasts. In a New Hampshire study of 204 women only 2 required additional reductions while 5 needed breast lift procedures following liposuction.

Cancer Risk Drops Following Mammaplasty

Several studies have found a correlation between breast size and breast cancer risk. However, a study published in the journal of Plastic and Reconstructive Surgery [May, 1999] found a significantly decreased risk of breast cancer in women who had undergone breast reduction surgery. Subjects followed for six and one-half years also had reduced rates of non-colorectal digestive cancers, lung cancer and cervical cancer. The authors believe the decreased risk might be a result of positive lifestyle changes.

Psychosocial Reasons Are Important Too

Many young women, even adolescents, choose breast reduction surgery for social and psychological reasons as well as to relieve physical discomfort. Many feel self-conscious to the point of shying away from normal relationships and wear baggy clothes to cover up their large breasts. Some women with eating disorders cite the desire for smaller breasts as part of their obsession with weight loss. Large breasts can also interfere with participation in certain sports or exercise. One study of adolescent females, ages 13 to 20, found significant improvement in social adjustment, body image and self esteem six months after breast reduction surgery.

Change Can Be Easy

By Don Foxe, M.Ed.

It’s already February, and one more year of trying to lose weight has already been a lost cause.

Losing weight has to be one of the hardest things a person can try, especially once you turn forty.  The only thing harder appears to be keeping those few pounds you do lose off.

There is a simple solution; unfortunately it involves making that “lifestyle” change you so refuse to do.  Fortunately making a lifestyle change to just lose weight does not hold the dread you seem to think it does.  You do not have to move to San Diego, begin eating green leafy vegetables for breakfast, join a gym, or even wake up an extra hour earlier to run ten miles.  You don’t even have to give up your spouse and children.

If you reduce your intake by just 500 calories/day you can lose one pound a week.  500 calories is a McDonald’s biscuit, a peanut butter and jelly sandwich, 5 slices of cheese, cutting back on portions, but not giving up any particular food.

Doesn’t sound like much?  It isn’t much food, but it is 52 pounds lost in one year.  ONE YEAR!  Okay -- how long did it take to put on your “extra” weight?  Now one year seems fair, doesn’t it? Now if you add about thirty minutes of moderate exercise a day, nothing hard or boring, you can take off another 1/2 pound a week AND have a better chance of keeping it off.
The formula is simple and it works.  All it takes is consistency, and that, my friend, is all a “lifestyle change” amounts to.

  
(You can find more tips on weight loss and exercise at www.beachcityfitness.com.