There is a lot of emphasis placed on the size of women’s breasts. Most of the time, the emphasis is focused on enlarging the size of the breasts. However, large breasts can be equally difficult for women. Usually the problem begins in early adolescence when puberty begins or after pregnancy, particularly when a woman has gained a great deal of weight. When a young teenager has large breasts, peers often make fun of them or make rude comments. This can create psychological problems that may persist into adulthood. In addition, a significant weight gain can cause the breasts to enlarge. The medical term for this is breast hypertrophy or macromastia. The increased weight from macromastia can cause a lot of stress on the shoulder, eventually creating poor posture which may lead to shoulder, neck, and back pain. In addition, women find it difficult to exercise due to “bouncing” and increased weight on their shoulders. Other symptoms may include skin irritation under the breasts, indentations in the shoulders from the bra, and a feeling of self-consciousness about the size of the breasts.
What are the options for correcting macromastia? First, height and weight criteria should be examined. If a woman is grossly overweight, a weight reduction program should be initiated. This may help to bring the size of the breasts into the correct proportion. If the breasts are still large, a surgical procedure can then be planned. There are literally thousands of such breast reduction surgeries performed every year.
Breast reduction surgery, also known as reduction mammoplasty, is a procedure designed to remove the excess breast tissue. When the breasts enlarge, the nipple and pigmented area around the nipple (the areola) descend down below a “normal” plane. In addition to removing the excess breast tissue, this procedure also raises this complex into a normal position. This involves a great deal of incisions and suturing. It is performed in an operating room under a general anesthetic, usually on a same-day surgical basis.
There are a variety of procedures available for reduction mammoplasty, which often results in a fair amount of scarring; this scarring is permanent, but may fade in 1-2 years. This is probably the drawback to this operation. However, women are often thankful to have the increased weight off their chest, back, and so forth, so that they consider this a fair trade off. It is very helpful to see pictures prior to surgery and these are usually shared with the woman at the initial consultation with the plastic surgeon. Additionally, in the last few years, a great deal of emphasis has been placed on reducing the scarring and preserving nipple sensation and increasing the ability to breast-feed if a woman is still within the childbearing age.
The type of procedure used will be discussed and determined during the initial consultation with the plastic surgeon. Although many incisions are necessary, there is usually not enough blood loss to necessitate a blood transfusion.
The timing for breast reduction surgery is individualized. However, if women are of the childbearing age and feel strongly about breast-feeding, the procedure should be postponed until after this period.
Some commonly asked questions include: How does a woman determine what size she wants to be after the operation? This is a decision that is made with the plastic surgeon. Factors that enter into this decision include body habitus and height and weight. Pictures are also extremely helpful and additional helpful information can be found on the Internet. Women who gain weight after breast reduction surgery will experience an enlargement of their breasts; the reverse is true as well.
Most insurance companies do not consider this a cosmetic procedure. However, they do set guidelines in order for this procedure to be covered. They will usually allow payment if more than 500 g or 1 lb is removed from each side. Preauthorization for medical necessity is required. This involves taking pictures, including height, weight, bra size, and symptomatology prior to the surgery. The insurance companies make the decision, not the doctor, as to whether this meets the criteria. Breast reduction surgery can be an extremely rewarding operation. However, a thorough consultation, examination, and understanding of the details of surgery should take place prior to making this commitment.