When Less is More by Elvira Maricic For many women, oversized breasts are a load they'd rather not bear print article      send to a friend

According to Alison Masterson, when it comes to breast size, one woman's blessing can be another woman's curse. While many would say that with a 36-D chest measurement the petite 38-year-old bank employee has been amply blessed, she doesn't see it that way. Masterson (not her real name) has recently consulted with a plastic surgeon about having breast reduction surgery. "I just want to be a normal B-cup. I want to get these bowling balls off my chest," she says candidly.

"I have a hard time breathing when I lay down, and my bra straps are always cutting into my shoulders," Masterson adds. "It's painful and difficult carrying heavy breasts around," she says. "It's just not worth it."

A Measurement of Pain

A study presented at the 68th Annual Scientific Meeting of the American Society of Plastic Surgeons (ASPS) validates Masterson's complaints. According to the study, the level of pain suffered by women with breast hypertrophy (large and heavy breasts) can be more severe than that suffered by patients with major health conditions such as arthritis, cancer, or back pain.

The study included 263 women, aged 18 to 74, who completed a variety of questionnaires including the McGill Pain Questionnaire (MPQ), which measures four categories of pain: total, sensory, affective, and cognitive-evaluative. Their answers were compared to population norms for women in similar age groups.

Results showed that patients with large breasts reported greater total pain on the MPQ scale (27.6) than patients with other pain syndromes including: back (26.3); cancer (26.0); phantom limb (25.0); pain following herpes (22.6); dental (19.5); arthritis (18.8); and menstrual (17.5).

A study presented at a previous ASPS meeting showed that among the benefits of breast reduction surgery is a measurable improvement in breathing and lung function. Among the objective criteria tested and calculated, three were significantly improved, notes the ASPS: inspiratory capacity (amount the patient breathes in), peak expiratory flow rate (rate at which the patient breathes out) and minute ventilatory volume (the amount of air moved in and out of the lungs). Patients with larger body mass showed even greater improvement in minute ventilatory volume and peak expiratory flow rates with breast reduction.

"Reduction is more of a symptomatic operation than it is cosmetic," says Mark Salzman, MD. "They're thrilled that they look great, but a lot of them are functionally impaired in their daily activities. Their exercise regimens, their attempts at weight loss are hampered by these big breasts that get in the way," says the Louisville, Kentucky plastic surgeon. "The pressure from the undergarments worn for support bother them and they have neck, back and shoulder pain," he adds. Other symptoms reported by women with large breasts include breast pain, shoulder grooving, hand numbness, shortness of breath, discomfort when standing, and rashes beneath the breasts, not to mention extreme self-consciousness and ill-fitting clothing. "They have true symptoms and we can not only alleviate them, but we can make [patients] look better and have more functional and aesthetically pleasing breasts," he says.

"A lot of these women have been big all of their lives and they have [the surgery] done at age 50, and they love me the rest of their lives," says Dr. Salzman. He notes that he's operated on women ranging in age from 18 to 70.

Putting It into Proportion

Technically known as reduction mammaplasty, breast reduction surgery removes fat, glandular tissue, and overlying skin from the breasts, making them smaller and more proportionate with the rest of the body. During the procedure, which is done under general anesthesia, the surgeon makes an anchor-shaped incision that circles the areola and extends downward. Excess tissue is then removed through this incision and the nipple and areola are moved into their new position. Next, the skin from both sides of the breast is brought down and around the areola, and is then closed with fine sutures that can be removed seven to 10 days after surgery.

"The surgery takes about three hours, compared to 35 minutes for a breast augmentation, and recovery takes two weeks," says Dr. Salzman. Possible complications include excessive bleeding, infection, reaction to the anesthesia, discoloration of healing skin edges, and the development of seromas (small, tumor-like cysts) in the breasts. Additionally, the procedure leaves permanent scars and is not intended for women who plan to breastfeed. According to Dr. Salzman, about 50% of women can breastfeed afterward. "It depends on the technique," he says. "If you're leaving all the gland tissue behind the nipple, there theoretically should be enough breast tissue behind the gland to nurse. However, I would never [make that] promise to anyone that I cut."

Paying for Less

Despite the potential complications, Alison Masterson says she is eager to have the surgery. "The only concern I have is whether or not my insurance will cover it," she says. Breast reduction surgery is often considered a cosmetic procedure and is not generally covered by insurance. While some insurance companies will pay for it if it's medically necessary, they may require that a certain amount of breast tissue be removed. "It used to be you would remove 350 grams, and no matter how big the patient was the [insurance company] would accept it. Now, they have strict height and weight tables," says Dr. Salzman.

Even if her insurance company doesn't cover it, Masterson says she would pay out-of-pocket for the procedure, which can range between $3,500 and $5,000. "It's a quality of life issue," she says, "and it's worth the cost." Of all plastic surgery procedures, breast reduction results in the quickest body-image changes, which is something patients seem to like. Dr. Salzman notes that his breast reduction patients "are the happiest patients."

"No matter what complication they may get, and there are some--thicker scars, the fat doesn't all live and can become a rock hard mass you have to go back and cut out--I've never had an unhappy breast reduction patient," he concludes.