Less is More
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.
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."
Measurement of Pain
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.
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.
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).
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.
level of pain suffered by women with large breasts can
be more severe than that suffered by patients with major
health conditions such as arthritis, cancer, or back
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.
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.
It into Proportion
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.
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.
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."
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.