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If overly large breasts have caused you years of head, neck and back pain, the decision to have medical breast reduction surgery may be one of the most satisfying decisions you’ll ever make.
And if you’ve considered a breast reduction recently, you are definitely not alone. Reconstructive breast reductions for medical purposes in the U.S. numbered well over 60,000 last year, up 6% from the previous year.
Complaints and physical symptoms brought on by overly heavy breasts (known as symptomatic macromastia) can range from strain on the shoulders or neck to deep grooves in the skin caused by the pressure from bra straps. Some patients find they must wear two sports bras in order to exercise, or have difficulty keeping the skin beneath the bra dry and moisture-free, creating rashes and other hygiene problems.
And some studies show that the pressure applied to the neck and shoulders by overly large breasts can also compress nerves that trigger migraines and pain from the front through the rear of the skull and into the neck.
It’s clear that a pound to a pound-and-a-half of extra weight across the chest with no bony support takes its toll on the neck, back and shoulders and can worsen over time.
Breast reduction for medical purposes differs, of course, from cosmetic breast reduction (mastopexy). In mastopexy, we tighten the skin with a lift, which benefits breasts sagging due to extreme weight loss, childbirth or age, where no reduction or augmentation is needed. On the other hand, a reconstructive breast reduction (reduction mammoplasty) involves removing volume and reshaping the breast to help relieve the patient’s physical symptoms. A lift is part of this procedure as well.
Is your breast size affecting your lifestyle? It may be time for a breast reduction consultation. Dr. Masden explains. @MedStarWHC via https://bit.ly/34N81kg.
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Quality of Life
A patient’s quality of life can rapidly become affected by breast hypertrophy—the condition when breasts become enlarged and begin to droop, stretching nerves and spurring neck and back pain.
The patient may be forced to stand and walk differently to compensate for the strain on her muscles and back, potentially affecting her overall posture as well as her self-esteem. Teenagers in particular often struggle with body image if their breasts are extremely out of proportion to their bodies. Hypertrophy can trigger skin irritations, breathing problems, and even skeletal deformities.
When chest size interferes with quality of life, many patients simply want to achieve a physique that’s healthier and less problematic for them.
What Does the Procedure Involve?
In the past several years, I’ve performed approximately 300 of these breast reduction procedures here at MedStar Washington Hospital Center. My patients are generally 20 to 60 years old, although we’ve performed this surgery with great results on females ranging from 18 to 70+ years old.
In reduction mammoplasty, we remove tissue from the breast and create a more optimal contour that suits the patient’s body. Because, in any procedure of this kind, there is the potential for scarring, we operate in such a way that any resulting scars are minimized or not easily visible.
For example, in most breast reductions, we must reposition the nipple, calling for a circular incision around the areola. A cut must be made from the bottom of the areola down to the bottom of the breast, creating what’s known as a lollipop incision. This short-scar method—which reduces the amount and size of visible scars and shortens the patient’s recovery time—works well for thinner, smaller-breasted people with very large breasts.
For other patients, we may perform a Wise pattern lift, which involves an incision along the inframammary fold, in the area where the underwire of the bra sits. The result looks like an inverted T—almost like a traditional boat anchor with a circle, a line down and a semi-circular line across the bottom.
Candidates for medical breast reduction surgery connect with us either directly or by referral from their primary care physician, physical therapist or spine specialist following a long period of chronic back and neck pain.
We review the patient’s breast and mammogram history, pregnancy and breastfeeding history (as well as their expectations to breastfeed in the future), and any family history of cancers. We also examine the patient for lumps, bumps or other breast abnormalities.
Next, we obtain anatomic measurements to help us estimate how much weight or mass to remove in surgery, and to plan the appearance and shape of the breast and the repositioning of the nipple. We review with the patient the procedure we recommend to obtain the best result given her body type and breast structure and mass.
At this stage, we also capture pre-operative photos for the patient’s file, including images of the shoulders, back or any other areas of pain or irritation, to inform insurance coverage of the surgery.
As mentioned, some patients ask if or how their procedure might impact their ability to breastfeed going forward. Over time, we’ve found that some women are able to breastfeed after surgery, while others are not. In the case of a “free nipple graft”—in which we must fully remove the nipple from the breast then reconnect it as a graft—the patient will no longer be able to breastfeed post-surgery. Therefore, we counsel patients that they may want to postpone this surgery until after they have finished nursing for good.
We typically recommend against surgery if the patient has difficulty undergoing elective surgery, if she has a comorbidity such as cardiovascular disease or if she has had an abnormal mammogram or is at risk for breast cancer.
Also, prior to surgery, we ask any patients who are smokers to quit. Smoking and vaping can constrict your blood vessels and affect your skin, which in turn impacts wound healing after breast reduction surgery. Even a small-scar breast reduction requires several inches of incisions, and we want to avoid any barriers to proper healing.
Breast Reductions in Men
Of course, medical breast reductions are not limited to female patients. Surgeries in men have increased about 18% in the last 20 years, from 20,351 in 2000 to over 24,000 per year today.
In men, we tend to see gynecomastia—in which the patient develops abnormally large breasts related to hormonal imbalances, testicular tumors or drug use—or lipomastia, an excess of fat in the chest area. We may perform liposuction to remove the extra fat or, in the case of low-hanging breasts, conduct an actual breast amputation then reconnect the nipples to the chest.
On the Day of Surgery
This is typically a two-hour operation, performed either at MedStar Washington Hospital Center or one of our surgery centers convenient to the patient. Most patients go home the same day.
After check-in on the day of surgery, you will be taken to the pre-operative area, where we start your IV, introduce you to your anesthesiologist and nursing team and begin to mark your chest area in preparation for the operation.
Next, we bring you to the operating area, where the team will place compression devices on your legs to help prevent blood clots, the anesthesiologist will assure that you are set up to breathe comfortably during the procedure and they will administer anesthesia to help you sleep.
When you awaken from your surgery, you will find your chest area protected by a surgical bra—a sort of sports bra with gauze pads. We advise that you continue wearing this bra for support and sponge-bathe until your first follow-up visit.
We generally send our patients home with a small supply of pain medication. Although there is inflammation following this procedure, most patients report feeling very little pain.
Ensuring a Quick Recovery
I see my patients again one week post-surgery, then again at about three weeks, six weeks and three months.
Surgical stitches are removed after the first week, and many of our patients feel well enough to return to office work in a week to 10 days. If you have a position involving a higher degree of physical labor—such as a police officer or a nurse—I typically recommend you take a minimum of two to three weeks off work following your breast reduction. All patients should avoid heavy lifting for three to four weeks after surgery and be gentle with the surgical area for up to six weeks.
For all patients, we predict about six weeks for 90% recovery, and, in most cases, you will be fully healed at three months.
A patient’s likelihood of scarring post-surgery can depend on genetics: Asian Americans and African Americans are more prone to keloids (abnormal scar tissue collection) than are Caucasian Americans. Ten to 14 days post-surgery, I recommend that all patients begin scar and breast massage, using vitamin E oil, cocoa butter or shea butter products, available at most pharmacies. This keeps the skin around the surgical wound soft and helps reduce the chance of very visible scars.
Take Care of Yourself
Remember that it is not necessary to live with persistent pain and discomfort. If you have chronic neck, back or shoulder pain, shoulder grooves from your bra straps or chronic skin irritation beneath and around your breasts, you may well be a candidate for medical breast reduction surgery covered by insurance.
Here at the Hospital Center, outpatient elective surgeries are proceeding as normal despite the current pandemic.
From a patient satisfaction standpoint, breast reduction surgery is easily one of the “happiest” surgeries we perform. Our patients often say, “I felt the difference as soon as I got home” or “I wish I’d done this 10 years sooner.”