Getting It Off Your Chest

Breast reduction is a medical, not cosmetic, procedure, doctors say

THURSDAY, Aug. 29, 2002 (HealthDayNews) -- Most people may think breast size is a matter of personal preference, but for many large-breasted women it can be a medical issue.

April Borry-Black, 47, lived with years of chronic back pain and deep grooves in her shoulders from her bra straps. As she got older, she got tired of having to wear two heavy-duty bras when she went running and dealing with people staring at her breasts rather than her face.

Borry-Black is one of the growing number of women who are opting for breast reduction surgery. Last year, 114,926 women in the United States had surgery to have their breasts made smaller, according to the American Society for Aesthetic Plastic Surgery.

That's only about half as many as had breast augmentation (216,754), but the number is growing. Breast reduction surgery is up 28 percent from 2000 and 140 percent from 1997.

Meanwhile, plastic surgeons are trying to get the word out that breast reduction surgery is often done for medical, rather than cosmetic, reasons.

"It is a medical procedure," says Dr. Alexander Moya, a plastic surgeon at Geisinger Medical Center in Danville, Pa. "These patients present with low back pain, shoulder pain and even numbness and tingling in their fingers because of nerves that are being compressed by their bra. They actually have a depression in their shoulder where their bra has been holding up their breasts. Teenagers come in who can't perform in school and sports because their breasts are in the way."

Because it's widely considered a cosmetic procedure, insurance companies often won't pay for breast reduction surgery, Moya says. Even among insurance companies that will cover it, there are often strict guidelines for how much breast tissue must be removed for it to be considered a medical procedure.

Moya says this puts doctors in a difficult position because every woman's body is different, and every woman has a preference about what size they want their breasts to be after the surgery.

The most common method of performing breast reduction surgery involves three incisions. One is made around the areola, or the area around the nipple. A second runs vertically from the bottom edge of the areola to the crease underneath the breast. The third follows the natural curve of the breast crease.

During surgery that takes two to four hours, surgeons remove the excess breast tissue, fat and skin. They then reshape the breast, including reattaching the areola to a higher position on the breast.

The surgery usually requires one night in the hospital. Women can return to normal activities after about two to three weeks, Moya says.

Doctors usually remove from 2 pounds to 4 pounds of tissue. "That's a huge amount of weight to have off your chest," Moya says.

Of all the procedures he does, women who get breast reduction are among the most pleased with the outcome.

"It's amazing," Moya says. "Once you go ahead and perform the surgery, they are so happy. They can wear normal clothing. They can do activities they couldn't do before and not be bothered by any pain."

Borry-Black, who had the surgery a few months ago, is thrilled with how her breasts look and feel.

"I only wish I had done it years ago," says Black, the mother of a teenaged daughter and director of the Health Center at Susquehanna University in Selinsgrove, Pa. "I considered doing this 10 years ago, but my ex-husband didn't want me to do it."

For most of her life, Borry-Black says, she suffered from back pain. She tried massage, physical therapy and anti-inflammatory medications, with little relief. She never suspected the pain was because of the weight on her chest.

Borry-Black says there is scarring from the surgery, so women shouldn't make the decision lightly. But for her, it was the right thing to do.

Now she can fit comfortably into a D-cup bra. The buttons on her shirts aren't constantly being pushed out. She can sleep on her stomach. Her back doesn't hurt anymore.

"I highly promote it," Borry-Black says. "The pain after the surgery isn't that bad, and the health benefits are phenomenal. You won't have to wear all those straps on your back. You'll be able to shop for regular clothes. People look at your face, not just your breasts."

What To Do

If you're considering breast reduction surgery, check out the American Society for Aesthetic Plastic Surgery or the American Society of Plastic Surgeons for more information about what to expect or how to find a surgeon.

SOURCES: April Borry-Black, R.N., M.B.A., director, Health Center, Susquehanna University, Selinsgrove, Pa; Alexander Moya, M.D., plastic surgeon, Geisinger Medical Center, Danville, Pa.
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