Are Big Breasts a Pain in Your Neck (and Back)?

Large-breasted women often have chronic back and neck pain from the sheer weight of their breasts...gouged shoulders from bra straps...discomfort during exercise...and feelings of self-consciousness. Breast reduction can provide relief.

• Surgical techniques. Surgery is done un- der general anesthesia and takes two to three hours. The "anchor" or "inverted technique typically is used when more than 1,000 grams (about two pounds) of tissue are removed from each breast. An incision is made around the nipple. down the front of the breast and under the breast. Excess tissue, fat and skin are then removed. Nipples may be repositioned to give a natural appearance. When removing less than two pounds from each breast, the vertical or short-scar technique is used. This incision runs around the areola and down the front of the breast only, resulting in less scarring.
  
• Risks. Breast reduction usually involves minimal blood loss. As with any surgery, there are risks from general anesthesia and possible infection. Complication rates generally are low, but can be higher for women who smoke, have diabetes or are overweight.
  
• Postoperative care. The patient usually goes home the same day, with a dressing over each incision. Sometimes small tubes are attached to the incision to drain fluid. These are removed after a few days. Discomfort can be managed with prescription or nonprescription pain medicine.
  
• Recovery. A supportive sports bra worn constantly for one month minimizes swelling. After one week or so, you can return to work and do moderate, low-impact exercise. You can resume all normal activities after a month.
  
• Appearance. Age, skin condition and breast size and shape affect results. At your initial consultation, ask the surgeon how your breasts will look after surgery. Generally, they will be smaller, rounder, higher and more symmetrical. Typically some scarring is visible.
  
• Sensation. Breasts usually feel numb over-all for up to three months but return to normal within six months. It may take a year to regain normal nipple sensation, and in 10% to 15% of cases, it does not return completely. In some cases, if nipples were repositioned, they lose all sensation.
  
• Cost. Breast reduction ranges from $4,000 to $12,000. Usually health insurance covers reduction when medically necessary (for instance, to ease pain).
  
• Breast-feeding. Most women can nurse after reduction--but if breast-feeding is vital to you, delay surgery until you are done having children.
  
• Cancer concerns. Women age 40 or older and those at high risk for breast cancer due to family history should have a baseline mammogram first. Among high-risk women, reduction may diminish breast cancer risk. Breast reduction does not interfere with breast cancer detection or treatment.