Dr Rajendra S Rampaul
Pink Hibiscus Breast Health Specialist
Many women who come to us to discuss whether a breast reduction is right for them would often discuss many areas of their physical and breast health. One of the common misconceptions is that many women believe breast reduction surgery is painful and difficult, the other is that it will affect their breast screening, both of which are not true. So what are the reasons a woman may wish to consider breast reduction and what is involved in breast reduction itself?
In general, for non-cancer surgery there are three ways a woman may wish to change the appearance of her breasts. If they are too small, augmentation is often desirous–this can be done either with fat, an implant or with both. We have discussed implant surgery in previous columns.
Another condition that affects women is that over time and pregnancy her breast shape may change due to the effects of gravity or weight change. It may not be as pert as it used to be in her younger years, this can lead to a drop in the breast and so she may need what is called a Mastopexy or breast lift. However, when her breasts are too large for her frame and body size, then we get into the discussion of whether a breast reduction is of benefit.
One of the key questions that I tend to ask patients to assess whether there is a medical indication so she may benefit from breast reduction surgery, is if there is neck and back pain as well as grooving in the shoulders from the heaviness of her breasts in her bra. Sometimes women get rashes under the breasts (called the inframammary fold) and this can lead to blistering and soreness especially during the heat of the day. Artificial fabrics in the bras as well as dark colours such as black only serve to exacerbate these rashes.
If the answer is yes to any of these conditions then clearly the breast size is too large for her frame hence leading to all of these problems. The big concern is not only that there is difficulty carrying very large breast but it can lead to chronic neck and back pain as well as spinal instability, which in the later years continues to get worse.
Many patients in severe cases can complain of tingling in their arms coming down from their neck which is due to chronic nerve root irritation as a result of the strain on the musculature and bones of the spine.
In order to enjoy successful breast reduction surgery, you should be aware of certain key issues such as, what it entails, what is the size you wish to go to, more importantly what are the scars like after surgery, and understanding what are the implications of keeping the nipple alive and sensitive. Discuss with your doctor the pros and cons and if this surgery is right for you, and ensure that you discuss risk and complications.
One of the key things that I do in my practice is that I will show before and after pictures of surgeries I have performed (not downloaded from the Internet and elsewhere). If at this point in the consultation the patient thinks this is right for her, we also open the opportunity for her to meet a patient who has had surgery where she can discuss some of the personal aspects of her journey and how she has been able to cope with it. Overall these are important components of care as you make a decision whether such surgery is important for you.
In general, while breast reduction surgery does not address the same issues as breast cancer surgery, quality of life is a major issue here. A poor quality of life from large breasts can be a significant impediment to all other aspects of your life. Whilst this is not in the essential lifesaving surgery, it is at the same time not cosmetic surgery.