Ask an Expert: Breast reduction to ease back and neck pain

Q: “I am considering breast reduction surgery to ease my chronic back and neck pain, but I’m afraid. How common is the procedure, what’s involved, what are the risks, and is it worth it?”  

Answer provided by Meegan Gruber, M.D., plastic and reconstructive surgery, Providence Medical Group-Sherwood and Bridgeport:

Breast reduction is one of the most common plastic surgeries performed in the United States, and satisfaction with the procedure is generally very high. In the “worth it” rankings of 160 cosmetic procedures listed at RealSelf.com, breast reduction ranks in the top seven, with 92 percent of patients saying that the procedure was worth it.

While the cosmetic improvements can be significant, these are not the main reasons why most women choose to have breast reductions. Like you, many women experience chronic backaches, neck pain and tension headaches caused by heavy breasts. Some also develop rashes, chaffing and yeast infections under their breasts. Reducing the weight of the breasts eliminates these problems. Some insurance plans cover breast reduction when it is chosen for these medical reasons. The improvements in appearance and proportion are just a bonus, but one that most women are thrilled with.

What’s involved

If you opt for breast reduction surgery, it will be performed at the hospital while you are under anesthesia. An incision will be made around your areola – the colored area around the nipple – and then down to the bottom of the breast, where your bra sits. In the approach that I use, the nipples are not removed – we keep them attached to maintain feeling and blood flow. Excess breast tissue will be removed from the sides and lower parts of your breasts. Then the extra skin is removed, which helps lift the breasts. Because large breasts often have a stretched look to the areolas, I often make these a little smaller, as well. No incisions are made along the top of the breast or in the cleavage area, so scarring will be hidden by a bra or bathing suit.

You will spend one night in the hospital and then go home the next day. Your post-operative care will be pretty minimal: most patients go home with no surgical drains and no dressings to deal with, other than some small butterfly tapes and a surgical bra. Pain is surprisingly low – most patients take pain medicine for just two or three days, and some find that they don’t need anything stronger than Tylenol.

After the surgery, I recommend that you take two weeks off. You might feel like going back to work after a couple of days, but it’s important to take it easy, to minimize movement and to give your body time to heal. It’s common to feel very tired after any type of surgery, and it’s important to listen to your body and to lie down and rest when you need to.

Weighing the benefits against the risks

All surgeries involve some degree of risk for infection, bleeding, or reaction to anesthesia. With breast reduction, some women experience numbness in the nipples; it’s not common for this to be permanent, but it can happen. This Healthwise article provides more information about breast reduction risks.

One risk that could use more study is the risk of reduced milk production in women who want to breastfeed after breast reduction surgery. This risk appears to be related to several factors, including the type of reduction surgery performed. In the approach that I use, the breast tissue that is left behind is still attached to the nipples and ducts, and there is no scar tissue between them. This method has the lowest risk of affecting breastfeeding ability and milk production. One small study showed the rate of unsuccessful breastfeeding after this type of surgery as being about equal to that of the general population, but more study is definitely needed. The La Leche League offers a good summary of this issue.

Making a personal decision

Breast reduction is a very personal decision, and in my experience, the vast majority of women who make it are very glad they did. They feel better, and they look better, too. As one patient wrote after her surgery, “I feel like I can do whatever I want without any limitations. I’m extremely happy with my new appearance and feel 100 percent more confident.” If you would like to discuss this further, I would be happy to meet with you for a consultation.