More and more women are opting to go UNDER THE SURGEON’S KNIFE but not for a tighten or tuck. KATE O’BRIEN takes the measure of breast reduction procedures
Men stare. Women are envious. And cries for help such as this appear on internet boards: “I’ve been seriously considering it for about eight months now because of the back pain, the indents from my bra straps on my shoulders, the backne [sic] it’s causing me to have, not to mention the comments I get at work from men (and some women) which make me feel very self-conscious and unconfident. I’m quite tall for 19, and without the breasts that ‘some women pay for’ I would be a small size 12.” Is this how a young woman with her life ahead of her should be feeling?
As many women will attest, overly large breasts can cause physical problems such as back, shoulder and neck pain, poor posture, excessive sweating, rashes and infection under the breasts, marks or grooves on the shoulders from weighed-down bra straps. All of this in addition to the emotional anguish that affects most, especially younger women who become increasingly self-conscious and begin to hate their bodies.
Take Sandra for example: even in primary school her breasts were large. An E-cup by age twelve, F-cup at 13 and a 34JJ by the time she was 19, Sandra hated sports, hated her body, her clothes and she hated herself. Last year, after months of taking painkillers for chronic back and neck pain, she had 2.2kg (primarily tissue) removed from her breasts and now is comfortable between 34C and D. “No one ever looked me in the eye,” admits the 21-year-old, and while she always tried to brush off the name-calling (“Tits” among others), it hurt deeply. “This was one of the best decisions I ever made. While there is a little scarring, I can do everything, my clothes actually fit and I’m paying €5 for a bra that cost me €55 or more before surgery.”
Getting accurate statistics for Ireland is very difficult as many private clinics won’t disclose numbers.
Breast reduction, or reduction mammoplasty, is an increasingly sought-after procedure in Ireland. The operation removes excess breast fat, glandular tissue and skin to achieve a breast size more in proportion with the body, and to alleviate the discomfort associated with large breasts.
“Getting accurate statistics for Ireland is very difficult as many private clinics won’t disclose numbers,” says Mr Jack Kelly, consultant plastic and reconstructive surgeon at Galway University Hospital and the Galway Clinic. Kelly and many other Irish-based plastic surgeons are members of the British Association of Aesthetic Plastic Surgeons, or BAAPS, the legitimate professional body recognised by The Royal College of Surgeons in the UK and Ireland. Recent figures released by BAAPS for 2013 show a total of 5,476 breast reductions carried out by its members, an increase of 12.5 per cent from the previous year. While these numbers are not exact, they are the only statistics available. Kelly himself typically performs two breast reductions per month in Galway and estimates the annual national average to be between 15 and 30 per surgeon.
Hollywood breast surgeon and author Dr Norman Leaf is noticing an increased number of younger women attending his clinic in Beverly Hills. “It makes a huge difference to a woman’s self esteem,” he explains when we speak on the telephone. His youngest patient was a very overweight 13-year-old who had a 2.3kg reduction on each breast. This was a very unusual case where the young girl’s breasts were so large that it was affecting her development physically and emotionally and Leaf worked very closely with the girl’s family and pediatrician.
A GG for example, doesn’t necessarily look that full, just very droopy. Sometimes my patients will end up with the same cup size post surgery simply because their bra didn’t fit properly in the first place.
“In Ireland we tend not to operate on women under 18,” says Kelly, “except in exceptional circumstances like gigantomastia, a rare medical abnormality of the breast connective tissue in which a girl has very large breasts at a very early age. In cases like this, we may need to reoperate as the breasts can regrow.”
Mr Tom O’Reilly is a plastic surgeon at Dublin’s Blackrock Clinic and St Vincent’s University Hospital. He typically treats women between ages 35 and 50, with large, heavy and unbalanced breasts (36-38E and F-cups or thereabouts) who are post-children and breastfeeding. He doesn’t like to operate on women younger than 20, and if he does, pre-operative counselling is mandatory.
When it comes to the actual procedure there are no hard and fast rules and generally no limit to the degree of reduction possible. Leaf expresses concern about the manipulation of bra sizes brought about by certain stores as they “try to make women feel better about their bodies”. “So much so that the concept of cup size has got mixed up in a swamp of hyperbole. A GG for example, doesn’t necessarily look that full, just very droopy.” Leaf rarely reduces more than one cup size but works to reshape the breast. “Sometimes my patients will end up with the same cup size post surgery simply because their bra didn’t fit properly in the first place. “At the end of the day it is what my patient is most comfortable with, but never less than a B-cup.” Many women who have had large breasts for many years may not wish to go from one extreme to another anyway and therefore tend to request a C or D cup.
I could never get clothes to fit, my shirts were always gaping in the middle and too big around the waist. Safety pins were a staple of my wardrobe.
Insurance benefit for breast reduction is subject to prior approval and payable only if specific criteria, as set out in the Schedule of Benefits for Professional Fees and Private Hospital Services, are satisfied in full. These include: BMI (Body Mass Index) of 20 or under; cup size F and up; symptoms including back pain, thoracic pain for at least three months; daily use of prescription analgesics for at least four weeks and cranio-clavicular syndrome (ongoing chronic pain in the shoulder area). “Costs vary from €7,500 in the west of the country to between €9,500 and €11,500 in the Dublin area.”
Niamh had an elective breast reduction in Dublin’s Blackrock Clinic in 2010. At 56, she had lived with large breasts for the best part of her life. “I could never get clothes to fit, my shirts were always gaping in the middle and too big around the waist. Safety pins were a staple of my wardrobe,” she explains. It never occurred to her that she could do something about the problem until a friend mentioned it. “In hindsight, my motivation was part vanity as I didn’t suffer to the extent that other women do,” she admits. “But I did have years of undiagnosed shoulder and neck discomfort.” Nor did she realise that medical insurance was an option.
About 400g was removed from each breast and her final bill was approximately €10,000. Niamh was back to her regular routine just eight weeks after the initial consultation. “The surgery was worth every penny and I just wish I had done it sooner,” she adds. Now a DD cup, she is far more comfortable, as her breasts are in proportion with her body.
I have operated on hundreds of women over the years and found just one breast cancer, in one patient, throughout my career.
Leaf is noticing an increased trend for mastopexy, or breast uplift, in the US. Mastopexy is designed to reshape and firm breasts that have sagged as a result of ageing, breastfeeding (distension of the breasts causes the supporting fibrous bands to break down and the skin to stretch), weight fluctuation and the forces of gravity.
O’Reilly says many women present seeking breast reduction when it is mastopexy they actually need. “Their breasts are not always that large, just very saggy. Mastopexy removes less than 400gms of tissue per breast and it reshapes them.” During the procedure, pleats of surplus skin are removed from underneath the breast and the breast itself is remodelled with the nipples repositioned higher up. This surgery is also performed to reduce the size of the areola (the darker skin surrounding the nipple).
With the high incidence of breast cancer in the western world (approximately one in nine) O’Reilly wants to reassure women that large breasts do not increase the risk of breast cancer. “I have operated on hundreds of women over the years and found just one breast cancer, in one patient, throughout my career.” Every woman who is 50 and above attending his clinic with a family history of breast cancer is sent for a baseline mammogram. “If anything suspicious is noted, I refer them to a general surgeon before any breast reduction procedure is undertaken.”
Post-breast reduction there is an increased incidence of delayed healing and loss of sensation in the nipple areolar complex (approximately one in ten). But women with large breasts can have reduced sensation in this area anyway as the nerves are stretched.
Breast reduction is a safe procedure with typical operating time between 90 minutes and three hours. And apart from the change of shape and reduction in breast size, the most obvious consequences are the scars. These are designed to lie under the average bra or bikini top and to be invisible while wearing normal clothing. The scars do fade with time. Leaf affirms that the major concern with almost all his patients is the post-reconstruction scarring, “but when surgery is performed properly these scars are insignificant.” As with most surgeries there is a risk of infection and haematoma, but this is rare. “There are general complications with every surgery,” adds O’ Reilly, “but post-breast reduction there is an increased incidence of delayed healing and loss of sensation in the nipple areolar complex (approximately one in ten). But women with large breasts can have reduced sensation in this area anyway as the nerves are stretched,” he qualifies. O’Reilly doesn’t recommend reduction for women who are yet to have children – in his experience, less than ten per cent of women can actually breastfeed after reduction surgery.
Kelly urges women to thoroughly research both the surgeon and hospital or clinic before committing to an operation. As well as discussing the procedure, preferred breast size, potential complications and effects, women should ensure the hospital or clinic is Joint Commission of Investigation approved. JCI is recognised as the gold standard in healthcare accreditation globally, setting minimum requirements for safe healthcare. “All JCI accredited centres undergo rigorous training and safety checks so you can rest assured you are in the best possible place for your surgery. You may also have a better chance of getting insurance,” he adds. O’Reilly advises women to get a GP referral to a listed surgeon on the specialist register of the Association of Plastic Reconstructive and Aesthetic surgeons in Ireland (www.plasticsurgery.ie).
Dr Norman Leaf is adamant that in his 40-year surgical history, breast reduction has undoubtedly given the highest level of patient satisfaction of any operation performed. And although breasts may start to sag over time, “reduction rarely needs to be repeated,” says O’Reilly. What greater recommendation could any deliberating woman need?
Image by Trunk Archive
Kate O’Brien @KateOB99
This article appeared in a previous issue, for more features like this, don’t miss our July/August issue, out Thursday July 7.
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