Breast size usually isn't considered an appropriate topic for social conversation. But for a woman suffering the medical and social consequences of having large, pendulous breasts, talking with someone who has undergone breast reduction can be a "life-changing experience," says Mary-Margaret Richardson, a public affairs specialist with the Food and Drug Administration in St. Louis, Mo.

Before surgery, Richardson, 53, had adapted to a "lifetime of discomfort — bras that never fit and caused deep grooves in my shoulders, plus neck and back pain, heat rashes under my breasts in the summer, and ever-increasing stooping under the weight of them."

After talking with Kellie Feldman, a neighbor who had undergone breast reduction, Richardson decided to have the procedure done herself. "I had gone for a cancer screening several months earlier, and the doctor who did the examination looked at my rutted shoulders and asked whether I had ever thought of having reduction. The seed was planted then," Richardson said. "Then I talked with Kellie, and she was so positive about it."

Feldman, 27, is a special education teacher in St. Louis. "Actually, my father had been encouraging me to have the surgery," she says. "I was a bit put off, wondering why he was looking at my breasts. But he said that when I got older, they would look terrible. And I knew I already had deep shoulder indentations from my bra. In addition, the male students in school were always looking and commenting, which made me feel uncomfortable."

Margie, 40, an advertising executive in New York City who asked that her last name not be used, had a very different reason for undergoing breast reduction. "I have breast cancer and had a mastectomy on my right breast and then an implant," she says. "My surgeon recommended reduction for the left breast so that it would look more like the right."

Medical Concerns

Although very different from one another, these women share a mix of medical problems and cosmetic concerns that led them — and thousands of other women across the country — to undergo breast reduction surgery. "I can move my head and neck without pain, my shoulders have healed, and I just feel so much better," says Richardson. "I think about my grandmother, who had this problem all her life and was always stooped in pain. I wish she could have had something like this done then."

"Among my patients, I find there are certain age clusters with similar concerns," says George Beraka, M.D., a board-certified plastic and reconstructive surgeon who is assistant professor of surgery at Cornell Medical Center in New York City.

"Those in their late teens realize they don't want to live with such large breasts. Women who have finished childbearing and breast-feeding say to themselves, 'Now I'd like to look and feel better.' And older women often are referred by their internists because of neck and back pain."

In some women, breast examination and mammography may be easier to perform after reduction. "From the standpoint of the physical exam, it may be more difficult to pick up a very small lesion [lump] in a woman with very large breasts," says Charles Finder, M.D., a radiologist in FDA's Mammography Quality and Radiation Program. "Imaging large breasts for mammography may be a bit more technically demanding, since the technician may have to get each view done twice, or do two images per view."

Richardson notes that she "kept getting abnormal mammograms with 'dense tissue' reports that made me think I had breast cancer." She is "looking forward to a normal result this time."

But Finder cautions that this may not be the case. "If the breasts are reduced uniformly, then the tissue may still be dense, and she could still have problems with mammography," he says.

Contraindications to the procedure "would apply to any major elective surgery," says Beraka. "The woman should not have any significant illness, either physical or mental."

Patricia McGuire, M.D., a board-certified plastic and reconstructive surgeon on staff at Parkcrest Surgical in St. Louis, says she prefers not to perform breast reduction on women who are heavy smokers because of a loss of blood supply, or on those with diabetes, since they may not heal well. Also, "if a woman is really overweight, I encourage her to get her weight down first. This is particularly a problem with teens with large breasts, since they may try to gain weight so that their bodies look more balanced," says McGuire, who performed the reductions for Richardson and Feldman.

Both physicians believe it is best to wait until a young woman's breasts are fully grown, usually by age 18, before doing a reduction. The procedure is not recommended for women who intend to breast-feed, according to the American Society of Plastic and Reconstructive Surgeons.

Breast Cancer

Concerns that breast reduction might increase the risk of breast cancer are unfounded, according to Beraka. "There are no data to suggest that women who undergo breast reduction are at greater risk for breast cancer, or that those with a family history of breast cancer should not have the procedure," says Beraka. "In fact, reduction is like a giant biopsy of the breast, because all tissue that is removed during surgery is examined by a pathologist."

During 20 years of performing the procedure, Beraka says, malignant tissue was found among his patients "maybe half a dozen times." McGuire, who has been performing reductions for five years, had one patient in whom cancerous tissue was discovered.

Tags: Women's Health

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