photo by: Mike Yoder

Dr. Scarlett Aldrich, of Plastic Surgery Specialists of Lawrence, says breast reduction surgery is the most common procedure that she performs. It's not a cosmetic surgery, she says, but a "functional procedure" that improves the quality of many women's lives.

The stereotypical image of a large-breasted woman as happy, vibrant, active and fun-loving often couldn’t be further from reality.

Most naturally large-breasted women know too well the activity-limiting neck, back and shoulder pain that comes from being overly well-endowed; the frustration of having to shop in specialty stores that charge three or four times as much as the average retailer for a simple bra; and the self-consciousness that comes from having a noticeably disproportionate upper body.

So to large-breasted women, it should come as no surprise that breast reduction surgery is among the most popular procedures plastic surgeons perform.

“This is really the most common surgery that I do,” said Dr. Scarlett Aldrich of Plastic Surgery Specialists of Lawrence.

Breast reduction, also known as reduction mammoplasty, is a procedure to remove excess fat, glandular tissue and skin to achieve a breast size more in proportion with the rest of the body and to alleviate the discomfort associated with excessively large breasts, or macromastia.

Although breast-reduction surgery is typically done on an outpatient basis, it’s far from a minor procedure. The surgery itself can last several hours, and the recovery can take several weeks. The patient typically goes home from the surgery with significant incisions, stitches, and, often, drains. It’s common to require prescription pain medicine for a few days and to need assistance for tasks such as going to the bathroom and showering.

Yet “every single patient who comes in says, ‘I wish I had done this earlier,’ ” Aldrich said.

And although some people might see the surgery as an issue of vanity, proponents argue differently.

“I certainly don’t ever consider a breast reduction a cosmetic surgery,” Aldrich said. “It is definitely a functional procedure, whether you have back or neck pain, trouble buying bras, or just embarrassment.”

Perhaps surprisingly, many insurers will cover the procedure for qualifying patients.

Aldrich said surgeons calculate how much breast tissue would have to be removed and then consult a scale to determine whether the procedure is considered medically necessary. If so, many insurers would consider it eligible for coverage.

But Aldrich also cautioned patients not to give up if at first they don’t succeed in getting the procedure covered.

She said women who truly have macromastia find that their breasts really don’t grow or shrink if they lose or gain weight.

But if the woman is planning to lose weight anyway, Aldrich said, “the formula can change, and you could get a result you’re happy with and get insurance to cover it.”

What typically doesn’t happen is for a patient to tell the surgeon exactly what cup size she wants to be. Surgeons tend to communicate in terms of breast volume to be removed rather than the specific cup size that will result.

“Cup size is tricky, for a number of reasons,” Aldrich said.

The goal of the surgeon is to match the volume that should be removed to end up with a well-proportioned breast with the patient’s desires and lifestyle.

“It’s absolutely key” to get to know the patient, Aldrich said. “Each one is unique. Their lifestyle is really important.”

For example, “are they athletic … and truly want a small chest?”

Aldrich said most patients come in because of how they feel more than because of how they look.

“It’s usually related to their neck, back, shoulder pain, posture, rashes under their breasts (or) difficulties with activities,” she said. “But yeah, they usually do discuss social embarrassment.”

And how a woman is going to look is important, she said.

“You have to anticipate the long-term outcomes,” Aldrich said. “As soon as you get rid of the (pain) symptoms, the very next thing on their plate is how do they look.”

Aldrich said that in certain cases, she would discourage a woman from proceeding with the surgery.

“The main reason would be if I don’t think that I can give them a result that they’re going to be happy with,” she said. “Or if they have unrealistic expectations.”

Another reason would be if Aldrich thought the woman wasn’t in a position to manage her recovery well.

“I want to make sure that they have some sort of support network in place,” she said.

Although the recovery can seem daunting, Aldrich said most patients actually feel better after surgery.

“The great majority are so used to living with chronic pain that not having that is significantly better than the incisional pain,” she said.

Like any surgery, breast reduction has some risk of complication. Aldrich said delayed wound healing is probably the most the common issue she sees.

“Changes in sensation are also common,” she said, but most of those cases “are just transient and get better over a few weeks.”

Scarring complications and breast asymmetry can happen, too, but with regard to asymmetry, Aldrich reminds patients that their breasts never were identical.

“They’re sisters, not twins,” she said.

Aldrich believes that the risk of unlikely complications is outweighed by the procedure’s proven benefits: reduction in pain, improved posture, improved self-image and ease in finding clothing, among others.

Aldrich also is a staunch advocate for informed decision-making.

“I spend a lot of time in patient education,” she said.

But “the biggest thing that I really appreciate … is when patients have actually done that, when they have bought into their care and recovery” and have educated themselves, too.

Aldrich said a number of her patients have been relieved to have a female surgeon.

“I have worked with nothing but professional men,” Aldrich said of her fellow surgeons who are male, “but the patients don’t always feel that way.”

“It’s not so much a difference of perspective from the medical community as from the patient,” she said.

A bigger advantage Aldrich and other local surgeons might offer patients is proximity. Although larger medical facilities can be found 40 miles away in Kansas City, those road trips in the days immediately after surgery can be tough.

Patients “do want to stay close, and if they feel like they can get the quality care that they need, then they want to stay here,” Aldrich said. “This is certainly something we do a lot of, and so we can provide that quality care for our patients.”

Aldrich’s office, Plastic Surgery Specialists of Lawrence, is at 1130 W. Fourth St., Suite 3202. It can be reached at (785) 505-5875.

Paying for it

The average cost of breast reduction in 2018 was $5,680, according to the American Society of Plastic Surgeons. Anesthesia, operating room facilities and other related expenses can increase that amount, although many surgeons combine all costs into one simple price. Many health insurance plans will cover breast reduction surgery if it is deemed medically necessary. Most surgeons will communicate with your insurer on your behalf to obtain authorization for the surgery. You would still be responsible for any copayments or deductible amounts. If your insurance plan does not cover breast reduction, you might decide to pay for the surgery yourself. In that case, be sure to ask whether your surgeon offers a discount for cash patients.

Surgical candidates

Are you a candidate for breast reduction surgery? You might be if:

• You are physically healthy

• You have realistic expectations

• You don’t smoke or are willing to quit

• You are bothered by feeling that your breasts are too large

• You have breasts that limit your physical activity

• You experience back, neck and shoulder pain caused by the weight of your breasts

• You have shoulder indentations from bra straps

• You have skin irritation beneath the breast crease

Source: American Society of Plastic Surgeons

Before you talk with a doctor, consider:

• Why are you considering breast reduction? Many good reasons exist to support the desire for surgery, although back, shoulder and neck pain are among the most common. Knowing why you are considering breast reduction surgery will help your surgeon ensure that you are satisfied with the results.

• What are your size and shape goals related to breast reduction? Most plastic surgeons talk about breast volume, not cup size, when discussing reduction and about proportion when discussing what the patient will look like ultimately. What are your goals for how you will look or feel?

• Are you intending to have children whom you will want to breastfeed? Depending on how far the nipple must be moved, it is sometimes necessary to remove it and reattach it rather than just relocate it. This typically makes breastfeeding impossible. If you fall into this category, you could forgo breastfeeding, or you could postpone your breast reduction.