Best Candidates for Breast Reduction Surgery

Iconic women like Marilyn Monroe, Raquel Welch, and today’s Kim Kardashian embody the voluptuous hourglass figure, but when the top curves are disproportionate to the rest of a woman’s body, physical and psychological side effects can become very real issues.

Among patients who suffer from macromastia, or large breasts, physical side effects may include back pain, shoulder pain, neck pain, deep clavicle grooving, and chronic headaches, while psychological side effects may involve a lack of confidence, poor self-esteem, depression, or even anxiety.

Reduction mammoplasty, or breast reduction surgery, can help patients alleviate their upper body issue by removing excess fat, glandular tissue, and skin in the area to reduce the size of the breast to a more proportionate, comfortable size. Since comfort is the key word here, patients must understand that breast reduction surgery offers a better quality of life (QOL), not a cosmetic transformation.

To help my prospective patients determine whether they are appropriate candidates for breast reduction surgery, I always pose the following questions:

• Are the breasts disproportionate to the rest of the body?
• Does the size of the breasts limit certain physical activities, such as jogging and jumping?

If my patient says “yes” to one or both of those questions, then I generally feel that she is an appropriate candidate for a breast reduction. From there, I speak with the patient about what the surgery entails, what she can expect in terms of recovery time, and what other procedures she may want to consider.

One such procedure is a mastopexy, which lifts and firms a woman’s breasts to create a more balanced, youthful appearance. During this breast lift procedure, the excess skin that causes sagging is removed, and the tissue that surrounds the breast is tightened to supply new shape and support to the improved breast contour.

Liposuction of excess fat from the back or removal of excess skin from this area can also add to the effects of breast reduction surgery. However, these additional cosmetic procedures may not be deemed medically necessary by health insurers, so they may not be covered.

Fortunately, health insurance providers will often cover a mammoplasty reduction when certain criteria are met, including but not limited to:

• Supporting documentation: A description of the treatment, the side effects related to excessive breast size, and the probability of relieving these issues through the surgery.
• Interference of everyday activities: Explanation of how the aforementioned physical effects have interfered with the patient’s daily activities, including work.
• Amount of breast tissue to be removed: Monthly visit reports from the surgeon documenting the patient’s height, weight, and the amount of breast tissue to be removed. Some insurance plans even require a minimum amount of breast tissue to be removed before they deem the procedure medically necessary.

Given that more than 42,000 breast reduction procedures took place in 2012, it is plain to see that, when it comes to breast size, bigger is not always better. If comfort and improved QOL is a patient’s desired outcome, then it is the job of her healthcare provider to discuss her options and subsequently help her get the procedure covered by insurance. After all, helping patients look and feel their best is what we strive to do!

Robert T. Grant, MD, MSc, FACS, is Chief of the combined Divisions of Plastic Surgery at New York-Presbyterian Hospital-Columbia University Medical Center and New York-Presbyterian Hospital-Weill Cornell Medical Center. He is also Associate Clinical Professor of Surgery in the College of Physicians and Surgeons at Columbia University and Adjunct Associate Professor of Clinical Surgery at Weill Cornell Medical College. For more information about Dr. Grant or to contact him, visit his website at www.robertgrantmd.com.