Breast Reduction Surgery: A Weight Off The Chest

Breast reductions are some of the most common plastic surgery procedures in South Africa.

At the age of 12, Fentsy Leshabane was a 34C. By the time she had turned 17, her breast size had increased to a 34EE. Suffice it to say, the weight she was carrying around soon took an emotional toll. “In addition to the constant strain on my back, the size of my breasts also took a huge toll on my self-esteem,” she explains. “I would literally have breakdowns in the changing room whenever my mom and I would go bra or bikini-shopping because I could never find the right fit; it was either the tops were too small or my breasts would sag.”

So, it wasn’t long before Fentsy followed in her mother’s footsteps and underwent breast-reduction surgery. While most people associate breast surgery with enhancements and implants, breast-reduction surgery is one of the most common surgeries performed worldwide and is among the top five performed in South Africa.

It’s a heavy burden to carry

“Breast-reduction surgery falls into the group of plastic-surgery treatments that are technically termed ‘cosmetic’, but are very often beyond the scope of pure cosmetics,” explains Dr. Liza Jordan, a plastic and reconstructive surgeon at Chris Hani Baragwanath Hospital. Like Fentsy, many women have to deal with a range of issues as a result of their large breast size. For instance, from the sheer weight on the chest, they experience constant back, neck, shoulder, and, in some cases, chest pain.

“Women often find support-wear lacking or inadequate, and this often leads to ‘bra-strap pain’, as the heaviness of the breast pulls down on the bra straps, leading to discomfort, pain and even indentations/grooving and discolouration in the area where the bra straps sit,” says Jordan. She adds that some women may experience headaches and nerve-related hand/arm numbness too.

A constant weight pulling on your chest and back muscles can also make it difficult to exercise. This can be upsetting for women who can’t go out for a jog without risking significant pain. Furthermore, the constant weight on the chest and upper abdominal skin can lead to moisture build-up. It can also cause shearing of skin in the area, which triggers skin irritation.

The mental strain

Large breasts can also weigh down your self-esteem. A study published in the Scandinavian Journal of Plastic and Reconstructive Surgery and Hand Surgery found that up to a third of women who seek breast-reduction surgery suffer from anxiety, depression, or both.

“For a young woman whose body is developing and changing from girl to woman, when their breasts are enlarged and out of proportion, there may be a feeling of shame and a feeling that their breasts look ugly, abnormal – there may be attempts to hide, inspect continually and compulsively fixate on the area of their body that they do not integrate as a part of themselves,” suggests Dr. Marilyn Davis-Shulman, a clinical psychologist who specializes in trauma and addiction.

“In addition to feeling uncomfortable and self-conscious with their appearance, young women also have to battle with being objectified, especially at such a critical stage in their lives. Wolf-whistles and catcalls can be humiliating, creating feelings of embarrassment and feeling very ashamed… These feelings may restrict social interaction and limit social engagement.”

How is the procedure performed?

The procedure involves the removal of breast tissue, fat, and skin. There are various techniques that the surgeon can use, with the less-invasive lollipop method being the most popular. The technique involves the surgeon making a “lollipop” incision around the areola and down the chest. They then remove the excess fat and breast tissue.

What are the risks?

“Complications are unfortunately a potential risk of any surgery, even in the most experienced hands. Patients would have been extensively counselled about the potential risk and complications, and the management and treatment thereof,” explains Jordan.

The most common complications resulting from breast-reduction surgery include:

• bleeding
• abnormal scarring
• slight asymmetry
• loss of sensation in the nipples

Can I still breastfeed?

Breast-reduction surgery can affect the production of milk, causing the milk ducts to produce less or no milk at all.

“After breast reduction, about a third of women can breastfeed, another third will have to supplement with formula, and the last third won’t be able to breastfeed,” states Dr. Vivien Jandera, a plastic and reconstructive surgeon in Pretoria. She points out, however, that larger-breasted women don’t find it any easier to breastfeed anyway. So perhaps this complication may not be much of a concern.

Does having breast-reduction surgery increase my risk for cancer?

“No,” says Jandera. “There is no association with breast cancer and breast reduction. There are normal changes seen on mammograms after surgery, but it is easy to distinguish these from breast cancer.”

The recovery period

“The recommended recovery time is three months,” shares Fentsy, who admits that while she was discharged two days after her surgery, within a week she was up and about at the malls, as she experienced little to no pain. “The only pain I did experience was immediately after my surgery and the day after, but the nurses said it was a good thing because that meant I still had feeling in my breasts.”

Most patients spend one night in hospital, although some surgeons may send their patients home the same day, Jandera says. “You need to take it easy, but still move around normally. I tell my patients not to drive for a week after the operation. Every surgeon’s post-operative instructions are slightly different. It’s important to listen to your surgeon’s instructions, and not all the people posting about their operations on social media.”

How much does it cost?

The price of the procedure isn’t exactly cheap – R55 000 to R60 000.

“The costs are relatively high, but you do it once, and there isn’t another solution,” Jandera says. “For the cost of an overseas holiday, less than a new car (which eventually has to be replaced), it’s really a question of what you can buy for that amount of money vs the huge improvement in quality of life. It’s an investment in yourself.”

Fentsy says: “My procedure at the time cost R65 000. However, my doctor had written a letter to my medical aid, motivating for payment of the procedure. They approved within two weeks, stating that they would pay R60 000 for the surgery, as it was evident that it was a medical problem for someone of my age.”

So, will my medical aid pay for it?

The answer may not be the one you’re looking for. Unfortunately, most medical aids still view breast reduction as a cosmetic procedure. As such, you may have to go through a rigorous process if you want your medical aid to cover the costs. It all comes down to your medical aid and the plans it offers.

The medical aids speak

Discovery Health

“Discovery Health Medical Scheme (DHMS) funds breast-reduction surgery for DHMS members on the Executive and Comprehensive plans (except Classic Smart
Comprehensive plan) who meet specific clinical entry criteria,” says Dr. Noluthando Nematswerani, head of the Clinical Policy Unit at Discovery Health.

“DHMS reviews funding decisions for medical care regularly to ensure ongoing clinical appropriateness and affordability. This funding has been in place for many years. DHMS does not pay for surgery where it is solely for aesthetic purposes, as all “cosmetic” surgery is considered a General Scheme Exclusion for the majority of open schemes in South Africa. That said, we invite our members and treating healthcare providers to contact us to confirm their cover before any procedure, to ensure they understand how their care will be covered.”

Fedhealth

“At Fedhealth, breast-reduction surgery is a scheme rule exclusion due to the likelihood of the request being for cosmetic reasons,” explains Jeremy Yatt, principal officer of Fedhealth. “In terms of cosmetic surgery and surgery which improves a person’s health, a distinction needs to be made if this is purely a cosmetic request or if there is a functional reason for the request. If the reason is the latter, members can apply for ex-gratia funding, and the request can be assessed on individual merit.

“The circumstances for which the scheme may consider funding for the procedure include if the bra cup is bigger than D, the BMI is less or equal to 27, the tissue to be removed estimated at more than 500g per side, and there is documentation of a chief complaint of pain in the upper back and shoulders caused by the weight of the breasts, and/or ulceration of the skin of the shoulder and/or shoulder groove that has not responded to a six-month course of conservative treatment. ”

Momentum

At the time of publishing, we were unable to receive comment from Momentum.

However, the medical aid has committed to reviewing its cover for breast reduction surgery. More information can be found on their website.

Do I qualify for breast-reduction surgery?

Are your large breasts affecting your ability to be active? causing you back, neck, and shoulder pain? affecting your ability to sleep? If so, you may qualify for breast-reduction surgery.

If you are planning to fall pregnant in the next two years, Jandera advises waiting until after you have children, as pregnancy may cause the breasts to sag, which would have to be corrected thereafter.

What are my non-surgical options?

There are a few ways to mitigate the symptoms that come with large breasts.

“Self-care routines are paramount in becoming your best self, as well as addressing mental-health concerns,” says Davis-Shulman. “Preparing healthy meals, adequate sleep, hydrotherapy, and yoga is an excellent option for the mind. Additionally, low-impact exercises that help to strengthen the back and the core are fundamental for someone with a large breast size.”

The bottom line

Opting for surgery, regardless of the procedure, is no easy decision. However, when it comes to breast reduction, going under the knife could be the one thing that could help you lead a fulfilling life.

“After the procedure, I was able to partake in physical activities effortlessly. I was a regular member at the gym and my body was in the best shape it had ever been in,” shares Fentsy. “The surgery allowed me to live my life freely, to the fullest. It helped me a lot with my self-esteem, and it helped me become the outgoing and confident person I am today.”