Disproportionately large breasts can mean more than struggling to find clothes that fit: they can cause back and neck pain, make it difficult to take part in physical activities and have a detrimental effect on a woman’s self-image.

If you’re considering breast-reduction surgery – a reduction mammaplasty – here’s what you need to know. ‘Being a young teenager with a heavy-duty challenge permanently planted on my chest is what made me decide on the surgery,’ says 18-year-old Joanna Jones*, who underwent a reduction mammaplasty at the age of 15.

With breasts so large that finding ‘clothes that didn’t bulge open’ was impossible, Joanna had a kilogram of tissue removed from each breast during the course of a two-hour operation. ‘Oversized breasts, or pathological breast hypertrophy, can cause a variety of symptoms including shoulder pain, muscle spasms of the shoulder girdle, headaches, skin rashes underneath the breasts, pins and needles in the arms and postural problems,’ says reconstructive and plastic surgeon practising at Mediclinic Hermanus Dr Peet van Deventer. ‘Once a person’s normal activities are hampered by the size of her breasts, a breast reduction can be considered.

Most patients never look back.’ That was certainly the case for Joanna. ‘Before the surgery, I never wanted to speak about my breasts or let them show. I had a full-on hate relationship with them and my body. Now, I have learnt to love my body, and I love my breasts and my scars.’ 

Breast-reduction techniques

‘In the free nipple graft technique, the nipple and areola are removed from the breast and replanted onto the reduced breast,’ explains Dr van Deventer. ‘The main advantage of this technique is that there is no limitation to the amount of breast tissue removed. The disadvantage is loss of nipple sensation and an inability to breastfeed. Good results can be obtained with this technique and it is ideally suited for patients with very large breasts or a higher risk of breast cancer.’

‘Alternatively, using a variety of “pedicle techniques”, the nipple and areola can be kept alive on a bridge of breast tissue. To be successful, these techniques rely on adequate blood supply to the nipple and areola. Therefore, there is a limit to the amount of breast tissue that can be removed. The advantages are retaining nipple sensation and the ability to breastfeed in many instances.’ 

What’s the recovery time?

Joanna’s recovery time was typical: ‘It was one week of very little movement, mostly just staying in bed. I had to keep the bandages on for the first week and couldn’t let them get wet, so bathing was a challenge. For the next few weeks I wasn’t allowed to do any heavy lifting, and for six months I had to put special tape on the scars to limit the keloiding.’ 

Why don’t most medical aids cover breast-reduction surgeries?

‘Most medical aids consider this operation cosmetic surgery and do not grant benefits. Those that do have strict guidelines regarding symptoms experienced, amount of breast tissue to be removed and body mass index. Benefits are usually not granted in overweight patients,’ Dr Van Deventer points out.

‘Anatomically, half of the breast consists of fat tissue, and overweight people can end up with large breasts. If they lose weight, the breasts will also reduce in size but may become droopy.’ ‘Having unusually big breasts can cause back problems and strains, and affects you psychologically. Fortunately, I only had to live with my very large breasts for about three years. Some women have to live with this burden their whole lives, as they can’t afford the procedure,’ says Joanna. 

What about the scarring?

Scarring is a possible side-effect of the surgery, although the extent of the scarring depends on a number of factors. Sometimes scar tissue grows excessively, forming smooth, hard growths called keloids that can be much larger than the original wound. ‘Before the surgery, I never wanted to speak about my breasts or let them show. I had a full-on hate relationship with them and my body. Now, I have learnt now to love my body, and I love my breasts and my scars,’ concludes Joanna.

Breast reduction surgery is one of the surgeries now offered to private paying customers as a Fixed Fees procedure.

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