Breast Reduction Surgery

For decades, women who have overly large breasts have suffered back pain, permanent indentations and even scarring from bra straps, and limitations on their physical activities. In some cases, the pain was enough for women to decide to have breast-reduction surgery, even though almost all insurance companies considered that procedure an optional, cosmetic surgery, and therefore refused to cover costs. The tide is beginning to turn, as more and more women request the procedure, and surgeons inform insurance companies of the medical validity of this treatment. Insurance companies are now covering the procedure in increasing numbers.

"I was crying in my office like I won the lottery," said Tamara Collins, 33, of the day she discovered her insurance would cover her breast reduction. "There are women who fight for years and get (second mortgages) on their homes to pay for it. This is not cosmetic surgery. This is life-changing surgery, and this is necessary."

More than 100,000 women had breast reduction surgery in 2002, an increase of 20 percent over 2000. Breast augmentations are still performed twice as often as reductions, but after burn care and surgery to address dental deformities, breast reduction is the third-largest growing area of plastic surgery, according to statistics from the American Society of Plastic Surgeons.

Some insurance companies still maintain that the surgery is cosmetic, no matter the physical problems of the patient, and will refuse coverage. Others will only approve payment if the patient has reported pain for at least a year, and if the surgeon will confirm that a certain minimum amount of breast tissue will be removed, following a complicated logarithmic formula.

The slight shift in acceptance by insurance companies may be the result of an exponentially increasing number of women who are having the procedure done at younger ages than in the past. Media exposure and high profile patients such as Drew Barrymore and Queen Latifah have made many young women aware that they don't need to suffer for decades before addressing the pain. The relative youth of newer patients is also leading to changes in the way surgery is conducted.

Plastic surgeon Dr. Eugene Elliot said that 20 years ago the average breast reduction patient was middle aged or older. These women were not as concerned with the aesthetic appearance of their breasts post-surgery, or with their ability to participate in athletics. "They never asked about cup size," he says. They just wanted to end the pain.

But with an increasing number of patients in their 20s and 30s, surgeons are now experimenting with newer methods that reduce scarring and retain nipple sensation. The surgery does not always affect milk glands, and many women can breast-feed after having the surgery, although surgeons do not guarantee that will be true in all cases.

Breast reduction surgery removes fat, glandular tissue and skin to reduce the size of the breast and create a new contour. The nipple and areola are often reshaped and repositioned in order to appear natural on the new, smaller breast. Women who undergo breast reduction surgery report permanent, small scars that are easily concealed with clothing.