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Too Much of a Good Thing?
by Eileen Nicol

Breasts loom large in our cultural psyche. Just look at the number of names for these lumps of fat and tissue that enable human females to nurse their young: bosom, boobs, tits, jugs, knockers – the list gets raunchier as it goes on. Look at the number of words written about Janet Jackson’s “wardrobe malfunction” – all because of the exposure of a single nipple on television. And look at the number of American women who underwent surgery to increase the size of their breasts (over 291,000 in 2005, according to the American Society of Plastic Surgeons), despite the risks and expense.

Given our mammary-crazed popular culture, some might argue that big breasts are a blessing, but for many women, they are a literal pain. Most very large-breasted women suffer more than lewd glances, suggestive comments and trouble finding bras. “I was getting headaches,” explains Seattle resident Kelly Boganwright, a 28-year-old actress and customer service representative. “Every couple of days I had a horribly bad headache.” Her back and neck hurt, too. “Anything I would try to take wasn’t really fixing it,” she says.

Since seventh grade, Boganwright had felt that her breasts were too large for her 5-foot-1-inch frame. In 1992, when TV’s “Punky Brewster” had well-publicized breast reduction surgery, Boganwright decided that one day she would have it too. Pre-surgery, she was a size 36-DDD, and felt it during auditions. “I didn’t feel comfortable with what I looked like and I think that probably showed in my performance. I feel like I looked a lot heavier than what I was.” Now, eight months post-surgery, Boganwright fits into a B or C cup bra. She feels more confident, and reports an increase in her acting roles. Exercising is much easier, and the bad headaches she suffered are a thing of the past.

Lauren Tyner was only 15 when, with her parents’ help, she decided to have breast reduction surgery. She played soccer, she rode horses, she was a natural leader – despite the disability of having a bra size of 36-HH. “I can’t even count how many rude comments or times of unwanted attention I’ve gotten because of my breasts,” she says. “You’re self-conscious about everything you do. I came home crying a couple of times. And it was just getting ridiculous to shop.”

Lauren’s mother, Wendy Tyner, had been big-breasted herself and had watched her daughter struggle since maturing in the fourth grade. She particularly remembers the attention Lauren got walking through lower Manhattan. “The eye contact people made with her, I was just very much aware of the vulnerability,” says Wendy. After a frustrating and ultimately futile day of trying on sports bras at Title Nine, Wendy first mentioned breast reduction surgery to her daughter. For Lauren, the decision was simple. “I said I wanted breast reduction,” she recalls. “About a year after that, after we talked about it more and more, my mom did a lot of research and talked to doctors and people who knew doctors. And then we set a date and it happened.” During winter break of her freshman year at high school, Lauren’s surgeon removed two pounds from each breast.

Early on, the Tyners made the decision to be open with friends, family and coaches about their daughter’s surgery. “From the very beginning we decided that it’s life!” says Wendy. “It’s just part of life.” Their matter-of-fact attitude paid off. When Lauren went back to school, there were very few whispers, because most of her friends already knew. As for the ones who didn’t, Lauren says, “If they asked, I told them. It was really accepted.” Now Lauren’s wardrobe has expanded beyond baggy sweatshirts, and she trains hard for track and soccer. Best of all, she finds plenty of pretty D cup bras to choose from at Victoria’s Secret.

Studies show that, like Lauren Tyner and Kelly Boganwright, most breast reduction patients are very pleased with their results. “I call this my big hug operation,” says Dr. Phil Haeck, a plastic surgeon who has practiced in Seattle and Bellevue for more than 20 years. “Because women with large breasts give these little side hugs; they never bear-hug anybody.

Afterwards when I walk in the room they give me these huge bear hugs because they can do it finally!”

What is breast reduction surgery? Technically known as reduction mammaplasty, the procedure usually takes two to four hours under general anesthesia, and does not typically require an overnight hospital stay. The most common technique involves an anchor-shaped incision that circles the areola, extends downward, and follows the natural curve of the crease beneath the breast. The surgeon removes excess glandular tissue, fat, and skin, and moves the nipple and areola into their new position. The new breast contour is shaped by bringing skin down from both sides around the areola. Stitches are usually located around the areola, in a vertical line extending downward, and along the lower crease of the breast. Sometimes tubes are placed in the breasts to drain off blood and fluids for the first several days.

Most often, the nipples remain attached to their blood vessels and nerves. This tissue attachment is called the nipple pedicule, and as long as it is maintained, there’s a chance that the woman could breastfeed after the surgery. But if the breasts are very large or pendulous, the nipples and areolas may have to be completely removed and grafted into a higher position. In these cases the chance for future breastfeeding is nil, and nipple sensation may be severely reduced.

Because they must eyeball the amount and type of tissue to remove once the incision is made, surgeons are reluctant to promise a certain cup size, and keeping the breasts equal size is somewhat of an art. “It’s impossible to use instruments during surgery to identify how much tissue needs to be taken off to balance the two breasts,” says Dr. Haeck. Sometimes patients need a touch-up on the bigger side. “But generally the success rate is really good with that. Less than five percent need to have a second operation.”

Other possible complications include bleeding, infection or adverse reactions to anesthesia, as with any other surgery. In addition, breast reduction patients risk not being able to breastfeed, and the possibility of permanent loss of feeling in the nipples or breasts. Scars from the operation may not ever entirely fade. And the breasts take time – often months – before they regain a normal shape.

“I was more interested in the surgery itself and I forgot about afterwards,” laughs Boganwright. “They looked scary. But Dr. Haeck was very reassuring to me that everything looked exactly as it should at that point in time.” Lauren Tyner’s mother also experienced a few anxious moments over her daughter’s healing, which were quickly allayed by their doctor as well. Now, nine months later, they are happy with the cosmetic outcome of Lauren’s procedure. “You can hardly even see the scars,” says Lauren.

For very young patients, there also is the risk that their breasts will continue to grow. Lauren’s surgeon advised her and her parents to wait until Lauren was 18. As a compromise, they waited six months. “We had to look at the consequences,” says Wendy. “If we wait until she’s 18, how will that impact her emotional stability and her social life? Lauren went in with full disclosure.”

Breast reduction surgery changed the lives of these two patients and they are increasingly not alone. Breast reduction surgery was the fifth most commonly performed reconstructive procedure in 2005, according to ASPS statistics. Although more women still undergo breast augmentation, the incidence of reduction surgery has increased by 187 percent since 1992. The ASPS categorizes breast reduction surgery as reconstructive rather than cosmetic, because it provides relief from physiological symptoms. Despite this fact, it can be tough or even impossible to get insurance to cover it.

Dr. Haeck is actually seeing fewer breast reduction surgery patients than he used to. “Not because there’s a decrease in people with large breasts, but because insurance companies don’t cover it anymore,” he says. “These are some of the happiest patients in plastic surgery. Not only do their breasts get a cosmetic lift and they feel better about the way they look, but all their back, neck and shoulder pain goes away.”

Insurance companies require a doctor to document that large breasts are causing physical symptoms like back and neck pain, or headaches. Also, they commonly require a patient and her doctor to try alternative treatments like physical therapy for a year or more. And if the patient is overweight by the insurance company’s definition, she must lose a prescribed amount of weight before they will consider covering the surgery. Dr. Haeck laments the “ridiculous hoops” insurance companies make his clients jump through. “The amount of money that gets spent trying to avoid the operation is always way more than if they’d just paid for the operation,” he says.

Kelly Boganwright paid for her surgery out-of-pocket. Dr. Haeck was the third surgeon she’d met with, and all three had advised her that despite her symptoms and discomfort, most insurance companies wouldn’t cover it. The Tyners ended up paying for Lauren’s surgery, too, saying that while it was costly, they would do it again. Dr. Haeck reports that most of his breast reduction patients self-pay. “I’ve had people finance it; I’ve had people get second mortgages, take out home equity loans.”

With a total cost of between seven and eight thousand dollars for the anesthesiologist, surgeon and clinic fees, obviously not everyone can afford to self-pay. Some insurance companies do cover it – eventually. “I tell every one of my patients that the squeaky wheel gets the grease, and there’s always a real person at an insurance company who makes this decision,” says Dr. Haeck. “A no doesn’t necessarily mean no.”

Often, employees at large companies can switch health plans at year-end if they are denied coverage under their original plan. Patients can and should work through their insurance company’s ombudsperson to represent their case. And if all else fails and patients decide to self-pay, they should negotiate the price up front with the surgeon, making certain they understand what exactly is included. For instance, are follow-up visits included in the fee, or are they billed separately?

Lauren Tyner and Kelly Boganwright would agree that, in the case of breasts, there really can be too much of a good thing. According to ASPS statistics, they are only two out of the 114,000 other large-breasted women who found a way last year to have breast reduction surgery. But there are others for whom the procedure unfortunately is prohibitively expensive even though they need it. In a perfect world, the whole process would be as simple as Lauren’s statement: “If it needs to be done, just do it.”

Eileen Nicol is a frequent contributor to Seattle Woman.

©2006 Caliope Publishing Company