Is Breast Reduction Surgery Right for You?

James Kong
Featured Speaker:

James H. Kong, MD
James H. Kong, MD has completed over 9 years of advanced surgical training after completing medical school. He particularly enjoys reconstructive procedures to help patients improve quality of life following cancer, injury, or illness.

Breast Reduction is designed to relieve the physical discomfort associated with large breasts while improving overall breast appearance. Elevating the breast and reducing nipple size is an integral portion of this procedure. This procedure is frequently covered by insurance if certain criteria are met.

Listen as James H. Kong, MD, Plastic & Reconstructive Surgeon at Aspirus Health System, discusses breast reduction surgery and how to decide if this procedure is right for you.

Transcription

Melanie Cole (Host): If you have disproportionally large breasts that are causing neck pain, back pain, or other physical symptoms, you may be considering breast reduction surgery. My guest today is Dr. James H. Kong. He’s a plastic and reconstructive surgeon at Aspirus Health System. Welcome to the show Dr. Kong. What is breast reduction surgery and for whom might it be something to consider?

Dr. James H. Kong (Guest): Just wanted to thank you for having me Melanie. Breast reduction surgery is one of the more common procedures performed by plastic surgeons today. Typically, people, women, are good candidates for breast reduction surgery for various reasons. The main problems women have when they are seeking breast reduction surgery related to the size of their breasts tend to be back pain, neck pain, shoulder pain, but there are also women who come in and see us because they have rashes underneath their breasts or some women see us because they are very self-conscious about the size of their breasts. The main way that we decide on whether a patient is a good candidate for a breast reconstruction is we clinically examine the patient and get a sense of whether the size of their breasts are contributing to some of these medical conditions that include back pain, neck pain. I would say the majority of women who come in do have disproportionally large breasts relative to their body frame. And our goal is to give them a procedure that not only reduces the size of their breasts but also does it in a way that is proportional to the rest of their body.

Melanie: Dr. Kong, who determines whether or not her back pain is being caused by the size of her breasts or whether or not she is developing kyphosis in her neck or upper shoulders because it is pulling her forward? Who determines that?

Dr. Kong: So typically a woman has started the process with their primary care physician and their primary care provider has examined them and sends them along to sometimes either a chiropractor or another spine specialist that can help assess whether the size of their breasts is contributing to their symptoms. Most of these women have had large breasts for a very long time and it’s become a chronic condition. And sometimes the primary care provider or a back specialist have included some imaging and other physical exam findings. When they present to see us as plastic surgeons most women have had gone through other nonsurgical treatments for their back pain, neck pain, and shoulder pain. And that may include chiropractic care, exercises with their primary care physician, or sometimes physical therapy to help alleviate these symptoms. Once they get to a point where it seems that the maximal medical treatments that their pain is not significantly helped by the medical treatments, that’s when the providers will refer them to a plastic surgeon to evaluate to see if the breast size is contributing to their back pain or their spinal alignment or their kyphosis. For us it is mostly a clinical evaluation, there is no magic test that says this person definitely has large enough breasts that would cause them back pain or not. We take the patient as a whole and evaluate them to see whether the size of their breasts is contributing to their back pain and from that standpoint there are some office-type maneuvers that we can use such as literally lifting the breast off and taking some of the weight off and seeing if the patient has some degree of relief from their back pain. Unfortunately, the only way to know how much the weight of the breast is contributing to back pain, neck pain, or shoulder pain is to actually go through the procedure itself. But based on our training and experience we are very good at estimating whether this procedure would help or not.

Melanie: Well I certainly ask that question because doesn’t the reason or the way that you determine have to do with whether or not insurance will pay for this procedure?

Dr. Kong: Correct. The way that determines if a procedure is covered by insurance is whether it is considered a medical necessity procedure. We perform breast reduction in the setting of improving quality of life and either relieving back pain, or neck pain, or shoulder pain, and also in the setting if women are developing rashes underneath their breasts due to the size of their breasts. Those are things we look into and the insurance company will also look into whether it would be medical appropriate or not. There is a similar procedure that we perform called a breast lift or a mastopexy type procedure. That is not a procedure that would covered by insurance. This would be considered a cosmetic procedure, however if a woman meets criteria for breast reduction surgery and meets the medical requirements for it, most insurance companies will cover that as a medical procedure, however each insurance company has slightly different criteria and for each woman it is an individualized process. What we take into account is a woman’s height and weight and their breast side relative to that, but also the size of their frame and their current weight status, whether they have been gaining or losing weight. We take all of those into account and we come up with a big picture view of the patient before we make a decision on whether it would be a procedure that would be a medically appropriate procedure or if it’s something that insurance would potentially cover.

Melanie: So what is the procedure like Dr. Kong for women who have gone through this process of getting accepted and their good candidates and insurance will cover it. They have had pain; this is really affected their quality of life. What is the procedure like, when can they return to normal activities? Is this a big procedure that would keep them out of work for a while? Tell us about the procedure.

Dr. Kong: So for most woman the procedure is a same day procedure or they would stay overnight in the hospital or in one of our surgery centers. The surgery itself ranges from anywhere an average of three hours, give or take an hour, depending on how much work that we have to do. Basically what we’re doing is we’re trading scars on the breast to remove some of the breast tissue to take some of the weight off of the breast. There is no way that we can perform this procedure without opening some scars somewhere on the breast. I typically tell women that they would plan for a 4-6-week recovery period before they would be completely back to full activity and completely back to themselves. That doesn’t mean that they can’t be back at work and doing things within 1-2 weeks. It’s just that they are restricted. The restrictions are actually very important to give the patient their best recovery. What I typically tell patients when they come in planning for their surgery is to plan taking 1-2 weeks off of work and then seeing how they feel. If they feel good and they feel that their pain is well controlled and that they are recovering well I usually let my patients get back to work at about the 2-week mark after surgery if they have met the criteria with all the incisions and they’re doing well and if they can have a lifting restriction at their work. If their job is a very physical and demanding type of a job I would have the patient wait until 4-6 weeks before they are able to return to work because we typically put a lifting restriction on women after this type of surgery, or pretty much any type of breast surgery. If you think about what happens when you move your arms the muscle that moves the arms also moves the breast. And we want to give the breast a chance to heal before we let patients go back to work. But the majority of women are dealing pretty good at about the 2-week mark. I would say the vast majority of them are off of their pain medication or maybe taking some Tylenol or ibuprofen only at that point. And that the point for the most part they feel like they can do pretty much anything but the incisions haven’t healed enough to let them have full unrestricted activity. So we restrict patients more to allow their wounds to heal, but they feel for the most part able to go back to their normal activities probably by about the second and third week. The main restriction we put on patients after their type of surgery is we don’t want them moving their arms around a whole lot, because that would put tension and stretch the incisions and the incisions themselves take a total of about 4-6 weeks to heal fully. A lot of the patients are back to work by maybe the second or let’s say the third week.

Melanie: Dr. Kong, does it affect future mammograms?

Dr. Kong: So, yes it does. For woman that have either a high risk of breast cancer, either by family history or previous surgery related to their breasts or previous mammogram findings, we would want them to have a mammogram prior to undergoing any type of breast reduction surgery to make sure there is not findings that would change what we would do. After surgery we would say that we do need to establish a new baseline mammogram or breast imaging. We typically do that 6-12 months after their breast reduction surgery. There will be some changes on the mammogram after any type of breast surgery whether it’s a breast reduction or augmentation or even a breast biopsy. However, the findings that we see on those mammograms are very easy to tell that they’re related to a previous surgery instead of a concerning potential cancer type of a finding. The majority of radiologists are able to tell us yes this is for sure related to a surgery even if they didn’t know that you had surgery. Or if it is something that is potentially a cancer or not. These findings look different on future mammograms but we do want women after their breast reduction or any breast surgery to get a new mammogram after about 6 months after they have fully healed.

Melanie: So wrap it up for us Dr. Kong in the last minute or so here. With what you want women to know if they’re considering breast reduction surgery, if they have some of those pains and symptoms we’ve discussed, what do you tell them every day? What do you want them to know about considering this type of procedure?

Dr. Kong: So when women come to my office the majority of them have been dealing with large breasts for pretty much most of their lives. What I would want women to take into account before they consider a breast reduction surgery is that we will be putting scars on the breasts and typically the stars heal very well, however because taking a large amount of tissue off a large breast requires us to put pretty long scars on their breast. The majority of women are very thankful after they have had the surgery and they feel a great literal weight has been taken off their chest. They do feel the relief almost immediately after their surgery. The majority of the patients feel that their back pain, neck pain, shoulder pain, and other symptoms related to the large breasts are improved almost immediately after surgery. However, some women still do have to do through a little physical therapy or other chiropractic care because the weight of their breasts have had some more chronic changes to the back itself. Sometimes it takes a little bit of time to get the full effect of the breast reduction surgery. The other main thing that we tell patients is that it takes a little bit of time for everything to heel and settle down before you get the final results. So even though we say that patients are able to go back to work within typically a couple weeks and are fully recovered from an activity standpoint in about 6 weeks, it can take several months for all of the swelling to go away before they completely feel the full effects of a breast reduction surgery. But the majority of women that do meet the criteria for breast reduction standpoint from a medical standpoint, the majority of insurances will cover that procedure, however it would be done on a case by case basis based mostly on how bad your symptoms are and how large your breasts are relative to the rest of the body.

Melanie: Thank you so much Dr. Kong for being with us today. You’re listening to Aspirus Health Talk and for more information you can go to Aspirus.org. This is Melanie Cole, thank you so much for listening.

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