Size does matter

Mumbai's surgeons say they are seeing an increasing number of women consider breast reduction surgery to deal with long-term pain and embrace an active life.

While breast augmentation continues to be a cosmetic procedure that's much sought after, interestingly, plastic surgeons are receiving queries for breast reduction surgeries. And the reason for this is more physiological than physical. Swati Patil (name changed to protect privacy), now 42, says that she first experienced severe and constant pain in the shoulders 15 years ago. Unable to fathom why, she visited her general physician who came up with a reason she thought bizarre. The heaviness of the breasts were taking a toll on her posture, the bra strap digging into her shoulder bone, causing discomfort, day in and out. Surgery seemed radical at the time, and Patil hoped the discomfort would subside. But when she moved to Mumbai four years ago, her problem was aggravated. "Due to the city's humid weather, I also began experiencing rashes."

Creams and painkillers brought temporary relief, but eventually she decided to consider breast reduction surgery. The procedure which was done this March, has relieved her of the pain, she says.
While the problem is one that women have grappled with for long, surgeons say that more women are choosing to consider surgical intervention. Dr Shraddha Deshpande, plastic surgeon at Wockhardt Hospital, says the rise in surgeries is equal to the rise in awareness about the possibilities that medicine offers. "Over the last five years, I've seen the number of patients grow from two cases a month to once a week. There was a certain hesitation and embarrassment women grappled with. They seem to be more confident now [of their bodies] and wish to seek solutions," she says. Other surgeons we spoke to agreed that they operate on women for breast reduction about 20 times a year.

Dr Shraddha Deshpande

Doctors explain that it's not just the shoulders, but back and neck too that bear the brunt of heavy breasts. Dr Devyani Barve-Venkat, a plastic surgeon associated with Nanavati Hospital, says that because the brassiere tends to take the weight, patients tend to opt for tighter fits, causing indentations and ulceration of the shoulders. They develop rash, complicating matters. "Some women also experience pain in the breast tissue due to fibrocystic changes," she adds.

Deshpande says her patients are typically women between the age of 45 and 55 years. "Older women have pendulus breasts because they have experienced child birth and may have breast fed. This could have led to minor deformity of the spine, leading to stooping while walking and resultant back pain. Ill fitting lingerie also contributes to the problem," she says. Several women also choose to wear minimizer bras that help flatten large breasts by a couple of inches, aggravating the discomfort.

Dr Devyani Barve-Venkat

But it's not just the older lot. Deshpande says younger patients, especially those who lead active lives, experience discomfort while taking up a fitness regime. "Younger patients are more careful about avoiding scars that surgery could leave behind. In such cases, we turn to liposuction to decrease the fat. Older patients suffer from skin laxity, so we remove the excess skin while preserving the breast tissue during surgery. It improves the contours and reduces the pendulous angle, too. We have seen the procedure improve the posture of the patient, leading to relief from back and neck pain," she explains.

The procedure typically lasts three hours. While the recovery period is not long, Venkat says patients are advised to follow precautions. "We ask them not to lift anything that's heavier than a couple of kilos for two weeks post procedure and not to raise their arms to protect the stitches. For six weeks, I also recommend that they not wear an underwire bra. We give them a special bra, like a sports bra, that offers better support."

Dr Leena Jain, consultant - plastic surgery at Jaslok Hospital, says the condition is hereditary. "Patients I see tend to speak of their mothers and aunts also having a fuller physique. Every woman experiences hormonal peaks in her life, at puberty and during pregnancy. Some women are affected by these changes and could see the size of the breasts change."

But the challenges are not all physical. Dr Mohan Thomas, senior cosmetic surgeon who consults at Breach Candy Hospital, says that body image is also a reason for young women to consider surgery. "We live in the time of selfies. I've seen a large number of women as young as 18 deal with poor body image. They are embarrassed of their physique. They can't buy clothes off the rack."

Venkat says that if surgery can improve the quality of a patient's life, she'd recommend it. She speaks of a 40-year-old patient with two children. "She was unable to take up a sport, whether running or swimming, although she was fit otherwise. The first thing she said to me after the surgery was that she got into a swimsuit and was able to pursue a fitness regime," Venkat recollects.

For all its benefits, Thomas also warns of the risks involved. Emphasising the need to listen to a patient's needs, he recommends that they take a second opinion before committing to the surgeon. "The surgery is not without risk. If done right, even a woman who has never been pregnant can carry a baby to full term and breast feed without a hitch. However, I've seen botched up cases too. It requires skill and involves investigating the blood supply to the breasts. It's up to the discretion of the surgeon to choose the best technique for each patient."

For Patil, the decision wasn't an impulsive one. She arrived at it after long discussions with her husband and the surgeon. "I was particular about working with a woman plastic surgeon. I knew I would need to have detailed chats to clear my doubts. Everyone has a different kind of apprehension, and it's important to find someone you are comfortable holding an honest talk about how the procedure will affect your body." Since this procedure doesn't involve implants, breast reduction is not as expensive as breast augmentation. The average cost varies between R1.5 to R2 lakh, say experts.

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Number of hours the surgery takes

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