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GETTING BETTER

For reasons far beyond cosmetic

Physical pain and inconvenience were part of one woman's daily life until she decided to undergo breast reduction.

August 04, 2003|Marnell Jameson | Special to The Times

By the time she was 35, Kathy DeBest decided she'd suffered enough. For 15 years, the Santa Ana mother of two had endured shoulder and back pain and extreme self-consciousness while limiting her activities and her wardrobe choices -- all because of her breasts.

Her problems had worsened over time. After having two children, DeBest, who is petite at 5 foot 2 and 115 pounds, went from an already cumbersome D cup to an F cup -- a 32F. "After nursing, my weight went down but my breasts didn't. I felt like a freak," she said.

"I always wore baggy shirts and never played sports. I wouldn't even throw a Frisbee. Jumping hurt, and running was out of the question."

Like many women with large breasts, she had deep grooves in her shoulders where her bra straps dug in. But the chronic pain in her back and shoulders was the worst of it. "My back ached all the time. Lifting kids made it worse."

Two years of physical therapy offered no long-term relief. At the end of some days, she would be in tears. An orthopedist who specialized in back problems told her the only way she would be rid of the pain was to reduce the weight of her breasts.

"I'd thought about having a breast reduction for a long time," she said, and the unrelenting back pain and the fact that she didn't plan to have any more children prompted her to take action.

DeBest consulted six plastic surgeons before choosing Dr. Ashton Kaidi in Newport Beach, who specializes in breast surgery. She ruled out surgeons who suggested she also have other procedures done at the same time. "I'm not a vain person, and I thought the doctors who suggested that I also have my tummy tucked were rude."

Less popular than breast-implant surgery, breast-reduction surgery is still the fifth-most commonly performed cosmetic surgery in the country, according to the American Society for Aesthetic Plastic Surgery. Last year, surgeons in the U.S. performed 126,000 breast reductions, the group says.

Reduction mammaplasty, as it's called, typically involves a three-part incision that circles the areola (the pink part around the nipple), extends downward, then follows the crease at the base of the breast. Surgeons remove excess glandular tissue, fat and skin, and raise the nipple and areola. Except in rare cases, the tissue and nerves leading to the nipple remain attached to it. (When the reduction involves removing 80% to 90% of the breast tissue, for example, surgeons sometimes have to relocate the nipple, severing it from the tissue and nerves and re-grafting it.)

After reducing the skin below the areola, the incision is then pulled back together to form a smaller, firmer and higher breast. (Breast lifts often involve the same incision pattern.) Because most big-breasted women also have large areolas, these are often surgically reduced at the same time.

Scarring is inevitable. However, in the last five years, new surgical techniques have emerged that allow doctors to sometimes (depending on the extent of the reduction) eliminate one of the lower two incisions. Increasingly, doctors also are reducing breast tissue with liposuction, though others frown on that procedure, saying that the scarring caused by the liposuction tool can look like precancerous tissue on a mammogram. Kaidi limits the use of liposuction in his reduction procedures to removing fat from under the armpit area, if necessary, to get a better contour.

After surgery, patients wear a post-surgical bra for several weeks and avoid lifting or pushing anything heavy. Most can return to non-strenuous work in one to two weeks. Risks include possible loss of nipple sensitivity and a reduced ability to breast-feed. Though nipple sensation often decreases, or sometimes increases, that change is usually temporary.

"After a year, 90% of patients have no long-term change," says Kaidi.

The surgery, however, interferes with nursing because it involves removing some milk ducts around the nipples.

"Most women will still be able to nurse after surgery," Kaidi said, "but they may not be able to produce enough milk to support a baby entirely without supplementing."

For some, the biggest obstacle to having the surgery isn't the scarring or the risks, but the cost. On average, breast-reduction surgery costs between $6,000 and $8,000. That includes the surgeon's fee, hospital costs and anesthesia.

When the surgery is deemed medically necessary (that is, because it has caused a physical problem), most insurance will cover it, as in DeBest's case. Kaidi says that about 60% to 70% of his breast-reduction cases are covered.

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