Women who have disproportionately large breasts (female breast hypertrophy or macromastia) can elect to have breast reduction surgery (reduction mammoplasty). Some women who develop abnormally large breasts experience significant stress on the shoulders, neck and trunk because of the compensatory need to support the additional breast weight.

Women with large, normal breasts are different from those with macromastia. This condition often starts during or soon after puberty. At times, this condition can arise during pregnancy and persist afterward. In extremely rare cases, a condition known as virginal breast hypertrophy can develop in which breast enlargement progresses very rapidly.

Large, sagging breasts can plague women because they restrict activities and often cause physical discomfort. The symptoms of female breast hypertrophy may result in persistent, debilitating pain. In such cases, the condition can be alleviated or, in most cases, eliminated, through breast reduction surgery (reduction mammoplasty). Some of the most common problems associated with disproportionately large breasts include:

• Chronic back, neck and shoulder pain
• Poor posture
• Breast pain or tenderness
• Notching on the shoulders from the straps of bras
• Self-image concerns
• Bras and clothing that are difficult to fit
• Restricted activity levels
• Heat rashes under the breasts
• Frequent headaches
• Positioning for sleep difficulties
• Breathing problems

Breast reduction is a surgical procedure designed to reduce the size of overly large, pendulous breasts (larger than a D cup). In this surgical procedure, performed by a plastic surgeon, a significant portion of the breast tissue is removed. For cosmetic reasons, the nipples and areola (dark area surrounding the nipple) may be repositioned higher on the breasts.

Reduction surgery removes a considerable amount of the breast, including the skin and underlying glandular tissue, in an effort to create a smaller breast. The average reduction reduces a woman’s bra size from a DD cup (or larger) to a C cup.

Most often, a woman will elect to have breast reduction surgery for physical relief from pain rather than for aesthetic purposes. A breast reduction in the absence of painful symptoms is considered a cosmetic procedure and is rarely covered by insurance. However, for women who require the surgery for relief of painful symptoms, insurance will usually cover the procedure. In such cases, breast reduction is considered reconstructive surgery because it is correcting a congenital defect.

Breast reduction surgery can take several hours to perform and is usually done with the patient under general anesthesia. Because this procedure involves fairly extensive surgery, it is considered an inpatient procedure, meaning that the patient will need to stay overnight at the hospital.

Breast reduction is a fairly common surgical procedure performed by plastic surgeons. More than 100,000 women each year elect to reduce the size of their breasts, according to the American Society of Plastic Surgeons (ASPS) – making it the fifth most popular reconstructive procedure performed by plastic surgeons. The reasons for these reductions vary, but often include both personal and medical reasons.

One drawback to the procedure is that many insurance companies will not cover the cost of breast reduction surgery unless it is medically necessary. In some cases, a certain amount of breast tissue might need to be removed in order to be covered under insurance. This can range from 250 to 500 grams, which is the equivalent of a half-pound to 1 pound of tissue from each breast. Patients should consult with their insurance company prior to the procedure to determine coverage.