Bigger the better? Not always

Though many women with small breasts obsess about being unattractive, women with heavy, cumbrous breasts will testify that the same is true at the other end of the spectrum as they suffer from marked physical discomfort, poor self esteem and other psycho-social related problems. Dr. Purnima Aiyer, Consultant Plastic Surgeon explains the condition known as macromastia.

Macromastia can have a profound effect on a woman's personality and lifestyle. "Many women come to me before they get married," says Dr. Aiyer. "They are so embarrassed - they cannot buy proper clothing, they are often teased by young boys..."
Such situations create self-esteem issues, and a woman with macromastia may consider herself utterly unattractive, feel constantly compelled to cover up and draw as little attention as possible to herself. These insecurities may be carried into the workplace.

The situation is only made worse by the accompanying, very real physical complications - inability to find a bra that can provide proper support or straining bra straps cutting into shoulders, resulting in shallow, painful grooves in that region.

Poor posture combined with neck, shoulder and back pain are the side effects of the body struggling to bear the weight of the breasts. Irritation and rashes on the undersides of the breast, and fungal infections are caused by the constant sweatiness and friction. Physical activity too may be painful or awkward resulting in a lack of exercise and consequently weight management problems. Rarely, some neurological symptoms - typically numbness in the little finger - are also discovered.

Macromastia is the result of a few factors coming together. "It's partly in your genes," says Dr. Aiyer, explaining that big breasted women often have mothers, grandmothers and sisters who are similarly built. Hormone levels in the body and diet also play key roles in deciding what cup size you are.

Breasts can and do tend to change in size over time and for a number of different reasons, including the onset of puberty, menstruation and pregnancy. The size of the breast may also change if there is a marked weight loss or weight gain. Heavy breasts appear in some young girls between the ages of 10 and 15 due to a rare condition known as Benign Giant Virginal Hypertrophy.

Exercise has been known to help. The breasts are fully formed around the time a woman is 19 or 20 years old. If the breast is out of proportion to the rest of the body and distorts one's self image, surgery should be considered, says Dr. Aiyer

Breast reduction surgery under general anaesthesia reduces the breast size and weight - taking a woman from a D or F cup down to a B or an A.

In the procedure - known as mammoplasty reduction- the surgeon first makes an incision around the nipple and vertically down the underside of the breast. The size of the areolas is reduced and mostly glandular tissue, fat cells and redundant skin is removed leaving the breast firmer. The nipple may be repositioned higher and the skin closed up with stitches. In a few cases, the nipple and the surrounding areola have to be removed and stitched to a new spot. This can cause a loss of feeling in the nipple, since it has to be cut off from the nerves supplying it.

A breast lift or mastopexy can elevate the nipple and areola and reduce sagging, which is a common problem. Unlike in breast reduction, only skin is removed for a breast lift. This surgery is about staving off the inevitable and sometimes its effects may only last around five years, says Dr. Aiyer.

The surgery leaves visible scars that may fade a bit with time. "Numbness in the area of the breast may last up to a year," she says, adding that there may be a loss of sensation in the nipple and that this is temporary in most cases. There are also the possible complications of surgery that should be taken into consideration - the accumulation of blood, or the onset of infection. If you are planning to have a child, your ability to breast-feed may be seriously impaired after the procedure. Some women may still be able to breast-feed depending on what type of reduction was done, but in some cases the milk ducts under the nipple may be permanently damaged. "A patient should be counselled about the possible complications," says Dr. Aiyer.

But for many patients, the gain is well worth the risk. Women who have breast reduction surgery are often extremely satisfied, she says. They feel more attractive and express this in a renewed confidence and transformed physical appearance. The results of breast reduction surgery are considered permanent. However, the breasts may become larger or their shape may change as a result of pregnancy, weight gain, or weight loss. It is because of the latter that Dr. Aiyer recommends anyone considering the surgery to first reach their optimum weight and to work at maintaining it.

"Some studies have shown an increase of cancer in patients with large breasts," says Dr. Aiyer explaining that breast reduction is believed to reduce this risk. On the other side of the coin, she cautions that other cancer studies have shown that other factors like positive family history afford a much larger risk. If you are above 35 years of age, regular checkups are crucial, she says, explaining that all patients are screened for breast cancer both before and after surgery.