According to a study from NewYork-Presbyterian Hospital/Weill Cornell Medical Center and the New York University School of Medicine, smaller-framed women reap significant health and quality of life benefits from breast reductions that involve the removal of under 500 grams of tissue per breast.

The finding runs counter to the policies of most US health insurance companies, who typically do not reimburse women for these smaller mammoplasties because insurance companies deem them to be only of aesthetic value.

"Of course, as plastic surgeons, we know that isn’t true—you can’t apply the same number, in terms of the benefits of excised breast tissue, to different-sized women," says co-author Jason Spector, MD, a plastic surgeon at NewYork-Presbyterian Hospital/Weill Cornell Medical Center and assistant professor of plastic surgery at Weill Cornell Medical College. "Smaller women are going to have proportionally smaller breasts, but for their particular frame, their breasts may still be far too large and uncomfortable."

The study found that breast reductions of less than 500 grams per breast greatly eased women’s back, neck, and shoulder pain. The procedures also improved their quality of life by allowing them to exercise more, play sports, and choose from a wider variety of clothing.

The 59 patients in the study visited the study’s co-author, Nolan S. Karp, MD, of NYU Medical Center, complaining of pain linked to uncomfortably large breasts. None of the women in the study had ever undergone any form of breast augmentation before.

On average, the mammoplasties involved the surgical removal of 415 grams of breast tissue per breast (830 grams total), for an average breast reduction of more than two cup sizes. Seventeen of the women had less than 750 grams total of breast tissue removed—an average decrease of 1.7 cup sizes.

Three months and 1 year post-surgery, the women were asked about changes in pain and quality of life. They were asked to rate their pain from a score of 1 to 5 (5 being the highest).

The study results showed that scores fell dramatically after the reduction mammoplasties—in categories that included lower-back pain, neck pain, headache, and bra-strap "grooving."

"Women were also greatly relieved that they were more able to engage in healthful activities such as running or playing sports—demonstrating that breast reduction surgeries have even wider health implications," says Spector.

"The smaller-framed woman who comes to us complaining of chronic breast-linked pain is not having this procedure done for a ‘lift’ or any cosmetic purpose," he says. "Breast reduction surgeries involve some scarring, general anesthesia, and the usual level of surgical risk. Patients are not taking them lightly."

Spector is optimistic that reimbursement policies may change, based on the findings.

"This is going to be useful data that patients and other plastic surgeons should be able to turn to as they go back and forth with insurance companies trying to get the procedure approved," Spector says. "Women come in all shapes and sizes, and we’re just pointing out that breast reduction—like many other surgeries—is definitely not a one-size-fits-all proposal."

[www.medicalnewstoday.com, September 15, 2007]