Frequently, breast enlargement (macromastia) and morbid obesity are related entities, occurring simultaneously in some patients. There certainly are many patients who only have enlarged breasts without also being obese. In fact, in 2009 over 78,000 breast reduction procedures were performed in the United States.
The reasons to consider breast reduction include:
1) back pain
2) skin rashes under the breasts
3) pain from bra strap grooving
4) inability to exercise.
5) feelings of unattractiveness
Previous reports have shown that for many patients, breast reduction surgery can become a stimulus for further weight loss. However, many obese patients who do have severe breast enlargement are now considering both massive weight loss surgery (gastric bypass, lap band, etc.) and breast reduction. In these patients the question arises: Which operation should I have done first…breast reduction of gastric bypass?
Commonly the answer lies in the severity of symptoms related to breast enlargement. There is no question that breast reduction surgery provides almost instantaneous relief of most of the symptoms related to having severely enlarged breasts, namely back pain, shoulder pain and rashes. However, when plastic surgeons perform this surgery, we are aiming to provide the best shape possible for the new, smaller, reduced breast tissues. Rarely considered, is what will happen to the volume and shape of the breast tissues when breast reduction patients then go on to lose massive amounts of weight. Since breast tissue is comprised of significant amounts of fat, subsequent weight loss will certainly result in a further decrease in breast volume.
A recent study looked at just this issue (Plastic and Reconstructive Surgery, Breast Reduction and Massive Weight Loss, Vol 128, Number 3, p643, September 2011). The investigators noted that the majority of patients were glad that they underwent breast reduction surgery prior to undergoing surgical weight loss. However, most of the breast reduction patients reported a decrease in the satisfaction with the appearance of their breasts following massive weight loss. Some patients may have medical problems resulting from their enlarged breast that dictate this surgery be done early. However, if some morbidly obese patients with enlarged breasts can wait to have their breast reduction surgery until after their post-weight loss surgery weight loss, they may ultimately be more satisfied with their breast aesthetic.
*photos on this post are of an actual patient of Dr. Brenner.