Reading: Breast Reduction Surgery after 40? Yes!

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Breast Reduction Surgery after 40? Yes!

Women say goodbye to painful shoulders and “military bras” and hello to freedom

By Andrea Atkins

two cupcakes with cherries that look like breasts
Photo by Annie Spratt for Unsplash

After menopause, Judith Dupre’s breasts, which had always been ample, seemed to get larger.

“They took on a significant presence in my life,” says Dupre, a 61-year-old writer and historian. “When I looked at photos, all I could see were these breasts. They were suffocating my face.” And her back hurt. “As a writer who spends much of the day bending over a keyboard, it was uncomfortable.”

Nothing she did seemed to help. She dieted and lost 20 pounds, but, she says, “the breasts did not budge.”

Besides her back pain, her neck ached and she had dents in her shoulders where the very thick straps of the “military-style” bras she wore dug into her skin.

“Summer was just horrible,” she adds, “because I’d sweat, and I’d get itchy rashes under my breasts.”

And then there was the psychological toll. “I felt that my breasts were sending a message about me that had nothing to do with who I was as a person, as a mother, as a scholar, as a writer.” Dupre has written seven books, including Bridges: A History of the World’s Most Spectacular Spans and Skyscrapers: a History of the World’s Most Extraordinary Buildings, and she is the official biographer of One World Trade Center. “My breasts came into the room five minutes before I did. I think that people — especially men — made assumptions about who I was.”

When she was younger, Dupre liked her large bosom. “I always felt my breasts were attractive, sexy, and well proportioned,” she says. “But once I hit menopause, they got larger and larger.” After a frustrating shopping trip to buy unsexy bras, Dupre complained to her sister about her breast problem. “Why not have a reduction?” her sister said, and introduced Dupre to her friend Pam, who’d already done it. “Pam raised her shirt — she didn’t even have a bra on — but her breasts were amazing,” Dupre recalls.

Soon she was back in her hometown of Providence, Rhode Island, consulting with the surgeon Pam had used, and within a few months she underwent reduction mammaplasty, or breast reduction surgery. According to the American Society of Plastic Surgeons in the most recent statistics available, 43,635 American women chose in 2017 to take their G-, H-, or J-cup–sized breasts and make them smaller, an 11 percent jump over 2016.

Almost immediately after the procedure, Dupre felt like a changed woman. Gone were the rashes and the dents and the pain. Just one month after the surgery that removed 1.5 pounds of tissue from each breast and dropped her from a G- to a C-cup, Dupre was overcome with emotion while shopping at her local grocery store. As tears rolled down her cheeks, she remembers thinking, “’Wow. I’m just like everyone else now.’ Right there in the frozen food aisle, I just had this enormous release of anxiety that I didn’t even know I had,” she says.

Having oversized breasts causes many women anxiety, and many doctors know that reducing them can be life-changing.

HAPPY BOOBS ARE HERE AGAIN

“These ladies are my happiest patients,” says Roberta Gartside, MD, a Washington, DC — area plastic surgeon who estimates that she does about 100 breast reductions per year. RealSelf, an online resource for plastic surgery patients, reports that 98 percent of respondents said their breast reduction surgery was “worth it.”

“There’s no question. It’s got one of the highest patient satisfaction results of any procedure done in plastic surgery,” agrees Jeffrey E. Janis, MD, FACS, president of the American Society of Plastic Surgeons, professor and executive vice chairman of the Department of Plastic Surgery at The Ohio State University Wexner Medical Center, and chief of plastic surgery at Ohio State University Hospital. “And that’s true for women of any age. I have patients who are teenagers and I also have operated on women who are in their 60s.”

But women over 40 see changes in their breasts. When you’re young, says Dr. Janis, your breasts are filled with glands that produce milk. The tissue is “denser and firmer. As one ages, especially after you’re done with the childbearing years, you get fatty tissue replacement. The glandular portion of the breast is replaced by fat, and that fat can change with weight gain as well.” Add to that the pull of gravity, and your breasts may feel heavier and more pendulous.

Even so, most older women who opt for the surgery have always had large breasts, Dr. Gartside says. “They’ve generally had problems with them most of their lives. As they age, their tolerance for the neck, back, and shoulder pain and the rashes in the folds under their breasts starts to wear on them. They have to layer two sports bras to work out, they can’t wear a sundress, can’t find a bathing suit that fits, and they’re just tired of it.”

That’s exactly how Pam Stevens, a 57-year-old media and communications consultant who worked in three Republican White Houses, felt. She found her way to Dr. Gartside in 2017.

“I was sick of the bras that cost $75,” says Stevens, who is five feet tall and had double D breasts. “I mean c’mon! Double D?”

One year after her surgery, Stevens says she loves buying pretty C-cup bras and wearing button-down shirts and sundresses. Her only regret? “I wish I’d done it sooner…I feel lighter, happier, and my feet no longer hurt like they did before.”

INSURANCE STEPS UP

Like many who have the surgery, both Dupre and Stevens found that insurance paid for their operations. Most insurers will cover the procedure, but many companies are asking for more and more documentation before doing so. Your insurance company may want to see that you have verifiable pain and may require you to try “conservative” management techniques first, which could include special bras, physical therapy, chiropractic care, and even Motrin to relieve pain.

And many insurance companies require the Schnur Sliding Scale, a formula that assesses your weight and height and your symptoms to determine how much breast tissue should be removed. The scale requires at least 500 grams of breast tissue be removed for the procedure to be considered “medically necessary.” However, Dr. Janis says, “There is more recent evidence that these minimum requirements are not necessary, as symptomatic relief is possible even below 500 grams of removed tissue. Therefore, there are many women being denied this procedure based on that older scale who would benefit from it and really should have it.”

Most plastic surgeons’ offices know this, and according to Janis, if you’re denied coverage, most doctors will work with you to make your case to your insurance company through appeal. According to 2017 ASPS statistics, the average cost of the surgery is $5,482.

THE BREAST WAY TO DO IT

To read about the procedure is to cringe at what is surely an uncomfortable experience. Doctors make incisions in the breast and remove skin and the underlying fatty and glandular tissue. Your nipples will be repositioned (in some cases they may be removed and reattached). “They move the nipples back up to where they were when you were 21,” Dupre says. Most surgeries are outpatient, performed in a surgical center or hospital, and patients leave with stitches (either dissolvable or those that have to be removed). Some patients need drains.

“It is a major surgery, done under general anesthesia,” Janis says, “but it’s a lot more well tolerated than most people think.”

Gartside agrees, noting that most patients are pain-free in five to seven days and back to all activities one month post-surgery.

“My recovery was like nothing,” says Stevens. “Zip-a-dee-do-dah. No pain, nothing. No restrictions. My arms didn’t hurt. It was a lot easier than a C-section. There was no trauma.”

There is a risk of loss of sensation or color change in the nipple, though Gartside says these issues are not common. As with any surgery, there is a risk of infection, and, according to a 2011 study in the journal Plastic and Reconstructive Surgery women over 50 are twice as likely to develop infections post-surgery. Dr. Janis adds that if you are an active smoker, significantly overweight or obese, or have uncontrolled blood sugars, complications are more likely.

But doctors can work with their patients to make sure the outcome is positive. “This is a very helpful operation,” Janis said.

Betsy Gehring (57) of Falls Church, Virginia, says, “I’m so happy that I did it. It’s transformational in terms of the way your body feels and the way you feel about your body. The difference is huge and significant. And yes, it has improved my sex life.”

As for Dupre, who is divorced, taking off her shirt in front of a new lover was once a terrifying prospect. Now, she says, she’s even feeling sexy. “Living on a writer’s income, I wouldn’t have had this operation if it weren’t covered by insurance. That would have felt too indulgent. Now I know that it wasn’t indulgent at all. It returned me to myself.”

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