Contrary to popular belief, large breasts aren't always what they're cracked up to be. For many women, overly large, pendulous breasts can result in chronic neck and back pain, poor posture, breathing problems, rashes, and deep skin grooves resulting from bra strap pressure. What's more, excessive breast tissue can prevent some women from participating in physical activities and even lead to self-consciousness, poor self-esteem, and other psychological problems.

To ease their discomfort, more and more women are turning to breast-reduction surgery, also known as reduction mammaplasty. As the American Society of Plastic Surgeons (ASPS) reports, more than 104,000 breast reductions were performed in the United States in 2006, compared with 84,000 in 2000an increase of 23 percent. In addition, breast-reduction surgery may make it easier to perform mammograms and, according to a report published in a 2004 issue of the journal Plastic and Reconstructive Surgery, may even lower a woman's risk of developing breast cancer.

Although patient-satisfaction rates are generally high, experts are quick to point out that reduction mammaplasty is serious surgery. As such, prospective patients should do their research, find an experienced surgeon, and ask lots of questions so they can make informed decisions. Here, the basics on breast reduction.

Is Breast Reduction Right for You?

Whether you're seeking surgery to ease pain, to boost your confidence, or for cosmetic reasons, it's important to understand how the procedure is performed. In general, reduction mammaplasty is an outpatient procedure that reduces the size of the breasts by removing excess tissue, fat, and skin. In some cases, it may be combined with a breast-lift procedure, also known as mastopexy.

In most cases, the procedure is performed under general anesthesia, and there are several techniques a surgeon may use, depending on the patient's symptoms and/or aesthetic desires:

  • Inferior pedicle approach: Also known as the keyhole technique, this approach removes excess tissue, fat, and skin via an anchor-shaped incision that circles the areola and extends downward. The nipple and areola are placed into a higher position, in proportion with the patient's new breast size and shape. This approach can be especially effective for women with very large and droopy breasts.
  • Vertical scar approach: With the vertical scar approach, also known as short scar breast reduction, the surgeon uses a lollipop-shaped incision without horizontal incisions. According to some experts, this technique results in less noticeable scarring, a more natural shape, and better results over time than the inferior pedicle approach.
  • Liposuction-only approach: For women who require a minor size reduction or simply want to correct an asymmetry, the liposuction-only technique may be suitable. With this approach, fat is removed through a hollow tube and suction device. Compared with other forms of reduction mammaplasty, this technique offers minimal scarring, less trauma to the breasts, and quicker recovery.

15 Questions to Ask Your Cosmetic Surgeon

As with any cosmetic surgery, a breast reduction generally begins with a consultation. At that time, you should discuss your symptoms and ask for a detailed summary of the procedure, the results you can expect, and the amount of scarring that will likely result. Remember to be as specific as possible about the size and shape you'd like to achieve. All too often, a patient says that she wants to be a certain cup size, but her understanding of that size and the surgeon's may be quite different.

In addition, be sure to ask the following questions:
1. How many of breast reductions do you perform each year?
2. How many years have you spent performing breast reductions?
3. Are you board certified, and if so, with which board(s)?
4. In which states are you licensed to practice surgery?
5. What are the risks and complications associated with this procedure?
6. How many additional operations can I expect as a result of this procedure over my lifetime?
7. What are my options if I'm dissatisfied with the outcome of my breast reduction?
8. If I'm unhappy with the results, is it possible to reverse the procedure? If so, what results can I expect?
9. Will this surgery have any functional repercussions?
10. How can I expect my results to look over time?
11. What alternate procedures or products are available if I choose not to have this surgery?
12. Do you have before-and-after photos I can look at, and which of those results are reasonable for me to expect?
13. What's the most common complication you encounter with this procedure?
14. What's your reoperation rate, and what's the most common type of reoperation you perform?
15. Do you believe I'm an informed patient with realistic expectations who would be a good candidate for this procedure?

Breast Reduction Financing Options

The costs of reduction mammaplasty vary depending on location, surgeon, and technique, but according to the ASPS, the national average surgeon fee is $5,550. Keep in mind that this amount does not include costs associated with the surgical facility, anesthesia, medical tests, prescriptions, or surgical garments.

Although some insurance companies cover breast reduction surgery, it must be viewed as a medical necessity, as opposed to cosmetic, and the criteria for this may vary depending on the company. So be sure to check your policy first. If your policy doesn't cover the procedure, or if you don't have health insurance, there may be other options available. Financial institutions, such as Capital One, offer health-care loans specifically designed for cosmetic surgery patients.