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Having a breast reduction can be an emotional experience. Sandra (who didn't want her real name used), a 32-year-old health-care worker for the Forensic Psychiatric Institute and a mother of two, experienced mixed feelings after the breast-reduction procedure. She says that after the surgery, she was a little sad. "Something that was a part of me for so long were so small compared to before. I felt small-chested and a little afraid of whether I would grow to love them."

Despite her initial mixed feelings about the procedure, Sandra has grown to accept her new breasts.

"I have really grown to love them. They don't shake, I don't need to wear a bra if I don't want to. I have a lot more freedom than before. My shoulders are stress-free. I sleep really well. I look much better in clothes and I am now wearing bras that fit really nicely. I am getting compliments all the time."

Large breasts may seem like an asset to some, but for women who have them, they can be uncomfortable, awkward and even embarrassing.

Women have breast reductions to change their proportions and reduce discomfort such as back pain. According to the Canadian Institute for Health Information, 5,181 women had breast reduction surgery in 2006 at in-patient facilities in Canada.

The procedure, technically known as reduction mammoplasty, involves removing fat from the breast to make it smaller, more firm and lighter. Breast reductions are covered by all provincial health plans, but must be approved based on criteria that vary from province to province. (For example, in Ontario, size is not sufficient grounds for coverage, there must be associated back or neck pain. In Nova Scotia, at least 500 grams per breast must be removed.) If the breast reduction is not covered by a provincial health plan, costs range from $4,500 to $6,500.

"Breast reduction is a very common operation for plastic surgeons around the world," says Dr. Nasim Huq, a Niagara Falls, Ont.-based doctor who has performed the procedure on more than 80 women. "With the increased prevalence of obesity, people are a little heavier. The surgery has become more safe and more popular."

Tatum Rusak, a 30-year-old mother of two and owner of a home-based business, says the procedure appealed to her because she had trouble wearing nice clothes and finding bras to fit her 38H breasts.

"I had to go to specialty stores to find bras, they all cost over $100 — it was crazy to have to spend that much," she says. "They would only last a few weeks and would then be garbage - they just don't support that big a breast."

The procedure

Breast reduction is a medical procedure that requires consultation with a surgical expert. Patients usually find a plastic surgeon to perform the procedure through referrals. To check on the specialty of a doctor and to verify certification, Canadians can contact The Royal College of Physicians and Surgeons at 613-730-8177, 1-800-668-3740, or through www.rcpsc.medical.org.

The patient then discusses the details of the surgery with the surgeon, going over issues such as where the nipples and scars will be positioned, and how much weight will be removed. A typical procedure sees 1-3 cup sizes reduced from the breast. Rusak, for example, went from a 38 H to a 36 DD, while Leslie Holland, a Campbellford, Ont.-based homemaker with three kids went from a 48DD to a 40 C, losing nearly 7 kilograms (15 pounds).

The procedure typically takes about two hours, and is performed under general anesthetic.

The most common way of performing breast reduction surgery is the "Inverted T," where one incision travels along the bottom of the breast, and another goes upward to the nipple.

For smaller breasts, only a vertical incision is used, with no transverse cut along the breast. This technique is often used with liposuction, but is more difficult to do when a larger volume of the breast needs to be removed, says Dr. Huq.

Things to consider

The downside of the operation can include issues such as scarring and possible reactions to anesthetic, which can happen with any operation.

Having adequate support before and after the operation helps women to deal with its emotional and physical after-effects.

"Before the surgery I had some friends who went through it and coached me. I relied a lot on that. After the surgery, my mother took the kids for one week so that I can just relax and take care of myself. My surgery was on a Friday so my husband was home for two days with me ... mostly just reaching for things and lifting things and just helping me around the house .... After that I was home by myself. I was fine," says Sandra.

Rusak is pleased with the results of her breast reduction, but she experienced complications following the surgery.  Her husband took her to the emergency room, who then referred her to the plastic surgeon who performed the procedure.

"The incisions opened up, where the T meets," she says. "There was a triangle under each breast that was opened, that was bleeding, yucky and painful. I went to [the plastic surgeon] the next day. They said it is fairly normal."

The recovery time is also something women considering the procedure should take into account. Most people are back to their jobs (if they are desk jobs) within two weeks, but they are not able to do heavy lifting for four to six weeks after the procedure.

Due to the nature of her work, which involves running and lifting, Sandra says she took six weeks off of work after her procedure in February.

Many women, like Holland, experience minimal pain after the procedure. "Advil and Tylenol took care of the pain for me. I was still able to play with my kids, drive, but I couldn't lift things."

Some women who have had the procedure have trouble breastfeeding. Dr. Huq recommends that women do the surgery after having and breastfeeding their children, if they wish to breastfeed rather than bottle-feed.

"It depends on the techniques that are used. The traditional ways of doing the surgery usually cuts your breastfeeding ability in half," says Dr. Huq.

Reflection

"I'm not embarrassed to be out in public. I don't feel bad when people look at me. I'm more confident in myself," says Holland about her experiences after the procedure.

Most women are pleased with the results of the procedure and the decrease in discomfort. Dr. Huq says he has a 95- to 97-per-cent satisfaction rate for breast reductions.

"I would recommend the surgery to anybody," says Rusak. "I love it, it is absolutely the best thing that I have ever done."

Kim Edwards is a Toronto-based freelance writer and editor. Contact her at kim@kimedwards.ca.