Patients who come to the plastic surgery and hand surgery department of the Ebersberg district clinic for a breast reduction are not just about ideals of beauty. It is mostly women who suffer, both physically and mentally. The chief physician of the department, Timm Oliver Engelhardt, explains when an operation can be medically necessary.
SZ: When does one speak of a burdensome, large breast?
Timm Oliver Engelhardt: If they are disproportionately large or heavy in relation to their height and weight. There are no fixed dimensions for this so far. When assessing the need for a breast reduction, it is important for us that the patient’s functional disorder is the focus, not just the aesthetics.
Timm Oliver Engelhardt is chief physician in the department for plastic surgery at the district clinic in Ebersberg.
(Photo: Alexander Zettl/oh)
What functional disorders could this be?
Especially now in summer, when it is very hot, sweating and skin rubbing against skin under the breast can cause inflammation, eczema and even fungal infections. Many women also experience painful tension in the upper back muscles, shoulders and neck, poor posture, degenerative diseases of the spine and poor posture. Because the weight of the chest pulls the upper body forward and that puts a lot of strain on the musculoskeletal system. Our patients often complain about deeply cutting bra straps. Last but not least, psychological stress can also trigger the desire for a smaller breast. Those affected are often ashamed, find it difficult to find a partner or suffer from not being able to practice various sports, and may avoid social contacts. The result can be depression.
Are these all symptoms of a medically necessary breast reduction?
From a medical point of view yes. However, in many such cases, there is no guarantee that health insurance companies will cover the costs of the surgical treatment. We are fully committed to our patients and always look for solutions together. I recommend that those affected first exhaust all conservative therapies before submitting an application to the health insurance company through the district clinic – if they have not already done so. Depending on the symptoms, this is orthopedic physiotherapy, psychotherapy or treatment by a dermatologist. In my experience, this often brings short-term relief, but in the long term it only treats the symptoms, not the cause. My advice: If possible, also provide us with expert opinions for the application.
Can every affected woman undergo a breast reduction?
Basically yes. The same requirements apply to this operation as to other major interventions, because it is associated with general anesthetic and surgical risks. This means that the patient should be in good health, apart from the symptoms mentioned. In addition, in the case of a medically necessary breast treatment, she should have a normal weight as far as possible. Oversized breasts are often related to body weight, which means that overweight women often have larger breasts. We advise these women to lose weight first. However, it is a misconception that weight loss simply reduces the size of the breasts, making surgery unnecessary. Although the breast volume decreases because there is less fatty tissue, the skin coat shrinks only slightly. Complaints from close skin contact will therefore remain. We recommend a breast lift and, if necessary, a filling with the body’s own tissue or an implant.
Are there standardized procedures for breast reduction?
There are numerous different standardized surgical techniques, but we also consider different aspects of each patient individually, such as the habitus and body shape. The aim of the operation is to adjust the breast size proportionally to the body. Patient wishes also have an influence. However, hobbies also play a role in the choice of procedure, for example whether they would like to practice certain types of sport, and their living situation. Does she still want to be a mother and breastfeed? Then a procedure should be used in which the blood flow to the nipple is guaranteed and the milk ducts are spared. In the case of extremely large, sagging breasts, the nipple and areola can be removed and reinserted in a more appealing location. This may have aesthetic benefits, but will affect sensation and function.