Back pain caused by large breasts. Back Pain from Large Breasts: Causes, Treatments, and Surgical Options

13.09.202328.06.2023 by alexxlab

How do large breasts contribute to back pain. What conservative treatments can alleviate discomfort. When is breast reduction surgery recommended for back pain relief. How effective is reduction mammoplasty for resolving back issues caused by heavy breasts.

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The Biomechanics of Back Pain Caused by Large Breasts

Large breasts can significantly impact a woman’s posture and spinal alignment, leading to various discomforts. Dr. Peter G. Whang, a board-certified orthopaedic spine surgeon, explains the biomechanical aspect: “As a result of the added weight, [large breasts] can cause an individual to flex forward (i.e., become kyphotic), which subjects the spinal column and other supporting structures to significant, non-physiologic forces.”

This forward flexion puts extra strain on the back muscles, as they must work harder to maintain proper spine alignment. Dr. Whang adds, “The stabilizing muscles in your back have to work overtime to keep your spine aligned, which results in increased stresses and fatigue.”

The Role of Gravity in Breast-Related Back Pain

Gravity plays a crucial role in exacerbating back pain for women with large breasts. Dr. Michael Howard, a board-certified plastic surgeon, explains: “Many women can actually have large breasts that weigh several pounds [each]. In the course of a day with just the natural force of gravity, that pull and that gravity has to be displaced somewhere or supported somewhere.”

This constant gravitational pull creates a counterbalance effect. Dr. Howard likens it to a teeter-totter, where the body must exert an opposite force to prevent tipping forward. This counterbalance is primarily achieved through the back muscles, which are constantly engaged to maintain proper posture.

Common Symptoms Associated with Large Breasts

Women with large breasts often experience a range of symptoms beyond back pain. These may include:

Headaches
Postural issues
Neck pain
Upper and lower back pain
Nerve pain
Physical abnormalities caused by overloaded bra straps

Do these symptoms always indicate a need for medical intervention? Not necessarily. While many women with large breasts experience discomfort, others may not have significant issues. The severity and impact of symptoms can vary greatly from person to person.

Conservative Treatments for Breast-Related Back Pain

Before considering surgical options, doctors typically recommend conservative treatments for back pain caused by large breasts. Dr. Sheri Dewan, a board-certified neurosurgeon, suggests starting with non-invasive approaches:

Physical therapy for stability strengthening
Ice and heat therapy
Moist heat applications
Aquatherapies

These conservative methods aim to strengthen the supporting muscles, reduce inflammation, and improve overall posture. Can these treatments provide long-term relief? For many women, conservative approaches can significantly alleviate symptoms and improve quality of life without the need for surgery.

The Importance of Proper Bra Fit

One often overlooked aspect of conservative treatment is ensuring proper bra fit. A well-fitting, supportive bra can help distribute breast weight more evenly and reduce strain on the back and shoulders. Professional bra fittings can be instrumental in finding the right size and style to provide optimal support.

When to Consider Breast Reduction Surgery

While conservative treatments are often effective, some women may find that they do not provide sufficient relief. In these cases, breast reduction surgery, or reduction mammoplasty, may be recommended.

Dr. Whang notes, “I have certainly had to refer several individuals to plastic surgeons for consideration of breast reduction.” However, he emphasizes the importance of a thorough evaluation before proceeding with surgery: “The decision to proceed with breast reduction also requires the input of a plastic surgeon to ensure that this procedure is indeed the most appropriate treatment for a particular individual.”

Is breast reduction surgery becoming more common? According to the American Society of Plastic Surgeons (ASPS) 2019 Plastic Surgery Statistics Report, over 46,000 reduction mammoplasties were performed in 2019, showing an increase from the previous year. Many of these surgeries were specifically aimed at alleviating back pain.

The Effectiveness of Breast Reduction for Back Pain Relief

Breast reduction surgery has shown promising results in alleviating back pain for many women. Dr. Michael Howard, who has performed hundreds of breast reduction operations, observes: “Overwhelmingly, every woman comes in with some degree of shoulder, neck, and back pain. It is universally common to women with large breasts.”

Post-surgery, many women report significant improvement in their back pain and overall quality of life. The reduction in breast size helps redistribute weight more evenly, reducing strain on the back muscles and improving posture.

Realistic Expectations for Breast Reduction Surgery

While breast reduction can be highly effective, it’s crucial for patients to have realistic expectations. The surgery can significantly reduce breast size and alleviate associated symptoms, but it may not completely eliminate all back pain, especially if there are underlying spinal issues.

Patients should discuss their goals and expectations thoroughly with their surgeon to ensure a clear understanding of potential outcomes.

The Psychological Impact of Breast-Related Back Pain

Beyond the physical discomfort, breast-related back pain can have significant psychological effects. Many women report feelings of self-consciousness, reduced self-esteem, and limitations in physical activities due to their breast size and associated pain.

Addressing these psychological aspects is an important part of comprehensive treatment. Whether through conservative methods or surgical intervention, improving physical comfort often leads to enhanced emotional well-being and quality of life.

Preventive Measures for Breast-Related Back Pain

While not all cases of breast-related back pain can be prevented, there are steps women can take to minimize discomfort:

Maintaining good posture
Engaging in regular exercise to strengthen back and core muscles
Wearing properly fitted, supportive bras
Using ergonomic furniture and workstations
Practicing stress-reduction techniques to minimize muscle tension

Can these preventive measures eliminate the need for medical intervention? While they may not be sufficient for all women, especially those with very large breasts, these strategies can significantly reduce discomfort and may delay or prevent the need for more invasive treatments.

The Future of Treating Breast-Related Back Pain

As medical understanding of breast-related back pain continues to evolve, new treatment options and preventive strategies are likely to emerge. Research into improved conservative treatments, minimally invasive surgical techniques, and better supportive garments may offer additional options for women struggling with this issue.

Ongoing studies are also exploring the relationship between breast size, body composition, and back pain, which may lead to more personalized treatment approaches in the future.

The Role of Interdisciplinary Care

Treating breast-related back pain often requires a multidisciplinary approach. Collaboration between orthopedic surgeons, neurosurgeons, plastic surgeons, physical therapists, and primary care physicians can provide comprehensive care tailored to each patient’s unique needs.

This holistic approach ensures that all aspects of the condition are addressed, from physical symptoms to psychological impact, leading to better overall outcomes for patients.

Why Breast Size Can Affect Back Pain

Women know that gravity is cruel—maybe moreso to those with heavy breasts.

Large breasts can cause headaches; postural issues; neck pain; upper and lower back pain, nerve pain; and even physical abnormalities caused by overloaded bra straps.

Will a breast reduction help with back pain? Possibly, say our experts.

The condition known as macromastia or breast hypertrophy is frequently observed in women, and while many women don’t have issues with having large breasts, others find it to be difficult and even painful to their backs.

So what can be done?

How Pain Occurs

How Back Pain from Large Breasts Happens

According to Peter G. Whang, M.D., F.A.C.S., F.A.A.O.S., a board-certified orthopaedic spine surgeon and an associate professor in the department of Orthopaedics and Rehabilitation at the Yale University School of Medicine in New Haven, CT, heavy breasts must be considered as a back pain culprit.

“It certainly makes sense from a biomechanical point of view that women with large breasts may be predisposed to having increased pain in the thoracolumbar spine because of their abnormal posture,” he explains. “As a result of the added weight, [large breasts] can cause an individual to flex forward (i.e., become kyphotic), which subjects the spinal column and other supporting structures to significant, non-physiologic forces.”

“Additionally,” says Dr. Whang, “the stabilizing muscles in your back have to work overtime to keep your spine aligned, which results in increased stresses and fatigue.”

Sheri Dewan, M.D., a board-certified neurosurgeon at Northwestern Medicine Regional Medical Group in the Chicago suburbs, agrees: “Typically, hypertrophic breast tissue can cause a number of issues involving posture, muscular pain related to strain in the [shoulder area], and increased gravitational force that may all contribute to spinal discomfort or disorders.”

That’s right—gravity itself is part of the problem.

“Many women can actually have large breasts that weigh several pounds [each],” says Michael Howard, M.D., a board-certified plastic surgeon at Northwestern who specializes in microsurgical breast reconstruction. “In the course of a day with just the natural force of gravity, that pull and that gravity has to be displaced somewhere or supported somewhere.”

That somewhere is in the muscles of the back.

“If you think of the breast as a weight that is hanging out from the front of the body, the body has to counteract that weight to keep from tipping the woman over. It’s just a like a teeter-totter—there’s a balance,” says Dr. Howard. “So you’ve got to put force on the body in the opposite direction to counteract that several pounds of force pulling you forward. When you have that force puling you back, that’s your back muscles that are working overtime to really counterbalance the weight.”

Nonoperative Treatment

Conservative Treatment

Most doctors agree that non-operative treatments are the first line of defense.

“The majority of individuals who present with pain associated with larger breasts will experience symptomatic relief with conservative treatments,” explains Dr. Whang.

Dr. Dewan also believes a conservative approach is the best place to begin.

“I typically start with conservative treatments including physical therapy for stability strengthening and other modalities including ice/heat/moist heat,” she says. “In addition, aquatherapies can be beneficial.”

But conservative treatment isn’t always the answer.

“I have certainly had to refer several individuals to plastic surgeons for consideration of breast reduction,” says Dr. Whang.

While Dr. Whang has seen success with breast reduction surgery, he advises seeking more professional advice first.

“The decision to proceed with breast reduction also requires the input of a plastic surgeon to ensure that this procedure is indeed the most appropriate treatment for a particular individual,” he says.

Surgery

Breast Reduction for Back Pain

Breast reduction surgery, also called reduction mammoplasty, is becoming more common—“one of the most commonly requested and most predictably successful plastic surgery procedures,” says Dr. Bethanne Snodgrass, M.D., on the website of the American Society of Plastic Surgeons (ASPS). In fact, according to the ASPS 2019 Plastic Surgery Statistics Report, more than 46,000 reduction mammoplasties were performed in 2019, an increase over 2018. And a great many of those surgeries were for back pain.

“Having seen several hundred breast reduction operations … overwhelmingly, every woman comes in with some degree of shoulder, neck, and back pain. It is universally common to women with large breasts,” says Dr. Howard.

When it comes to the decision to have breast reduction surgery, it’s important to know what is and isn’t possible.

“I think the most important part of breast reduction surgery starts from the very first moment that I am meeting the patient, and that is expectation setting from the outset,” Dr Howard says. “If a patient has the right expectations for the surgery, then success is almost guaranteed in this.”

Dr. Howard adds that the “vast majority of patients” see improvement of their symptoms.

“So when you set that expectation ahead of time, then they go into it with a realistic look,” he says.

The surgery itself is generally outpatient, done under general anesthesia. Your surgeon will meet with you before the surgery and mark on the skin where incisions will be made. The surgery takes around two to three hours in operating room, with a full recovery time of about three to four weeks on average.

Your surgeon will use techniques to decrease breast volume—the reduction—but also to ensure pleasing aesthetic results and good breast function after surgery. That includes sensation and circulation in the nipples and even the ability to breastfeed.

There is also something of a lift effect after surgery, which in and of itself helps reduce back pain and back issues. For most women, according to Dr. Howard, “the breast ends up narrower, tighter, and lifted, and then obviously smaller in volume … you’re going to have less strain on the back.”

Post-Surgical Outcome

Satisfied Patients and Post-Surgical Outcomes

Breast reduction surgery results in one of the most satisfied patient populations, says the ASPS: “Patient satisfaction rates after breast reduction are very high, and it is the rare patient who will not experience significant relief of her symptoms after surgery. ”

Published medical studies have found similar results. A 2019 study in the journal Plastic and Reconstruction Surgery – Global Open stated “Reduction mammaplasty [sic] produces an unmistakable improvement in signs, symptoms, and quantifiable measures [in spinal angles, posture, center of gravity, and back pain reduction].” A 2020 study in European Spine Journal said, “The evidence gleaned suggests that [reduction mammoplasty] reduces the prevalence of back pain in patients with large breasts.”

If you are a woman with large breasts who has back, neck, and shoulder pain, problems with posture, or similar concerns, talk with your doctor about whether speaking with a plastic surgeon may be right for you. Your doctor and your surgeon can also help you speak with your health insurance company to get them to cover the surgery. After all, in these kinds of cases, it’s not aesthetics. It’s treatment.

“The primary goal is functional improvement” reminds Dr. Howard. Surgeons make sure “that the symptoms of the patients do point to a reconstructive/functional improvement. I encourage women to” look into it.

Aesthetic Surgery Techniques. Edited by James D. Frame, MD; Shahrokh C. Bagheri, MD; David J. Smith, Jr., MD; and Husain Ali Khan, MD. Part 4, Chapter 26: “Breast Reduction.” by Alexandre S.F. Fonseca, MD, PhD; Guilherme Flosi Stocchero, MD; and Gustavo Flosi Stocchero, MD.
Aesthetic Plastic Surgery. Summer 1993 . “Reduction mammoplasty for macromastia.” https://pubmed.ncbi.nlm.nih.gov/8213315/
Canadian Journal of Plastic Surgery. Spring 2013. “Reduction mammoplasty improves body posture and decreases perception of pain.“ https://pubmed.ncbi.nlm.nih.gov/24431933/
Plastic Surgical Nursing. Jan/Mar 2020. “The Effect of Reduction Mammoplasty on Body Posture: A Preliminary Study.” https://pubmed.ncbi.nlm.nih.gov/32102077/
The Mayo Clinic. “Breast Reduction Surgery.” https://www. mayoclinic.org/tests-procedures/breast-reduction-surgery/about/pac-20385246
The American Society of Plastic Surgeons. November 2012. “Large Breasts Causing Back Pain? Surgery Can Offer Relief.” by Dr. Bethanne Snodgrass, MD.