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Breast Reduction

A detailed explanation of breast reduction, your different choices, and what to expect during recovery.





John Q. Cook, M.D.

Chicago 312-751-2112
Winnetka 847-446-7562

The Double Benefit of Breast Reduction Surgery

credit: Yale Center for British Art

Breast reduction is a wonderful operation because it offers patients a double benefit. First there is an artistic benefit. When a woman’s breasts are restored to a proper position and brought into harmony with the rest of her body, she will experience the pleasure of her own physical beauty.

Second, there can be remarkable physical benefits from breast reduction. I have performed breast reduction surgery in over 1,000 patients, yet I still am amazed by the positive changes this operation produces: a reduction or even an elimination of pain in the neck and back, improvement in posture and body mechanics, and an increase in motivation for healthy nutrition and exercise.

If you are considering breast reduction surgery, this section of the website will provide you with a detailed understanding of the operation, your different choices, and what the recovery from surgery is like.

Why Many Doctors Don’t Understand the Consequences of Heavy Breasts

Structural Breast Reduction | John Q. Cook, M.D. | Whole Beauty Institute

Structural Breast Reduction. Click image to view in photo gallery.

Every year I perform breast reduction surgery on patients who have complained for years of significant pain in their neck and shoulders.

Their doctors have dutifully referred them to orthopedic specialists, physical therapists, and chiropractors, and have ordered expensive tests such as MRIs — all to no long-term benefit. The reason for this is simple: the root cause of the pain is the postural imbalance produced by heavy, settled breasts.

In general, female physicians are more likely to understand the consequences of heavy breasts, probably because they have friends with heavy breasts who have shared their experiences.

The lack of understanding on the part of many plastic surgeons may also stem from the way doctors are educated. We diligently study one area of the body or one organ system at a time, but less attention is given to the interplay between the different parts of the body.

I always suggest to my patients that when they experience a wonderful relief of their physical symptoms from breast reduction surgery, it is helpful for them to share the good news with their primary care doctors, so that there will be a gradual education of physicians about the benefits of this surgery.

There Are Significant Physical Consequences to Heavy and Settled Breasts

Classical breast reduction | Dr. John Q. Cook | Chicago and Winnetka

Classical breast reduction. Click here to view in photo gallery.

Over time, gravity will pull heavy breasts to a low position, and this will have predictable consequences on body mechanics.

Heavy, low-riding breasts actually change the body’s center of balance. Many types of exercise, including dance, tennis and running, are negatively affected when the center of balance is lowered. Patients try to compensate for this by purchasing harness-like bras in order to lift the breast to a better position. Unfortunately, this has its own set of negative consequences. The bras dig in to the shoulders and actually produce grooves over time that can become quite sore. Also, the shoulders are pulled forward. This puts excess pressure on the upper back and neck, and leads to pain in these areas. The spine takes on an exaggerated lordosis (curvature) in an attempt to compensate for all of the heaviness in the front of the chest. Over time, this curvature produces lower back pain.

If this description is familiar to your own experience, you will probably experience significant improvement in your physical comfort from breast reduction surgery. Of course there can be other causes to back pain, such as arthritis and injury, but even if these exist, corrective breast surgery can at least make the symptoms less frequent and less severe.

Patients with very heavy breasts often tell me that the skin under the breasts can become raw and irritated, especially during the warmer months.

The consequences of heavy breasts can be even more severe for patients who have asymmetric breast hypertrophy (overgrowth). This can be understood if you think of the following common experience: It is easier to carry a pair of fairly heavy suitcases, one in each hand, than to carry a heavy suitcase in one hand and a light suitcase in the other hand.  People who carry suitcases of two different weights almost immediately experience muscle spasm in the back. This is often the physical reality of women with massive breast enlargement.

All of the physical consequences of breast enlargement that I have just described are worsened if a woman has experienced a pregnancy that causes a widening of the gap between the rectus (sit up) muscles in the front of the abdomen. Now there are two sets of forces working against efficient back dynamics. For many of these patients, the combination of breast reduction and abdominoplasty can produce a wonderful benefit.

Unfortunately, in our culture women with large breasts are often teased during high school and college. This can set up a vicious cycle in which a woman may avoid situations where her breasts may be noticed. Frequently this includes many types of exercise. This also may lead to a hunched posture in an effort to camouflage the breasts and, in some people, even weight gain to balance the breasts with a heavy lower body.

There are also women who come to me for breast reduction who do not experience any of the problems I have just mentioned. For these patients, breast reduction is a personal choice that reflects the desire for a more streamlined body.

Different Patients Have Different Goals for Breast Reduction Surgery

When a patient comes to me to discuss breast reduction, we spend considerable time discussing her specific goals for the surgery.

This allows me to plan an operation that has the best chance of meeting her goals. Occasionally a patient will have a request that is not obtainable with current surgical techniques, and if so, that is valuable information for her to share with me.

Fortunately, for the vast majority of patients I am able to come up with a plan that produces a happy outcome. Different breast reduction surgery techniques produce different types of breasts and different advantages and disadvantages.

Breast reduction is about more than just breast size, but size is an important consideration for all patients considering the surgery. In fact, it is often the only consideration that comes to mind for many patients at the start of the consultation. As our discussion proceeds, patients often realize that they have other goals for the surgery. How do we determine breast size? One simple starting point is for the patient to specify a particular bra cup size. This is a good beginning, but it is more confusing than it used to be due to the marketing strategy of several bra makers; what used to be a “C” cup is now marketed as a “D.” We are fortunate that many of our breast reduction patients have generously shared their before and after pictures with me to use in consultation. Often we can find pictures of patients with a similar body type to the patient considering surgery. We can then look at the results I obtained for them to see if this is similar to what the patient desires. We may also need to discuss the possible effect of lifestyle changes that come about as a result of breast reduction surgery. Some of the patients who come to me for breast reduction exercise less than they used to, because of either discomfort or embarrassment. The majority of these patients will have lost weight when I see them at their six-month visit. Also, there are two main types of breast structure: fatty and glandular. This is an important distinction that I will make during your consultation. Breasts with a fatty structure will lose significant volume if a person loses weight, while breasts with a firmer glandular structure will lose much less volume from their breasts with weight loss.
One of the best things I can do for a breast reduction patient is to bring her breasts to a higher position on the chest. This changes the center of gravity and provides better body mechanics. It also improves the artistic balance of the body. I have learned that different patients have different goals in terms of the amount of lifting they desire. Different reduction techniques produce differing degrees of lift, especially over the long term.
If a patient has photographs of her breasts, even in a swimsuit from a time when she was pleased with her breasts’ shape and appearance, it is helpful, since this helps me to visualize her goals. For some patients, there can be considerable widening of the breast and an overall spreading out of the breast structure. If the patient desires correction of these issues, the structural breast reduction technique will probably be the most effective in achieving her goals.
A patient with a significant degree of difference between her breasts is likely to have a change in body mechanics that is greater than would be anticipated from breast size alone. I have also often noticed that patients with breast asymmetry can be quite self-conscious. The asymmetry may just be a matter of breast size, but often there can be significant differences in breast shape. A careful dimensional planning of the surgery will help to achieve our goals. As part of our planning for the surgery we will look at your breasts in the mirror, but we also have found that a review of the pictures we take (which are immediately available to you) help us to refine the goals in terms of breast shape.
With breast reduction surgery, it is possible to make changes in the nipple and the areola, the colored zone that surrounds the nipple. We will discuss four aspects of the nipple and areola during your consultation: level, size, axis, and border. The level of the nipple and areola is adjusted during breast reduction surgery, so that it is brought into proper visual harmony with the rest of the breast. Most large breasts eventually drift downward due to motion and gravity, and this carries the nipple along with it, so that the nipple sits at a lower-than-desirable level. Different patients have different concepts of ideal nipple position, so we will discuss your preferences during the consultation. As much as is technically possible, these preferences will be incorporated into the plan for your surgery. Many patients desire an adjustment of the areolar size as part of breast reduction surgery. Very often the areola is stretched to a larger-than-desirable size when breasts are significantly enlarged, especially if the patient has gone through the cycle of pregnancy and breastfeeding. When we create an areola that is of proper size relative to the new reduced breast, the visual harmony is increased. Every breast has an axis, in other words a direction in which it points. This axis is determined by the basic breast structure and by the position of the nipple and areola. Often as very large breasts stretch and settle, the areola will drift so that it points downward and outward. Less commonly, the nipple may point in an inward direction. With careful planning it is possible to design a surgical approach that will allow me to bring the areola into a position that determines a pleasing breast axis. It is also important to consider the areolar border in the planning of breast reduction surgery. Some areolae have sharply defined borders, while with others the border may be less distinct. As a general rule breast reduction surgery produces an areola that has a clearly defined border.
When breasts get beyond a certain size and density, it is very difficult to adequately screen for breast cancer. With a large breast, it is very difficult to detect a breast lump on physical exam, especially if that lump is relatively deep in the breast structure. Mammograms also become less accurate, particularly if the breast structure is dense. This leads to a more extensive mammogram with extra views and compression techniques that may be uncomfortable. If a patient has a family pattern of breast cancer, the difficulty in evaluating the breasts can be a source of anxiety. At my hospital, Rush University Medical Center, which is a major center for the treatment of breast cancer, I have had many patients referred to me by the breast oncologists because they have a family history of breast cancer and they have large, dense breasts that are difficult to evaluate. For these patients breast reduction surgery has benefits that go beyond the artistic and physical and include an improved ability to screen for early breast cancer.

Breast Reduction: Different Operations For Different Patients’ Needs

We offer our patients several different types of breast reduction surgery. This allows for an individualized approach that takes into account your goals and preferences.

How can I set goals and understand how my breasts will look after breast reduction surgery?

One objective of breast reduction surgery is to improve body mechanics. The other is the creation of a beautiful breast that fits your personal aesthetic goals. The breast reduction consult at the Whole Beauty® Institute is designed to help you to clarify your goals for the surgery. We perform a detailed dimensional analysis of your breasts, so that we can select the operation that will best meet your needs. We can further help you to visualize the result with our portfolio of before and after pictures that our patients have generously made available for us to share during the consultation process.

During the breast analysis, we obtain pictures of your breasts, which are immediately available for us to view in the consultation room. When a patient looks at a picture of herself, a different type of information is provided from when she looks in the mirror. I am able to sketch on the touchscreen and give you a sense of the changes that will come about with breast reduction surgery. This is where we can refine our analysis of the goals for your surgery and address issues of breast axis, breast shape, and position of the nipple.

The experience I have obtained from performing over 1,000 breast reduction surgeries with different techniques helps me to guide you during the consultation.

Breast Reduction Surgery Is a Catalyst to Positive Changes in Health and Well-Being

Very often the benefits of plastic surgery extend beyond the improvement in a person’s appearance. At its best, plastic surgery sets up a positive feedback cycle for a person and produces benefits in health and well-being. This is particularly true of breast reduction surgery.

For patients with very heavy breasts, there can be a sense of opening up of possibilities after recovery from surgery. It is no longer necessary to wear heavy, harness-like bras that are uncomfortable and restricting.

Body mechanics change for the better when the breasts are balanced and brought to a proper location on the body. The center of gravity changes, which allows for increased mobility and the chance to participate in dance, sports, yoga, and other activities that were previously quite difficult.

Over time, a woman’s shoulders will come back from their forward hunch, and this takes pressure off of the neck and upper back. Even the deep shoulder furrows from years of heavy bras will improve over time.

Many of my Chicago breast surgery patients tell me that they experience an increase in self-confidence and sense of freedom after breast reduction surgery. This often leads to a greater focus on healthy habits of nutrition and exercise. Very often at the six month visit we find that our patients have better posture, increased comfort, and a better level of fitness than existed before the surgery.

Contact the Whole Beauty® Breast Center

Dr. John Q. Cook has over 20 years of experience with breast reduction surgery. He takes a personalized approach to each procedure and is pleased to offer the very latest and safest techniques. If you have been considering breast reduction surgery, you owe it to yourself to consult with an experienced surgeon. Contact Dr. Cook at 312-751-2112, or 847-446-7562 today.