When ‘The Hills’ reality star Heidi Montag had breast reduction surgery this fall after citing health problems as one of the main reasons, we wondered how common this was and asked some of our LocateADoc.com doctors.
Montag famously had 10 cosmetic surgery procedures in a day back in 2010 which included a breast augmentation to increase to an F-cup. She told US Weekly last month that those implants weighed about three pounds each.
"I couldn't conceptualize the weight of them in my body," the 27-year-old said about the F-cup implants. "They felt like bowling balls on my chest."
“Many patients seeking larger breasts are under the mistaken impression that bigger is better,” Colorado’s Dr. Diane Duncan of the Plastic Surgery Associates of Fort Collins told LocateADoc.com. “There is a myth going around — quoted by the majority of my patients — that you should go at least one size larger than the doctor recommends. However, the choice can also be the doctors’. A number of my patients who came in for reversional surgery say that their doctor chose a much larger size than they wanted -- and now are seeking a more tasteful look.”
According to Baltimore, MD Plastic Surgeon Ricardo Rodriguez, MD, the majority of his patients that come in for an exchange of a breast implant surgery want a larger size. This was the case the first time for Montag who after initially having her natural A-cups increased to C-cups back in 2007 returned for the F-cups in 2010.
“There is, however, a small subset of patients who request a reduction in the size of the implant and in some cases removal of the implants,” Rodriguez said and noted the following major reasons:
1) The patient feels the implant size is no longer appropriate for her lifestyle. This patient is usually older and has had her implants for several years but now feels that a smaller size suits her figure or social situation better.
2) The implants are causing symptoms related to their size and weight. The symptoms may be pain, discomfort when wearing bras without strong support, or even a noticeable dropout of the implant position due to lack of tissue support for the implant weight. These patients are not necessarily unhappy with the idea of a breast implant, they just want something that will reduce or eliminate the symptoms.
3) The patient is experiencing extreme discomfort and "just wants them out"
Dr. Gary Brownstein who practices in Cherry Hill, NJ noted that patients who have large breasts often complain of:
- Back pain- upper (shoulder) and / or lower back
- Neck pain
- Grooving in the shoulders from the brassiere straps and the weight of the breasts in the brassiere
- Rashes under the breast that can often excoriate and bleed or even cause an odor especially in the summer with perspiration
- Numbness in the ring and little finger
- Difficulty exercising
- Other complaints relate to having a difficulty with clothes fitting
Dr. Duncan echoed these reasons adding that women in Europe and Asia traditionally choose much smaller implant sizes than many Americans do.
“While it is normal for the ‘have-not’ to want to overcompensate, the consequences of going too large with breast implants can be significant enough to cause the patient to ask for revisional surgery,” Dr. Duncan said. “Stretched-out skin can be difficult to work with, and the risk of droopiness or a poor shape can cause the surgeon to recommend a surgical lift, or mastopexy, that would leave more scarring. Unwanted attention can be another factor. The lack of ability to continue pursing athletic activity or a profession, such as ballet dancing, can also be a reason that patients request a downward size revision.”
It’s unclear which reasons Montag considered as she said health was among the reasons. Columbus, OH Plastic Surgeon Bivak Shah, MD said an often overlooked aspect of breast reduction surgery is the body image change that occurs after the surgery.
“Patients considering Breast Reduction surgery have often lived with body image that is based partially on large breasts,” Shah said. “However, due to significant pain, difficulty exercising, headaches, and many other symptoms, they are just so tired of large breasts that they just want to feel better and don't care about the size afterwards. However, after the surgery, though they feel better, many women are somewhat depressed about their new body image, proportions, and their breast size in relation to their stomachs.
“So I try very hard to counsel them pre-operatively, to really think about and do some soul-searching as to what they think would look "good" on them, and not to focus solely on "feeling" better. I explain, that once the pain is gone, their mind will start to focus on the look and that can be a difficult place. So, my staff and I try to give them an idea of what they will look like after the surgery, by showing them implants of the same size as the amount I’m planning to remove.”
Trying to find that balance is a one of the most important steps for the doctor and the patient.
“The appropriate size of the breasts is a very personal decision,” Dr Brownstein said. “Every female has her own idea of the specific volume of breast tissue that balances off her figure making her look curvy. When considering a breast reduction … in general, the more breast tissue that is removed, i.e. the more weight remove, the more comfortable she will be; however, since she is use to having large breasts it is important not to create too small a breast or she will be just as unhappy as she was with her large breasts. In order to gain a clear understanding of her goal concerning breast volume, my patients and I go through an in depth consultation; this detailed comprehension is most critical in achieving a successful outcome to a reduction mammoplasty.”
Dr. Rodriguez agreed that helping the patient determine the size of the implant they really want is a key issue.
“The best method I have found is to have a large number of implant samples so the patient can feel on one hand the size she has now and compare it to different sizes on the other hand,” Dr. Rodrigez said. “That way the patient has an accurate idea of how much smaller she wants to be.”
He also added that it is preferable when the patient keeps an implant, even if it is smaller because the implant gives the breast shape.
Dr. Duncan summed up the feedback to our questions by saying, “Careful thought about how implants will look in the distant future can help the potential breast enlargement patient make better choices.”
Learn about costs, recovery time, doctor reviews and more within the Breast Reduction Resource Guide, which includes an extensive before and after picture gallery. To consult with breast reduction doctor, look through LocateADoc.com profiles to find a specialist in your area.
Montag poolside photo from 2010 on Starpulse.com.
Montag headshot by Toglenn at en.wikipedia [CC-BY-SA-3.0 (http://creativecommons.org/licenses/by-sa/3.0) or GFDL (http://www.gnu.org/copyleft/fdl.html)], via Wikimedia Commons