Breasts and Your Back: Why Breast Size Can Affect Back Pain

Large breasts can cause chronic neck and back pain. Consider breast reduction for back pain relief if that’s what’s causing your pain.

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When it comes to women and back pain, most people think about the standard reasons for discomfort: injury or accidents, physical work, active sports lifestyles, and similar factors that often cause back pain in both men and women. But there is an issue that is specific to women: breast size. Large breasts can cause headaches, postural issues, neck pain, upper and lower back pain, and even physical abnormalities caused by overloaded bra straps.  

Breast reduction for back painWill 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. Problems caused by large breasts include chronic pain in the neck, back and shoulders; nerve pain; problems performing activities; poor posture; and even psychological issues.

So what can be done?  

How Back Pain from Large Breasts Happens

Most women don’t jump directly to breast reduction surgery, often because they don’t readily associate having large breasts with the cause of their spinal pain. According to Peter G. Whang, MD, FACS, FAAOS, a board-certified orthopaedic spine surgeon and an Associate Professor in the Department of Orthopaedics and Rehabilitation at the Yale University School of Medicine, there is a correlation to be considered.

“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, MD, a board-certified neurosurgeon at Northwestern Medicine Regional Medical Group, 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, MD, 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, as Dr. Howard continues to explain. “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. 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.”

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. 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.” 

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, MD, 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 continues. “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 2-3 hours in operating room, with a full recovery time of about 3-4 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 following surgery. That includes sensation and circulation in the nipples and even the ability to breastfeed after having the surgery.

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.”

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].”

Updated on: 12/03/20
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Kyphosis Causes, Symptoms, Diagnosis, Treatment, and Prevention
Peter Whang, MD, FACS
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Kyphosis Causes, Symptoms, Diagnosis, Treatment, and Prevention

Kyphosis can refer to the normal curvature of the spine. However, this information is about abnormal kyphosis, which is spinal curvature causing a hunchback or slouching posture.
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