Big Breasts can cause back pain! This is obviously a sensitive topic, but a common one discussed in many spine surgeon’s offices. Just so it is clear, spine surgeons do NOT perform Breast Reduction Surgery. We, however, are asked if the large sized breasts are the source of neck and or upper back pain. Breast Reduction Surgery often requires documentation of medical necessity. In other words, a spine specialist must often give the opinion that the source of neck and upper back pain is secondary to the disproportionately sized large breasts.
This documentation requires obtaining an accurate history. The questions can seem embarrassing to some, but by the time anyone is considering such an operation, the pain overcomes any issues of embarrassment or modesty.
Most of the time, accurate height, weight, and breast measurement are documented. Then the history of the breast development is discussed. Time is spent detailing when the pains occurred. Sometimes delicate questions of types of restraining clothing are also discussed. In addition, the spine specialist must document the time and duration of the pain, as well as the attempts to control the pain with the traditional physical therapy, weight loss and exercise.
In addition, to make sure there are not other sources of the pain, often times diagnostic studies such as MRI’s of the neck , upper back and or the lower back are necessary to rule out other sources of the pain.
As a spine specialist, I am often asked to render these opinions after a person has already seen a breast reduction surgeon. Some patients are disappointed that I will not just write a document to “rubber stamp” the recommendation. To me, I have a duty to the patient to make sure the Breast Reduction Surgery will be a reasonable option to treat the neck and back pain. If I am not sure the pain has been properly worked up, or if I am not convinced the proper counseling has been given, I probably will not generate that letter. In the end, I still would worry that a person would go through a rather difficult Breast Reduction Surgery, and still have a neck or back pain despite the surgery. In that scenario, the large breasts may not have been the source of the pain.
While there can never be a guarantee of any surgical result, certain parameters should be discussed, and met prior to making a surgical recommendation. For Breast Reduction Surgery, the spine specialist should be able to give the opinion that the history was consistent with the breasts causing the pain, there is no other explanation for the pain, and non surgical treatments have been tried.
- Lewin R, Göransson M, Elander A, Thorarinsson A, Lundberg J, Lidén M. Risk factors for complications after breast reduction surgery. J Plast Surg Hand Surg. 2014 Feb;48(1):10-4. PubMed PMID: 23627557