Breast reduction for back pain?

[Baron Samedi]

Greetings from the Pain Management world. I've been getting this question from patients a lot recently. Some of my patients with chronic upper back pain request referrals for breast reductions in hope of improving their pain. I was always taught(and tell patients) that it often doesn't help, but I was curious what the plastics literature might show since it still seems to be performed somewhat frequently. I would love to be able to give patients actual data so they can make informed decisions.

Any data on this? I tried a pubmed search but wasn't able to find much.

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[FalconSlice]

Greetings from the Pain Management world. I've been getting this question from patients a lot recently. Some of my patients with chronic upper back pain request referrals for breast reductions in hope of improving their pain. I was always taught(and tell patients) that it often doesn't help, but I was curious what the plastics literature might show since it still seems to be performed somewhat frequently. I would love to be able to give patients actual data so they can make informed decisions.

Any data on this? I tried a pubmed search but wasn't able to find much.

Breast is a weak point for me, but there is an enormous wealth of studies behind this including many meta analyses (just type "breast reduction back pain" into pubmed and so many studies come up, so it's difficult to believe you haven't been able to find any data). Long story short, there seems to be slight to moderate improvement for back pain, specifically (some say no improvement, but personal patient experience definitely goes against that). However, patients have many other symptoms too including shoulder pain, overall discomfort, inability to exercise adequately, inability to walk for long period of times, etc. Breast reduction patients are some of the most grateful patients I have ever come across. Even with Wise-pattern incisions, these women would do the surgeries again 9/10 with any scars (patient anecdotal experience) since their overall quality of life improve so much with this surgery.

That being said, isolated back pain (and no other symptoms) from large breasts are unlikely as they also have all those other sxs/signs and more. Additionally (depending on insurance), it is such a hassle to do the surgery since many insurance companies want to make sure all other modalities of treatment have been satisfied (usually just hoops to jump through) before surgery is covered: PT, acupuncture, massage, weight loss, etc.

Maybe more seasoned plastic surgeons can comment, but this is my take

 

[Baron Samedi]

Thank you for the response. I think the trickiest part is that I see the exact same pain patterns(mid-upper back pain, shoulder pain, postural abnormalities) in male patients and women without breast hypertrophy, so its difficult for me to ascertain what a reduction may give them in symptom relief.

I have no idea why I couldn't find anything before. I searched again and was able to find this helpful meta-analysis:

The Effects of Breast Reduction on Back Pain and Spine Measurements: A Systematic Review

The aim of this review article was to synthesize the literature on reduction mammaplasty and its effects on the spine. The particular focus was to find these few radiological studies and those investigating changes in spinal angles, posture, center of ...

www.ncbi.nlm.nih.gov

 

[droliver]

Breast reduction and even just mastopexy on longer/smaller breasts are actually very clinically effective for helping reduce back pain. It addresses a mechanical/leverage issue that there's no other way to solve. It's not magic pixie dust for orthopedic issues, but any upper body weight relief helps with this issue as you offload your lower back extensors and (to lesser degree) directly reduce pressure on your trapezius from the bra strap