Tuesday, January 6, 2009

Thoughts about breast reduction surgery

So, discussion about breast reduction surgery was all over the fatosphere a few weeks ago. I debated whether to get involved in those discussions because things got a little heated. After thinking it over for some time, though, I decided to weigh in with my own thought process on the topic because I went down this road too.

[Please keep in mind that in no way is this post meant to criticize the decisions of anyone else, either in having or not having the surgery, nor in any parenting/breastfeeding decisions either. I'm just sharing my own experience with reduction surgery, why I've made the decisions I've made so far, and reflecting back on those decisions. I'm not judging anyone else or telling them what they should or shouldn't do. It would probably be easy to read judgment into what I'm going to say, but I sincerely don't mean it that way.]

My Story

I came within a day or two of having breast reduction surgery when I was in my 20s. I did all the consults, got all the information, did all the required paperwork and pictures (ugh), got insurance approval, and was ready to go. Then at the last minute, the insurance company balked at paying for a significant part of it and there was no way at that point we could realistically afford it, and so the surgery got put off.

We wrangled with the insurance company but couldn't resolve it. In the end, we just decided to cancel the surgery rather than risk being stuck with huge medical bills. I was relieved in some ways, but incredibly bummed and angry too. I had desperately wanted to be rid of the problems associated with being so well-endowed.

Yet now, in my 40s, I have to say I'm incredibly glad I didn't do it.


I chose to consider breast reduction surgery because of all the usual reasons. I'm extremely well-endowed (anywhere from an F to a J cup, depending on brand) and it's been a tremendous burden in many ways, both physically and emotionally. The shoulder pain, the back pain, the difficulty with exercising comfortably, the difficulty in getting clothes that fit properly, the difficulty in finding comfortable bras in your size, the difficulty in getting guys to look you in the eye when speaking to you, the ordeal of being harassed by strangers, etc. etc. You know the reasons usually cited, and they were absolutely all true for me too. It most certainly was a very real burden at times.

Weight loss didn't help; I stayed proportionately large. So I decided to consider a breast reduction. The doctor explained to me in graphic detail what would be involved, and emphasized that because of the extensive changes required for my particular case, I might very well lose most sensation, and I might very well never be able to breastfeed.

The idea of losing sensation really bothered me, but the idea of not being able to breastfeed didn't seem like a big deal to me, honestly. I was formula-fed and I was okay, no one I really knew had breastfed their kids, and the whole idea of breastfeeding seemed more than a little squicky to me. Even then I knew breastfeeding was the "healthy" thing to do, so I hoped that my ability to breastfeed would not be too compromised, but frankly, I was not particularly concerned about it. Other concerns were higher on my list of drawbacks.

But then the surgery fell through, so I decided to postpone a decision about it. Then I became unexpectedly pregnant and it was too late, at least for a while.

Looking Back in Hindsight

Now I look back, many years later, and am incredibly glad the insurance company got in the way of that surgery. Because had I had that surgery, I likely would never have known the incredible joy and healing I got from breastfeeding my children.

I know, I know. A lot of folks will read that and roll their eyes. I know how strange it sounds to some; how weird it would have sounded to me back in my 20s. But really, it was life-changing and I'm incredibly grateful I got to experience it.

[I should probably clarify here that I know that not everyone finds breastfeeding as amazing and life-changing as I did. That's okay; people experience pregnancy, childbirth and breastfeeding in an amazing diversity of ways, which is to be expected.]

I should probably also point out that I had a HECK of a time breastfeeding at first----it certainly wasn't easy sailing right away. It took about 4-5 months before things really smoothed out and got easy; the hospital did a lot of things that made breastfeeding nearly fail for us, and I didn't always have the information and support I needed. So breastfeeding certainly had a rough start for us and I wasn't all that enamored of it.....at first.

Actually, I never intended to breastfeed long-term at all, regardless. I just felt I "should" do it at least that long for the health benefits for the baby, and honestly, because I wanted to be seen as a "good" mother in the eyes of my in-laws. So I determined to "tough it out" for at least 3 months. And believe me, it was tough at first.

But then something changed. The harder I fought to make breastfeeding work and the more I realized what I was missing, the more I came to value it. The more I read, trying to figure out how to make breastfeeding work, the more I really realized how very beneficial it was in so many ways I hadn't realized before, especially immunologically. And the longer I breastfed my daughter, the more I fell in love with the process....and with my daughter.

Surprisingly, in time, breastfeeding became a tremendous force of healing in my life. My first child's birth went so badly that I actually developed post-traumatic stress from it. Breastfeeding was a big part of what helped me come back "into" my body and to really connect with my baby afterwards, despite the PTSD. It was something that only *I* could do for my baby, and those hormones released during breastfeeding really made a huge difference in helping me over the difficult bumps of early motherhood...like the four months of terrible colic she had at first.

The one time when I didn't have to deal with her crying? When she was nursing, and right afterwards, when she'd been stunned by the "happy milk" hormones. It was the one time she was happy. It was the one time we could just sit and connect and really bond. It was the one time I could get her to interact, smile, and look around. It saved us; it totally saved us.....thank goodness for breastfeeding.

So when my 3-month deadline was up, I extended it for another month. Then for another month, and then another. Soon I realized I loved nursing so much I didn't want to give it up until both my child and I were ready to stop. And we didn't.

That breastfeeding relationship with my babies was one of the best experiences of my life and I wouldn't trade it for anything.

Emotional Healing

Somewhere along the line, I realized that not only did breastfeeding help me bond with my children, but it was also helping to heal my self-esteem issues around my breasts.

This part of myself that I was so ashamed of when I was younger somehow transformed into one of the most important parts of me. In my children's eyes, my breasts became the most beautiful part of my body. They became the very symbol of mother-love to them. How could I continue to hate my breasts when they were so very beautiful, so very essential to my children? I began to see my breasts through the eyes of my children and they were transformed for me.

It's so incredibly difficult to explain this to someone who has not experienced it. I would not have understood it before I had children. I would not have thought I was giving up that much. How can you miss what you do not know, what you do not value except in the most abstract of ways?

And yet, I found breastfeeding my children to be one of the most profoundly moving experiences of my life, and one of the most profoundly healing.

If I had had that breast reduction surgery, I might never have known that experience, and that makes me truly sad. Of course, if I'd had the surgery, I'd never have known what I missed and it wouldn't have been a big deal to me. But now, on the other side, knowing what I would have missed, it almost makes me weep to think that I might have missed that experience. It's that powerful and that vital to me.

So when women decide to have a breast reduction surgery before they have children, I have ambivalent feelings. Part of me wants to say, "Way to go! You do what you need to to feel better physically and emotionally." I know how hard it is to deal with being well-endowed, and I am all for women empowering themselves and doing what they need to do. And yet, part of me weeps to think of what they may miss if their surgery leaves them unable to breastfeed.

In the end, of course, it has to be their decision, and we have to respect their judgment about the relative strength of the pros and cons to them. I wouldn't tell anyone not to do it, but I do want to point out just how powerful some women find the breastfeeding experience, about how breast reduction surgery really can interfere with breastfeeding. I also want to inform women of the resources out there on breastfeeding after reduction for those who decide to go through with surgery first.

Caveats and Resources

Of course, there have been many advances since I nearly had this surgery ~20 years ago. Surgeons now can preserve a lot more function to the breasts than they could then. Many more women are able to breastfeed now after reduction than in the past. Still, a lot depends on how much reduction is needed, on the skill of the surgeon, on the techniques used, and sometimes on just plain luck. You just don't know for sure how things will turn out.

I know of women who have had breast reductions and gone on to breastfeed, so it can be done. Sometimes it doesn't work with the first child but is more successful with the second child because the milk ducts are able to re-connect. But most women I know who have had breast reductions struggle to some degree with supply issues, and many must supplement with formula. And that does come with a price, both financial and emotional.

Low milk supply issues are much more physically difficult and emotionally painful than most people realize, and few people who have not been through it understand just how devastating it can be. With enormous admiration, I salute the women who so value the immense benefits of breastfeeding that they work so hard to get their babies every drop of breastmilk possible.

But while partial breastfeeding is possible after reduction, full breastfeeding often is not. Now, some might think....so what? You give the baby what you can and you supplement when you need to, big deal. And for some it really isn't a big deal. But for others it is, and you never know which camp you're going to fall into ahead of time.

It's hard to understand until you are in that situation just how stressful and disappointing low milk supply and breastfeeding difficulties are, especially for women who never anticipated that it would be important to them at all. For some, the struggle ends up being far more devastating than they ever realized it might be.

Some women regret having had reductions because of this; some do not. Some wish that they had waited until after they had their children to have the reduction.....and yet others do not. People's reactions to this are very individual, but no reaction is "right" or "wrong." People feel how they feel.

But it's also important not to shrug off too easily the impact that reductions can have on breastfeeding and women's ambivalent feelings and experiences with that.

For those who are looking into this surgery seriously before having children, I highly recommend the website, Breastfeeding After Reduction, http://www.bfar.org/. It has excellent, non-judgmental information for those considering the choice, and great resources and support for those who have had the surgery and are looking for breastfeeding information and help afterwards.

It also has an excellent, thoughtful discussion on the pros and cons of delaying the surgery until after childbearing, with women weighing in on both sides of that question and offering a full range of perspectives. It is truly an outstanding resource.

Now what?

As for me, my pregnancy and breastfeeding days are basically over. So how do I feel about a breast reduction now?

In one word.......ambivalent. On the one hand, all the reasons that were there before (back and shoulder pain, bra issues, comfort while exercising etc.) are still there. Even while breastfeeding, those negatives certainly didn't go away; they were always a pain. And these issues will only get worse with time. The thought of dealing with this into my 60s and 70s and 80s.....well, the thought of reduction becomes quite attractive again when I look at it that way.

And yet. It's still major surgery, especially for someone like me. That's a lot of re-arranging and chopping out and reconnecting, you know? A lot of chances for things to go wrong, a lot of chances for infection to take hold, a lot of chances for painful scar tissue to form.

And having gone through a very bad surgery with my first cesarean, I will never take surgery lightly again. I know women as well-endowed as me who have had the reduction surgery and were totally unprepared for how much pain and recovery there was afterwards. Even though most felt it was worth it, they generally had months of recovery, not just a few weeks, and most had far more pain than they had anticipated beforehand. I know firsthand how much surgical recovery can suck, and I really have no wish to go there again.

Also, I've forced myself to watch videos of breast reduction surgery on cable TV, on the surgery/medical channels. Now, I like medical stuff; surgery rarely bothers me. I find it really fascinating, frankly. So I thought that perhaps if I could watch the procedure, really understand exactly what would be done, then I'd be more okay with the idea of it.

But actually, I found myself incredibly repulsed by it, unlike most surgeries. It seemed to me like they treated the body with such disrespect, pushing and pulling it around, jiggling it, mashing it, cutting it up, treating it like a slab of meat. It literally made me ill to watch it. I realize that that's the nature of surgery, but the thought of subjecting my own beloved body to such meat-cleavering made me want to throw up.

Honestly, I'm not sure why. I speculate now that perhaps it's because it takes a certain degree of emotional or physical disconnect from your body to consider doing something so radical to it, and pregnancy and breastfeeding helped me live so intensely in my body that I came to love and respect it and be connected to it in a way that would make altering it like that seem like a disfigurement, a sacrilege.

That doesn't mean that someone else choosing to do that is wrong or disfiguring; I can see how it can be helpful and even a good choice for many women. I'm not criticizing anyone for making that choice. I like the idea...in the abstract. But when I think of it for me, I get a profound sense of disquiet, of self-disrespect inside. And I need to listen to that feeling and honor it.

Yes, I have days when I am bothered by back pain, days when I see a picture and I see how very much my appearance is dominated by this feature....and I have moments when I absolutely want to consider a breast reduction again.

So I do not rule it out for the future; I might, at some point, consider having one......but at this point, it just seems wrong, almost sacrilegious to do it to my body. I honestly don't know if I'll change my mind on this, so I leave room for flexibility and for reversing the decision. I also leave room for choosing to leave my body intact. At this point, I have decided not to decide.

Either way I choose in the future, I can't escape the profound gratitude that my surgery was unable to go forward in the past, that I was able to experience the wonderful and profound healing that I found through breastfeeding my children, and that I was able to give them (and me) the amazing health benefits of breastfeeding.

I understand and respect that not everyone feels that way, and I understand and respect that some people will move forward with their surgeries regardless, feeling that a reduced ability to breastfeed is more than enough of a trade-off for the benefits they will get. That's their right, and I truly wish them well. I just felt that it was important to represent a variety of thoughts and experiences on the subject, and I wanted to share my own process with the community.

*I welcome comments to this post, but please use sensitivity and consideration. This is an emotional topic for many people. The post is meant to encourage dialogue, not condemnation.


Cherie said...

Very lovely and encouraging post. I have breasts about the same size as yours and have struggled with similar issues but I also wouldn't have traded being able to breastfeed my four babies for the world. I was spawned from a tribe of breastfeeding bohemians so I at least had a sense of how special and important it could before I had my first child at 24. Now at 40, after a few medically risky things happening, I won't be looking taking on a non-lifesaving surgery either.

Anonymous said...

Beautiful, powerful story. Thank you for sharing it.

wriggles said...

Well for me the point was why the difference between responses to weight loss surgery and breast reduction surgery.

My answer is none. Both set out to reduce and tend to damage the primary function of that which they operate on to achieve this.

I appreciate that you've indicated that they are better at preserving the function of the breasts now than previously, it is also true that WLS is not as lethal as it used to be (or as 'effective').

The problem with discussing this kind of thing is the sense, from some of those that have had the breast/weight reduction surgeries, that unless they are being supported they are being shamed.

This annoys me as it is shame that is the basis of most of these operations. Just because you have a successful reduction are very happy about it, doesn't mean that shame goes away immediately, or at all.

You set up new positive thoughts on your breasts, but that could be achieved without operating on them. The operation is essentially for the same ends as changing your thoughts.

That's the nub you either cut your body around your thinking, or change your thinking to fit your body.

The latter response is supposed to be in part what feminism is about, freeing women from the burden of having to destroy themselves to fit into society, being human rather than material that needs to be cut into being human. I'm talking as much about being made 'hysterical' or mental destablised, as much as I mean physically cut.

In the end I don't want to shame anyone, I don't think women should be ashamed or of or indeed hate their breasts regardless of their size.

That includes small ones, as someone who used to have v. large breasts (actually they are currently DD's so you can imagine how big they used to be!!) I've never been able to understand what's wrong with small breasts.
Whatever you have celebrate and embrace them as they are, we are allowed to be varied.

Elizabeth said...

I had a lumpectomy while I was in college. Looking back on it, I cannot imagine why I allowed that surgeon to touch me, let alone cut me open. As it turned out, I didn't even have any sort of tumor - I had normal breast tissue that had twisted itself into a lump somehow. When it didn't show up on ultrasound, he sent me straight to surgery without even having a mammogram first.

Now, fifteen years later, I am struggling with milk supply issues, and that breast produces about a quarter of what the other does. I know that most women have a "good" side for milk production, but I think the surgery must have damaged the ducts on that side to have such a big difference.

I'm sure that possible effects on breastfeeding were mentioned in the literature I got before the surgery, but I wasn't even sure I wanted children at that point, and breastfeeding was the last thing on my mind. Now I wish I could go back and slap some sense into that twenty-something, or at least that I could have read something like this before I went in for the surgery.

Anonymous said...

I'm glad to hear another woman talk honestly about how healing breastfeeding was for them. It's crazy to judge women for formula feeding (everyone's doing their best!), but I used to work for the WIC program and formula *is* a huge deal. Formula is expensive, a pain in the rear (to prepare and all), and worse, many babies get sick from it. I saw so many babies that would have to switch and switch and switch because they couldn't tolerate any of them. So many moms said to me, if only I had known the risks of formula feeding, I might have made it through those first hours/days/weeks of breastfeeding. But there is no support and formula is the norm, so they don't (on the flip side, women from a breastfeeding culture tend to love it from the start, maybe a day or two of sore nipples, and some not even).

I just love breastfeeding because it is the first time a woman can really see her body as a vehicle for joy, love, nuturing. You are feeding another human, sustaining their life! The more women speak out about this, the more interest there will be from women not from a breastfeeding culture. And these women, like you, are being change and support for the next generation.


Lori said...

Sorry I'm coming in so late on this. I googled BFAR and came across this site. I recently did a post about my experience with Breastfeeding after Reduction here: http://www.thetowells.com/2009/04/for-women-in-my-situation/. I hope this will help you and your readers.