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National Post, April 24, 2004: Their cups runneth over

By Antonia Morton

It's always the nipple story that makes my girlfriends wince. They can handle it when I tell them how the surgeon sliced open the skin on my chest, from below each arm inwards to the sternum, to remove a pound or so of yellowish fat and milk duct from each breast. They're unperturbed when I describe his cuts upward to each apple, scooping out more tissue. But when I tell them how he snapped around the edges of my nipples, transferred them up to the tips of my new, smaller breasts and stitched them back again like appliqués on a dress - that's when women fold their arms protectively across their chests, like men crossing their legs during talk of vasectomies I confess, though: The appliqué part was just for gross-out effect. There really is such a technique, known as "free nipple graft." But it's mostly used for women with really outsized breasts (four pounds or more per side) not for run-of-the-mill reductions like mine My nipples were mostly left attached, and repositioned with a few tucks and stitches.

I was the classic breast-reduction candidate woman in mid-40s (a tad overweight, had long since weaned her babes and divorced her man) realizing that big breasts were more burden than benefit. Yet my bosom was not spectacularly ample .I was merely a modest 38D, a far cry from some of the 5OH ladies who opt for the surgery.

Like most women, I dithered (for more than forty years) before finally asking my family doctor for guidance "Dr. Bell is an artist," he said enthusiastically "He'll remodel your chest and give you really nice-looking boobs". Aesthetics were actually less on my mind than comfort - though granted, floppy tits swagging down toward navel level are hardly sexy. But having been well endowed since 15, I thought it would be nice to go with small and perky" for the latter part of my life The dark secret of large breasts is that gravity's drag on the skin, and on the remains of the muscles that hold them up, is anywhere from mildly to extremely uncomfortable.

I wanted to get out of the shower and have both hands free to dry myself, instead of always having to hold up a pair of pendulous udders. I wanted to canoe and sun- bathe in just my swimsuit, and sleep au naturel without a bra. I wanted to dash up stairs or run for a bus without having to clamp hands to chest to contain jiggling. I couldn't even power walk for fear of looking ridiculous. Running was out of the question And not to be trivial or anything, but all those pretty little bra-and- panty sets are usually available only up to 36B The industrial strength bras I wore, reinforced with steel struts and concrete orders, were pricey humiliating. What finally galvanized me was an interlude in the lingerie department when a motherly saleslady said kindly, "You might find this one comfortable, dear." She handed me a dowdy beige garment, almost corset-like in its acreage of nylon and fastenings: It had four rows of hooks on the strap. That was it: I called the surgeon for an appointment.

It took a month even to see him, and another two months before a rare cancellation found me actually lying on the gurney in Ottawa's Civic Hospital, about to be anesthetized. Dr Michael Bell is a tall patrician-looking man with very blue eyes and an air of distant courtesy But his bedside manner became strained when I asked if he could put aside the stuff they took out, so I could look at it when I woke up.

"Why would you want to do that?" he asked, trying not to look shocked. His operating team all stared first at me and then at one another.

"Um, scientific curiosity?" l ventured. More like morbid curiosity plus an urge to gloat. It's not every day the surgeon's knife rids you of excess flesh. But, alas, all excised materials shipped to the lab to be biopsied, and then just gets thrown away. It seemed I had no say in the fate of my former titties. Three hours later awoke up feeling sore and groggy, but with a trimmer chest area than I'd had since I was 13. My friend Andrea drove me home right away, and we both admired my neatly bandaged torso. A week later Dr. Bell removed the tape, revealing upwards of three feet of livid red stitches, all puckered and raw.

He had warned me my nipples might become permanently numb (they didn't, luckily), and that I'd have to spend three or four weeks lining my bra with cotton handkerchiefs to absorb oozing discharge as the stitches dissolved and the flesh knitted itself back together (I did). He also told me I should take it easy for a few weeks.

Before the operation, I'd assumed I'd feel pounds lighter and would stride along jauntily, arms singing, with a new bounce in my step. In fact, for several weeks I crept around, hunched and tense, arms wrapped protectively around my bruised and vulnerable chest and the tender torn muscles in my sides. I thought I'd never throw my shoulders back again. To my surprise, the chest- wall discomfort from the drag of too-large breasts was not so very different from this post-up pain.

When I examined my ruined torso in the mirror, the incision ends looked lumpy, like badly let-out dress seams. The top of one breast seemed too high. The nipple on the other was definitely lopsided, pointing upward and outward instead of straight ahead. And my boobs looked oddly oblong and flattened, running more side-to-side than up and down. But again, Dr Bell assured me this was all normal, breasts take time to settle into their new shape. He explained that breasts remodeled to look good too soon would wind up, in a few year, "hanging like empty milk bags."

My breast-reduction surgery was typical of most women's experience including the lengthy contemplation beforehand. A woman I'll call Jean, who had the operation 18 months ago in Calgary, told me she'd "wanted to have it done for years and years - I'm 32 now, but I'd thought about it since my early 2Os. I'm fairly petite, but 36D. I felt so chesty and out of proportion, and I had these painful indents on my shoulders all the time from my bra straps digging in."

It's a familiar story for doctors: patients complaining of sore breasts, aching necks, shoulder grooves, back pain, problems with mobility and exercise, even an athlete's-foot-like skin rash where breast overhangs chest. Women want relief from these woes, but they're nervous about the risks of surgery - especially since Micheline Charest's death recently in Montreal during cosmetic surgery. But this surgery is relatively low-risk and relatively inexpensive as well. "Bilateral reduction mammoplasty" typically costs $5,000 to $8,000, but it's covered by all provincial health plans as long as the operation is "medically necessary." ln Ontario, "We need a supporting letter from the family doctor to send to OHIP,'' says Dr Wayne Carman, of Toronto's Cosmetic Surgery Institute. "Simply being large is not sufficient grounds for coverage. Your excessive size has to be symptomatic, causing back pain or something."

I'd always assumed that the natural candidates for the operation would my age - women who've lived long enough for gravity to take its toll. But in fact, Dr. Carman says he's operated on women "in every decade of life, from teens to 70s." Adolescents, he says, "mature faster nowadays, and some are already wearing a DD bra at 17." The two peak ages for surgery are the late teens and 2Os, and women in their 40s and 50s.

"The oldest I did was a lady in her 80s," says Dr. Elizabeth Hall Findlay, a surgeon in Banff, Alta. "If you've got huge breasts, and your poor old bones are starting to get osteoporosis - well, imagine carrying those things around with you!" For younger women, a big issue is breastfeeding. When the nipples are moved, some connections to the milk ducts are lost, either temporarily or permanently, and a certain amount of gland is also inevitable removed along with the fat. "There are some 20 to 25 ducts that all come together in the breast, like an umbrella, and it's really hard to separate them out during surgery," Dr. Hall-Findlay says.

This means women contemplating nursing should think carefully. "Modern procedures don't detach the nipple completely. Most tissue is still connected, and that's adequate to allow breastfeeding," Dr. Carman says. "Still, I generally warn my patients that chances are you'll breastfeed just fine - but lf it's the most important thing in your life, maybe you don't want to take the chance."

Jean did, and regretted it. "I got pregnant not long after the surgery, and Dr. Lindsay warned me that I might not be able to breastfeed,'' she recalls. "But my milk production was so low, I had to give up trying to nurse Ryan after just a few weeks."

However, a new method involving a smaller vertical scar is be- coming popular. Pioneered in Belgium in the late 1980s by Dr. Madelaine LeJour it eliminates the horizontal scar and supposedly creates a perkier breast. One of the world's leading practitioners of this technique is Canada's Dr. Hall-Findlay. "I've been in practice for 20 years, and used the anchor method until about 10 years ago," she says. "Then in the '90s I found myself setting next to LeJour at a conference. She said I should try her method. I said I didn't know if I could do it. And just looked at me and said, 'But you must!' She's Belgian, you know, a bit Teutonic. So I did."

The only drawback of the vertical scar is that it's not much use to those who need it most. "We can't handle too much volume that way," Dr. Carmen says. Really sizeable breasts still have to be tackled with the old anchor method. And they're definitely not candidates for liposuction either. "Only the fatty tissue is soft enough to be suctioned out. Gland is too tough," he says. "So if a breast is mostly glandular, and you can't tell that before you open it up, then you won't really get much of a reduction. Still, for the right person it's fabulous." The point, of course, is that liposuction requires just a quarter-inch incision.

Surgeons know how emotional the subject of scarring can be. After all, numb nipples or an inability to breastfeed can be kept private; but husbands, lovers, room- mates and the ladles at the health club can all see a bosom that looks like a road map As a result, if anything, doctors tend to overemphasize the issue. "Nobody ever thanked me for their scars," Dr. Hall told me bluntly. (It's true: If it ever does please God to send a suitable man into my life, I hope he isn't fazed by rigid pink lines encircling my feminine charms.)

But as Dr. Hall-Findlay observes, "Much of plastic surgery is about managing expectations. Yes, it gives you significant scarring, but the trade-off is so good, most of my patients tell me their biggest regret was not doing it earlier." In fact, in terms of outcomes, she says, "It beats any other operation hands down because it's so good at relieving the symptoms patients bring in."

But as with any surgery, things can go wrong - which is why pre-op counseling is vital. "Everything we do has a down- side," Dr Carman acknowledges. "Things may not turn out as expected. That's the risk factor of surgery: infection, scarring or nipples that turn numb or even dead or deformed. If you're the one woman in a thousand who has something happen, it's just bad luck, but that doesn't make you any happier."

One such bad-luck story happened to a Montreal woman I spoke to named Denise. "I felt no pain from the surgery itself, but afterward one of the wounds somehow got infected, so my doctor inserted a drain into the wound and wriggled it around to get rid of some of the infection," she recalls "That was intensely painful. He had to leave the drain in for 24 hours before the problem cleared up."

Yet she has no regrets "I'm delighted with the new freedom, and relieved of my back pain," she says Even Jean, who was disappointed that she couldn't breastfeed her son, is optimistic "I may be able to nurse more effectively down the road - this may have been just because my surgery wasn't that long ago."

But female breasts aren't only for nursing infants. They're a powerful focus of erotic attraction, too, and the male sex has a strong vested interest in their size and proportions. Do men have a problem with smaller breasts? "Frankly, I think the idea of making the breast tighter and more youthful-looking, with a better shape, appeals more to men," Dr Carman offers "I don't think men are generally enamored of droopy, floppy breasts."

What he does see is most women deciding for themselves, and the menfolk going along "Only a minority of my consultations involve the spouse or boyfriend - I see more men when it's an augmentation operation, and many are against that." Masculine disapproval is almost a non-issue, though "It's quite rare, the partner being unhappy. When breasts have a more modest size and shape, you've lost quantity but got more quality!"

But reductions are gaining ground. Between 1997 and 2003, augmentation operations increased by 177%, and reductions went up 207%. If that trend keeps up, the two sets of figures may one day intersect - unless the world first runs out of women who want to change the size of their breasts.

Has my breast reduction changed my life? Of course not. Physical comfort is sometime we all adapt to with remarkable ease: Now that I can sleep bra- less, I hardly remember having to clutch a cushion to my chest to prop up wayward boobs. I like the fact that my expensive talcum powder lasts longer now, because there are fewer places I need to apply it: The location "under the breasts'' no longer exists. I do have a broader choice of bras (though not, to my chagrin, as much as I'd hoped; in my obsession with cup size, I'd forgotten that my chest measurement has not changed from 38). And I can once again wear sweaters and shirts I'd put aside, hoping I'd lose weight sometime.

This aspect of body reshaping can be important to women. Reva, a friend-of-a-friend, had the operation several years ago, and then borrowed a T-shirt from Kathy. "She was so delighted," the latter recalls. "She said, I've never been able to fit into my friends' tops before!" The pathos of that made me give her the shirt."

But really, breast reduction doesn't change how one feels inside. "It's just like a new dress - it's not really going to make that big a difference to you," Dr. Hall Findlay says bluntly. "The women who do the best psychologically after the operation are the ones who psychologically need it the least. They already feel good on the inside, and just want to look good on the outside, too."

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