Recently, a 65-year-old woman came to my office for a breast reduction consultation. She had been referred by her daughters — both former cosmetic patients of mine. She was struggling with a myriad of classic pain symptoms and had been for her entire adult life. As I listened and discussed her literal and figurative pain points and the solutions I had to offer, the patient’s fears and anxiety lessened and she leaned back and asked, “Doctor, what’s your favorite surgery to perform?”
It was such a sincere question. Normally, I might have delivered a polished marketing soundbite, but in that moment, I paused. I wanted to give her an honest answer — one that reflected not just my experience, but also the connection I felt with patients like her who quietly endure the physical and emotional weight of living with large, heavy breasts.
As I reflected on my “favorite procedure,” images from three decades of surgical experience flashed through my mind: six years of general surgery residency at a busy county hospital, plastic surgery training, and over two decades in private practice. I’ve performed countless trauma surgeries, reconstructions, cancer surgeries, and aesthetic transformations. All of them were meaningful and life-altering in their own right. But when I looked back at her, I told her sincerely: “Breast reduction surgery — just like the one we’re planning for you — is probably my favorite and most rewarding operation.”
Why did I say that? After all, breast reduction surgery is not a “flashy” or “slick” trendy procedure. It’s not a new or marketed procedure like many cosmetic procedures. It is rather labor-intensive, and it does not really pay that well.
The truth is, as surgeons we enjoy procedures that are rewarding and life-enhancing. And we like to perform procedures that are proven effective and that we are good at. Over the years, like many of my colleagues, my practice has become more and more focused on fewer procedures as I develop more expertise in these procedures and deliver more reliable results. Over the last dozen years, I have learned to appreciate the dramatic, immediate, and lasting impact of this procedure on my patients’ quality of life. And yet, it remains one of the most underappreciated surgeries — especially among older or postmenopausal women. As aesthetic plastic surgeons it is one of the few procedures we do that is truly medically, physically and emotionally necessary.
The Hidden Burden of Large Breasts in Older Women
Breast hypertrophy — or macromastia — is more than a cosmetic issue. It’s a chronic, biomechanical strain on the body. Studies estimate that nearly two-thirds of women over 50 experience some degree of neck, back, or shoulder pain associated with breast weight. Many also suffer from headaches, fatigue, deep shoulder grooves from bra straps, and chronic skin irritation. These issues often worsen with age, menopause, and decreased skin elasticity.
Unfortunately, the toll isn’t just physical. Large breasts can limit physical activity, hinder weight loss, contribute to poor posture, and cause emotional distress. Many women who have this complaint talk about how they struggle to find clothing that fits, avoid social situations due to self-consciousness, or delay seeking help out of embarrassment or misinformation.
A Procedure That Transforms Health and Confidence
Breast reduction surgery addresses these problems at the root. By removing excess breast tissue and lifting the breasts into a more youthful and proportional shape and position, this surgery:
- Relieves chronic pain (neck, back, shoulders)
- Improves posture and mobility
- Enhances self-confidence and body image
- Allows for easier exercise and physical activity
- Resolves persistent skin rashes and infections
- Improves clothing fit and comfort
Even more compelling, large-scale studies have linked breast reduction to reduced lifetime risk of breast cancer, particularly in patients with dense or fibrocystic breast tissue. Remarkably, nearly 1% of breast reductions result in incidental findings of early-stage breast cancer in the removed specimen — enabling lifesaving early intervention. The surgery also facilitates better physical exams and clearer mammographic imaging for future screening.
Why Isn’t This More Common?
Despite its benefits, breast reduction remains underutilized — especially in older women. According to the American Society of Plastic Surgeons, only approximately 71,000 patients underwent the procedure in 2022. One major barrier is the lack of awareness, both among patients and primary care physicians. Another is the insurance landscape, where coverage is often difficult to obtain, and reimbursement to surgeons is disproportionately low given the complexity and follow-up care required.
Yet, this is where our role as health care professionals becomes critical. Whether in primary care, gynecology, internal medicine, or surgery, we must normalize the conversation around breast reduction. For the right patient, this is not just a cosmetic option — it’s a medically necessary, lifestyle-enhancing intervention.
A Message to Fellow Surgeons and Physicians
As surgeons, we find joy in procedures that offer real, tangible improvements in our patients’ lives — operations that combine technical skill with human impact. Breast reduction surgery does exactly that. With satisfaction rates consistently above 97%, it ranks among the highest in all of plastic surgery.
For me, it’s a privilege to offer a procedure that not only reduces pain and improves mobility but also helps women — especially older women — reclaim their confidence, health, and freedom of movement.
Do you have a favorite surgery to perform? Share in the comments!
Dr. Yamini is a board-certified plastic surgeon in private practice in Los Angeles. He specializes in primary and revision breast surgery.
Image by J_art / Getty Images
