Whenever a man jokingly asks Bethanne Snodgrass why a woman would ever consider breast-reduction surgery, her reply puts the lightheartedness implicit in the question quickly to rest.
"I tell them, take 10 pounds of flour and hang it around your neck. Now go about your daily activities - going to the store, picking up the kids, playing racquetball. It would be something they would not enjoy," says the Sylvania-based plastic and reconstructive surgeon.
Dr. Snodgrass is the author of one of the first major books written for women on breast reduction, When Less is More: The Complete Guide For Women Considering Breast Reduction Surgery (Collins, $24.95). The book was published last month.
Swanton resident Connie Bardwell, 46, is one of the women Dr. Snodgrass has helped and at whom the book is targeted.
"I've always been big-busted. I developed very early and I didn't realize a breast reduction was something you could do," says Ms. Bardwell, who suffered from indentations in her skin, headaches, and neck pain as a result of having very large breasts.
Ms. Bardwell, who started wearing a bra when she was in the fourth grade, didn't know surgery was an option until a customer at her local pet-grooming business mentioned it to her.
"It really made a difference in my own self-esteem after I had it done. Before, when I looked down I couldn't see my feet. All I saw were boobs, and now when I'm eating and food [accidentally] falls, it doesn't land in my chest," Ms. Bardwell says.
Dr. Snodgrass, 51 and the single mother of a young daughter, says she was partly inspired to write a guide for women considering breast reduction because some health-insurance providers - most commonly managed-care plans such as HMOs - exclude the surgery from their policies.
"Some insurers consider breast reduction to be a cosmetic surgery, but when you have women who are suffering from deep grooves in their shoulders, and who suffer from chronic back and neck pain, and headaches, [insurers] are excluding an entire group of women ...
"The world needed to be aware of this issue and that making breast reduction a major line item that is excluded from coverage - that is grossly unfair."
She adds that clinical studies prove that breast reduction, or reduction mammaplasty in medical jargon, is far from a cosmetic procedure.
Wendy Morphew, spokesman for Aetna, says the insurer considers reduction mammaplasty not medically necessary unless large breasts are causing significant pain, tingling, or ulceration. Surgery for members without such symptoms is considered cosmetic, according to Aetna's policy.
"We do cover if symptoms include chronic pain in the back, neck, and shoulders," she says.
Dr. Snodgrass points to the Breast Reduction Assessment of Value and Outcomes study, sponsored by the Plastic Surgery Educational Foundation, which evaluated processes and outcomes of care in hundreds of women undergoing breast-reduction surgery.
According to the American Society of Plastic Surgeons, women with large, pendulous breasts may experience a variety of medical problems including skin irritation, skeletal deformities, breathing problems, pain in the neck and back, headaches, and bra-strap indentations in the shoulders.
The society adds that unusually large breasts can make a woman or a teenage girl feel "extremely self conscious" and that breast reduction is among the Top 10 most commonly performed major plastic surgical procedures. Some 114,000 breast reduction procedures were performed in the United States last year, and greater public attention has been drawn to the surgery with celebrities such as Queen Latifah and Drew Barrymore going public with their surgeries.
Dr. Snodgrass, who received her undergraduate degree from Oberlin College and her medical degree from Penn State University, includes 12 chapters in her book that cover an array of topics including the invention of breast-reduction surgery, how to find a surgeon, what happens in the operating room, and recovery.
A breast-reduction patient is likely to stay in the hospital or surgery center for just under 24 hours, says Dr. Snodgrass. Her younger patients, especially those without small children, sometimes go home the day of surgery, but overnight stays are sometimes recommended for patients to control pain and nausea.
The main complication that can arise from the surgery - which removes glandular tissue, fat, and skin from the breasts to reduce their size and reshape them - involves "fat necrosis," or fat that does not survive the surgery.
Dr. Snodgrass says this is a particular problem because extensive incisions are made through fat tissue that already has poor blood supply compared with other body tissues. Other risks include skin necrosis, nipple loss (the failure of the entire nipple and areola to survive), chest cords (the development of a painful inflamed vein under the skin in the lower chest), and galactorrhea (milk drainage). Very rarely - in less than 1 percent of operations, according to Dr. Snodgrass - breast cancer is detected while performing a breast reduction.
A plastic and reconstructive surgeon since 1986, Dr. Snodgrass performs 20 to 40 breast reductions per year. Fees are likely to be in the range of $2,500 to $5,000.
Another of Dr. Snodgrass' patients, Sarah Deatrick, of Payne, Ohio, says her angular figure was always hidden because she opted to wear clothes in big sizes to accommodate her large breasts.
"In junior high and high school and as an adult, I spent of lot of time being very embarrassed. I've always been a pretty thin person, so I would wear big shirts or big sweaters, and nothing too form-fitting to hide my [large breasts]. I didn't like that kind of attention, so I would always wear a jacket or very loose clothes," says Miss Deatrick, a Spanish teacher at Wayne Trace High School, who went from a bra size of 36 DD to a 36 C cup.
Before the surgery, she says she suffered from severe headaches and indentations in her skin.
"Having the surgery, it's just changed so many things. I never realized how much pressure was on my shoulders. I tell people, I feel so different, it's hard to describe, but it's like air," Miss Deatrick says.
Contact Rhonda B. Sewell at: firstname.lastname@example.org