Are you a medical professional? Breast reduction for teen

[Whatwouldnanado]

My gorgeous, intelligent daughter has decided she needs surgery to reduce the size of her breasts. In a year she has gone from 32E to 36F. Hates not finding clothes to fit and says she has back and shoulder pain.
She says she has felt awkward about having bigger boobs than her friends for years.
She is nearly 19, andit’s her body her choice but I want her to explore alternatives before she goes down the route of an operation.
Is this usually suggested by doctors before surgery?
Being something completely new to me I did some research and found a medically based website on the subject with masses of suggestions to help herself through diet and exercise. This was rejected as criticism of her weight.
Before going to university she attended three dance classes a week. At home we’ve always had a normal healthy diet, home cooking, lots of fruit and veg available etc. No big deal. We are all naturally slim I suppose, her dad and I enjoy walking together at the weekend. he rides a bike and I do yoga.
At university she caters for herself, and when she’s home she joins us for some meals when she’s not working etc.
Anyone who knows her can see that she has put on weight all over. She is tired all the time too. She wanted me to accompany her to a doctors appointment where she lied and said there was no other weight gain. It’s as though she wants a quick fix.
After one or two questions they referred her to a NHS clinic.
I understand there will be a waiting list.

One thing for her to bear in mind is that breasts often grow again after reduction.

I had a reduction 15 years ago. I was a 36GG/H. I had lost over 8 stone and my breasts were very pendulous. After the op I was a 36D (which felt tiny to me) but over time I they have totally regrown and then some. I now wear a J cup. I don't regret the op because they are a much better shape than they were - and actually look smaller because of them being a better shape but that won't be true for a teenager.

Where exactly did she get measured as I think the reason her size has gone up in her eyes is that the fitter was crap.

I'm a size 14, just at the edge of healthy BMI and easily get in a 32 back. And as a 32 FF I'm not especially large.

The GP can't really do much if she's lied to them and has probably just referred on so the clinic can sort it out. She's very likely not to be eligible on the NHS and either the referral be turned done or be told at clinic she isn't eligible.

A quick Google found this as NHS eligibility criteria:

The woman has received a full package of supportive care from
their GP such as advice on weight loss and managing pain.
• In cases of thoracic/ shoulder girdle discomfort, a physiotherapy
assessment has been provided
• Breast size results in functional symptoms that require other
treatments/ interventions (e.g. intractable candidal intertrigo;
thoracic backache/ kyphosis where a professionally fitted bra has
not helped with backache, soft tissue indentations at site of bra
straps).
• Breast reduction planned to be 500gms or more per breast or at
least 4 cup sizes.
• Body mass index (BMI) is <27 and stable for at least twelve
months.
• Woman must be provided with written information to allow her to
balance the risks and benefits of breast surgery.
• Women should be informed that smoking increases complications
following breast reduction surgery and should be advised to stop
smoking.
• Women should be informed that breast surgery for hypermastia
can cause permanent loss of lactation.

My cousin, in her 50’s had to loose any excess weight before she would be considered for a reduction on the NHS. She did have it done after waiting 5 years. This was about 8 years ago. It was a big operation and not one she would wish on anyone.

I'm a size 8-10 and there is no way I could get into a 32 back 🤨

I bet you could if the cups were big enough

From experience losing weight 1st = a dress size = go down a back size.

Cup size is a whole different story.

Well perhaps I could get it on back size, but the cups wouldn't fit!

If she’s unhappy with part of herself is it not talking therapy you should turn to first? Not chopping bits off.

The weight gain doesn’t sound too unusual after 1st year of uni. Lots of people go a bit podgy not helped by all the alcohol. They generally sort themselves out by the end of 3rd year.

I wonder if the GP was avoiding discussing weight with a teenager who is obviously already unhappy with their body

I have a friend who's a GP and I asked her how she tackles the thorny issue of weight with patients and the short answer is - she doesn't unless they specifically mention it. She says all it would take would be one complaint from one patient and she could end up being struck off. She says loads of people consult her about issues that could be massively helped by weight loss, but she feels helpless to talk about it, because if they take it the wrong way (as it sounds like your DD would OP - you being her own DM and afraid to mention it!), then they can make an official complaint and bang! She could be suspended while an investigation goes on.

The recent Lucy Letby case, where doctors who were her colleagues found it hard to get any traction with management when they were worried that there was a murderer in their midst just goes to show how difficult it is in the health service to have difficult conversations with or about anyone! Those doctors risked their careers, were threatened by the management of their own hospital and were made to write an apology to a nurse who was murdering babies!! I don't blame the GP for saying nothing and giving your DD the referral she wanted.

That's the point! You can fit the back size but you need a bigger cup size to get everything in.

If she's really a 36 back size (get her to measure using BoB) then she's definitely going to be far too overweight

I had a 36 in band when my bmi was 22.4 and I was a slim size 10-12. It’s 34 now I’m an 8-10 with a bmi of 18.4 so judging someone with a 36 band as too overweight is ridiculous.

No, that's the opposite of the point. The cups would be massive. I'm not a c cup by any stretch of the imagination!

The back measurement is literally a measurement of your back. You don't adjust it if you have big boobs.

Well if you fit a 32 back but your boobs then don't fit in a C cup, you are a bigger cup!

Don't forget not all C cups are the same size - plus C is pretty tiny anyway. A 32C is not going to be the same size boob as a 38C.

Try measuring yourself on Boob or Bust to get an idea of what size you really are.

@cheezncrackers you've highlighted a really good point. I'm always stunned that GPs won't tackle weight. I wish we were weighed and measured as a matter of course and given advice accordingly.

My friend is morbidly obese. She lost 6 stones and went to a private clinic for a consultation about a breast reduction. The consultant gave it to her straight, he wouldn't operate until her BMI was greatly reduced. It was what she needed to hear but she was distraught. I've no idea why it came as a surprise to her. He told her to lose another 4 stones and return. She has been really motivated and is doing it. When she returns after the 4 stones I know he's going to tell her to lose more because her BMI was still going to be above 30 even with that loss. But I've often wondered why the NHS don't do this regularly with people. We are ticking time bombs.

Anyway, this is a long way of saying your daughter will have to lose weight in order to get the operation. Do you know what her BMI is sitting at. The post above said below 27 BMI for an NHS op. That is actually quite a low weight. I was shocked when I calculated my BMI. I've seen videos from private clinics where the surgeon has agreed to do it at 29 but that's because the breasts themselves weigh 1.5kg.

But there's no way she's going to get an op for an F cup on the NHS!
Please be careful that she doesn't jet off to Turkey for an op if she can't get it here.

It’s quite tricky. I have just had a breast reduction at a 34JJ/K but I am overweight - I had to have it done privately. Where we are they won’t even consider it unless your BMI is below 27 and stable for over a year, and then there is a 2 year plus weight for the psych evaluation even to get on a waiting list for actual surgery (and the amount of pain /distress needs to be insane to get through that eval.) it’s almost impossible, basically.
If she is overweight at the size she is, the chances are high that losing weight to get down a couple of stone/dress sizes will take a reasonable amount off her boobs, which are not excessive like mine were - I had a kilo removed from each side. She is likely to be saggy though, which isn’t going to feel great as a teenager. Unless her weight is over about a bmi of 35 she wouldn’t be likely to be referred to the weight management clinic either.

Essentially, she would have to go private - it’s about 8k, but they would almost certainly do it.

A C cup flaps open on me. And my boobs aren't "tiny" thanks. They are a standard B.

The cup sizes are obviously different, but the back measurement is a literal measurement around your back. It doesn't change if your boobs are bigger or smaller.

(ETA - my bmi was just on the cusp at 30.5 which was the absolute max the surgeon would do it, lost a few pounds beforehand abs then effectively 4 pounds in surgery so I was under 30 by the time he finished.)

Be aware that even after a breast reduction, breast tissue can grow back and not always evenly.

@Notooserious I hope you feel great now! It must feel marvellous. What size are you now and how was your recovery?

I got measured yesterday and the fitter said that most people are above a D cup nowadays. They barely stock any B or C cups as there's not much demand for them so I don't think your dd has very large boobs so not sure what is causing the back pain. I'm a 32 G and don't have any back pain or shoulder issues.

Going from a 32E to a 36F in a year is really weird - she must have put on a lot of weight (putting on 3 stone only took me from a 32 to a 34) but also her cup size has comparatively shrunk 🤔

She needs to get measured properly.

I'm a GP. No one - and I mean no one - would get this in my region on the NHS.
I wouldn't even bother referring personally but some of my colleagues would as they think that it's better not to get the moans/grumbles/hate directly but to send a text after the referral is rejected. I get where they're coming from but I tend to tell people directly. But if I get any pushback, I just refer as well and then let them know it's been rejected.
I also don't often discuss weight unless invited to do so. You only have to look on posts on here or on Instagram of people with BMI of >40 who are insistent that their knee pain is nothing to do with that and how dare their doctor say so...
I might ask the question but if, as your dd did, the reply is "no I'm the same weight I always was", I'm not going to suggest that's not the truth!
If someone is going to caringly suggest eating healthily and exercising healthily, I would gently suggest that that is the role of family?

@Blingstar thank you! Still recovering as I had some complications, but once it’s all healed it will be fab. I still don’t know what size I am going to be but hopefully about a D. I’m probably a bit bigger than that right now but need to lose about another stone anyway, but it will be a lot easier without them, and the back pain has improved immeasurably! 🥳

BOB claimed I was a 32 C cup rather than the 36 A cup I was.
As an experiment I bought the size suggested but I couldn’t actually do the band up and still breathe in a 32 and I’ve never been more than an A cup in my life.

Someone will talk to her at the clinic

But honestly OP that isn’t an especially huge cup size for her size, I don’t think they will offer anything on the NHS.

You could ring Hospt she’s been referred to and ask about the waiting lists, and once they tell you it’s a v long time that might encourage her to think of other things.

Weight gain in the first year or two of university isn’t all that unusual, so you could frame it like the to make her feel less defensive about it.

There can be a lot of scaring and nipple sensation loss, plus it’s not unheard of for breast tissue to regrow if patients continue to gain weight. So it’s only a last resort.