Thigh days before Christmas 2015, when I was 19, I had my breasts reduced in size. Sitting alone in my apartment after surgery at the Ross Hall hospital in Glasgow, I confronted my scars for the first time and I cried.
It wasn't the first time I had shouted over my body, but it was not the tears of a miserable, frustrated teenager. I felt like I had been through a fight and had come victorious. By holding the prickly breasts, a manageable 32E down from a 34GG, I was finally, glorious.
After Simona Halep was crowned the 2019 Wimbledon champion, I wondered if she had felt the same after her surgery 10 years ago. Halep, when a 17-year-old star, had felt her breast affect her game and chose to have her breasts reduced from 34DD to 34C. "It's the weight that worries me," she said at the time. "My ability to respond quickly – my breasts make me uncomfortable when I play."
Although she told Sports Illustrated last year that her breast reduction surgery was her "biggest victim" of the sport, Halep said she had never regretted the decision. "I also didn't like them (her breasts) in my everyday life. I would have gone to surgery, even though I hadn't been a sportswoman."
Today, as a 23-year-old journalist, I still feel the size of my decision and its influence not only on my body but on my mental health and on all other aspects of my life. I no longer need to hide my body under layers of clothing or sleep in a particular position to avoid stress. I can sit right without attracting stares or accusations of being aware. The most liberating of all, the operation freed me from chronic headaches and back and neck pain that had made me take painkillers every day.
Breast reduction surgery is performed under general anesthesia, most often by cosmetic surgeons in private practice. The operation usually involves the removal of excess fat, glandular tissue and skin and reshaping the remaining breast tissue. The nipple has moved, creating a scar that for most women runs vertically and over the breast in an anchor shape.
The operation can remove up to one kilogram from each breast and takes between 90 minutes and four hours depending on the reduction. A two-night hospital stay is recommended. It is also expensive: approx. £ 6,500, according to the NHS, exclusive consultations or follow-up care.
After all, the number of people who have the procedure is increasing. In 2018, 4,409 women had their reductions paid by the NHS England, from 4,354 in 2017, 4,188 in 2016 and 3,959 in 2015. The British Association of Aesthetic Plastic Surgeons' Annual Review in May found out that it was the second largest procedure for women (after breast augmentation), where 4,014 women in the UK had paid to have their breasts reduced in the past year, a 7% increase between 2017 and 2018.
That so many women are prepared to raise the price themselves is testament to the life-changing potential of the procedure. A study by Georgetown University Hospital in 2010 showed that many breast reduction patients reported an improvement in their chronic headache and migraine following surgery reduction.
Patient satisfaction is high: in 2012, a 10-year retrospective analysis of 600 consecutive patients in a single US institution showed that more than 95% of them would choose to have the surgery again. It concluded that there was a demonstrable improvement in the patient's quality of life regardless of their weight and size or how much breast tissue was removed.
"I'm not considering a breast reduction to be a cosmetic procedure – it's an incredibly beneficial operation," said Chris Hall, a plastic surgeon in Belfast and a member of the British Association of Plastic Reconstructive and Esthetic Surgeons (Bapras). "The physical benefits that patients feel psychologically behind and improving their quality of life are all well documented. Unfortunately, eligibility criteria that have been increasingly tightened over the years are almost impossible to get the NHS procedure."
The NHS criteria are supported by the Academy of Medical Royal Colleges, which includes the Royal College of Surgeons and the independent National Institute for Health and Care Excellence reviewers. One patient must have had a stable BMI of less than 27; their breasts should be of "massive disproportion to body habitus"; they could or should have "intractable intertrigo" (inflammation caused by skin-to-skin friction), "asymmetry greater than a cup size" and "significant psychological disorder".
But many women who have tried to get the operation covered have complained about inconsistencies and lack of transparency on how to qualify. Amy Hill, a 23-year-old personal trainer, was initially rejected for a breast reduction despite a bra size of 28KK. "I hated my breasts – they were a constant strain on me," she says.
Getting a bra was impossible. When she went to Bravissimo, a specialist shop with the slogan "inspiring big-boobed girls" told them they didn't make them in their size. "I cried in the locker room."
In the best part of a year she had a bikini top. "It was all that would suit me. I would always attract unwanted attention: people thought they were fake. You could always see them. They were huge."
When Hill was told she did not meet the criteria for reduction – "they told me they had no influence on me mentally enough" – she replied, she said. "I was so desperate for it. For someone to turn around and tell me no – it ruined me."
But she continued to push. "The whole process was so long and exhausting. I would wait three months for an appointment for them to tell me something they could have told me on the phone. I should give up but my mother had (the operation) when she was mine age, and told me that I just have to keep trying. She said it wasn't as hard for her as it was for me. "
Hill eventually had a breast reduction on the NHS in 2016 when she was 21. In the hospital, a post-operative nurse did not believe her breasts had previously been as large as she said. "She made me get out of bed to measure them," Hill says. "Everybody else in the ward commented that I might not have been the size I said I was, that it was impossible.
"I was so embarrassed, I cried. I felt a little ashamed of people not to appreciate my breasts and would get rid of them."
But Hill has not undone the operation for a moment. "Before I went to the gym I had to wear three bras. Now, within a year when I start training as a personal trainer, I open my own gym. I was very fortunate to get the procedure."
The eligibility criteria differ in all sectors of the NHS, which means that women seeking surgery are almost beneficial for a zip code lottery, says Russell Bramhall, consultant at Canniesburn Plastic Surgery Unit in Glasgow Royal Infirmary. "I can't remember the last time I did a breast reduction on the NHS. Everything has become tighter and tighter; we're working in a poorly funded state system." The referral process and long waiting times can also be a barrier.
In my case, I had the right to compare my journey to a fight. I campaign for my operation to be performed by the NHS for four years. NHS Scotland recognizes breast reductions under its extraordinary referral protocol for procedures that do not treat an underlying disease process, thereby only giving them in very rare cases. Patients should be referred to a clinical psychologist for assessment and subject to clinical commissioning.
I was expected to strip and stand at every hearing, poked and prodded by male doctors, student doctors, and nurses. I felt I had no choice – it was as if by choosing to get the surgery I had given up on my right to privacy.
On a deal, a young doctor prescribed NHS advice on breast reduction after Googling it. At my psychiatric evaluation, a female clinical psychologist asked me, "When you say you think people are staring at you in the street – are you staring at them first?"
After an exhausting, humiliating and intrusive battle with my doctor and NHS Scotland, I ended up paying for the surgery myself. The system effectively pushes women seeking private sector breast reductions, says Bramhall and Hall.
Ann (not her real name), a 22-year-old student living in Scotland, wants a reduction operation for her 36FF breasts, but can't afford to go private. "I want the way my breasts look, but I do not, even though all my sexual partners love them. There have been times when I have felt so frustrated, I have imagined the psychological and physical relief of Just cutting them straight out of my body, they don't make me feel more feminine, so I don't think I will feel less of a woman without them. "
Ann finds that clothes never fit properly, and bras cost much more than those in standard sizes. But most of all, she says, "My back hurts – but not enough for the NHS".
Bramhall says that as well as the physical problems associated with large breasts – "back pain, shoulder pain, infections, chest belt cutting, impetigo-like comfort under the breast" – the impact on human mental health and quality of life is often not considered. "A common mental symptom in my patients is low self-esteem and poor body image. They lack confidence socially and when they are out of their clothes with their partners. I get women all the time who do not feel comfortable in swimsuits or summer Clothing – The amount of fun they get in the summer is less. People wear loose clothing all the time to camouflage their appearance.
Those who cannot afford private operation can be tempted by cheaper options that are not always safe or well-regulated. Bapras members report seeing patients who had post-op complications following cosmetic procedures outside the UK, where eligibility criteria are often more salmon or even non-existent. In many cases, excessive breasts are associated with health complications such as obesity, due to the inability to exercise and anxiety and depression due to low self-esteem and self-image (which can multiply to the body's dysmorphic disorders).
Hall says the NHS criteria may refuse surgery for those who need it most. "Many criteria are based on bad evidence: for example, it is very difficult to maintain a BMI of less than 27 for two years with large breasts. You cannot exercise. If you are slim, they look bigger. If you have one size M, your breasts can weigh the equivalent of 2 lb sugar on both sides. "
Both consultants acknowledge the pressures that the NHS is under, leading to prioritizing trauma and cancer cases. "The NHS does not have a bottomless pit of money," says Hall, "but what Bapra wants is transparency and uniformity. We want the same access criteria across the country, so it's consistent wherever you live. If the NHS decides to no one gets a reduction, so it must tell us that there is no money and that it is not going to fund it. "
It speaks to a wider problem in women's health issues that are not taken seriously, that thousands of women pay each year for a procedure that undoubtedly improves their health and quality of life. I had struggled with the decision to seek surgery, wondering if it was anti-feminist to want to change my body – but my reduction turned out to be the most rewarding decision I had ever made. It wasn't just about making my breasts smaller – it was a way to a life of confidence, free of pain. I got autonomy over my body, but I had to fight for it.
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