Contrary to popular belief, females with very big breasts can be just as unhappy as those who are underdeveloped, sometimes more so. Instead of feeling a greater sexuality from their size, they are usually self-conscious and insecure. Many feel that men are too aware of their bosoms and not their personalities, and they may become wary of relationships. They have trouble buying clothing that fits right. Ponderous breasts are especially prone to sagging, and this condition is unattractive and sometimes embarrassing.

But it is most often the physical problems that cause women to seek breast reduction. Women who carry extra breast weight often suffer from severe back and breast pains. A particular source of discomfort comes from the need to carry the breast weight in a brassiere. This causes grooves in the shoulder from the downward pulling of the bra straps. These indentations might even be permanent. Another source of displeasure comes from difficulty with personal hygiene, as there may be skin irritation under the breasts. This happens because it is difficult to clean under the bosoms that are constantly rubbing against the chest skin. Persistent skin rashes may eventually result. Heavy breasts can even interfere with normal activities like sports, dancing, driving a car, and even sex.

There are several variations in the procedure to reduce a woman's breasts, called 'reduction mammoplasty,' and each surgeon will probably have an individual preference. But for the most part, they involve the same principles.

While the operation must almost always be done with general anesthesia, the procedure begins while the patient is still awake. She sits up, allowing her breasts to be observed in a natural position, and the surgeon draws his incisions including the new position of the nipples with a marking pen. Afterward, the patient lies down and is given a general anesthesia.

Then the surgeon makes his incisions as outlined and removes the unwanted breast tissue. Next, he reduces the amount of skin to fit snugly with the reshaped breast. As the skin is pulled tighter, the nipple is drawn up into the correct position. Finally, the incisions are sutured.

In most cases the nipple remains connected to the underlying breast tissue throughout the operation. But if the breasts were unusually low to begin with, the nipples are removed and replaced later as a free skin graft.

Surprisingly there is very little or no pain after the operation, and the sutures will normally be removed in about one week. One could return to work in just a few days after the procedure but must not do any vigorous activity three or four weeks following the operation.

This operation normally produces excellent results, and the women who have it are almost always delighted. But, there is a major trade-off -- extensive scarring. There will be a circular scar around the nipple, a vertical scar from the nipple down to the fold beneath the breast and a scar in the breast fold itself, sometimes extending under the arm. The scar is often described as having the shape of an anchor.

As to exactly what kind of scars will result, it is impossible to say. No matter how carefully the wound is sutured, it is the person's own body that creates the scar tissue. It could be thick, thin, spread or irregular.If a patient is very concerned about the scars, then they should not risk the surgery. Anyone undergoing this operation must be prepared to have permanent, visible scars on her breasts.

Loss of sensation in the nipple area is common, but nursing a child remains possible if the nipples have not been detached.

Aside from the visible scarring, there are a few possible complications. Postoperative infection or bleeding is fairly rare as is inversion of the nipples, which can be corrected later. While minor areas of skin loss can occur, the main risk is significant loss of some of the skin, breast or nipple. This can happen because the technique by which the breast is reduced interferes with some of its blood supply. If not enough blood supply remains (which is usually not the surgeon's fault) some of the remaining tissue could die. If this were to occur, the dead tissue would have to be removed and much more extensive scarring than anticipated would result. It could also cause unevenness of the breasts.

Happily, several studies have shown that doing a reduction mammoplasty does not increase the risk of breast cancer in any way.

Concern about the large anchor-shaped scar has led to the creation of operations that minimize the scar. One uses a 'coring' technique in which the only scar remaining is around the nipple. But, this can be done only for very modest reductions. The removal of the excess skin that is done as a doughnut shape around the nipple may result in a puckering appearance around the nipple that is very unsightly. This is not a preferred method.