Back in 2009 I wrote a post titled "Pro tennis player Simona Halep's cups no longer runneth over." (yes I was making bad puns then too) which highlighted WTA tennis player, Simona Halep, a promising Romanian junior tennis champion who's progress was being hampered by her very large breasts. Later that year she underwent a breast reduction surgery from a DD to a C cup bra size and has made steady progress with her career and is currently ranked #65 on the world tour. Today, Ms. Halep reached the final of a WTA event in Morocco and will play for her 1st WTA tour level title tomorrow.
BRAVO! As shown below, it's easy to see how Ms. Halep's mobility should have been greatly improved by her surgery. It's hard to argue with results.
According to Greek historian, Herodotus, the Amazons were a race of female warriors living on the Thermodon River in Scythia. There were no men in the community, and any boy born was killed or dispatched to his father beyond the river.
Hippocrates wrote that the girls had their right breast burnt off with hot irons such that they might better draw the bow. In the 3rd century AD, Roman historian Justin asserted that the mythological Amazon is derived from the Greek roots a (without) and mazos (breast). In Anabasis of Alexander, mention of the Amazons, said that their right breasts were smaller and were uncovered in battle. This observation could mean the legend of elective mastectomy was really right breast underdevelopment caused by deliberate binding or pinching.
Does it make sense that a mastectomy would make using a bow easier?
Actually it does. It's been observed that most competitive women archers are smaller breasted, and a chest guard is actually worn by many competitors to avoid inadvertent injury to their breast when shooting. The weight of the breast also changes the center of gravity and requires active extension of your lower back muscles to remain erect, a distinct liability for horseback based or hand to hand combat.
Among these legendary Amazonians were Queens Hippolyta, whose girdle Hercules was assigned to recover (sure sounds like a panty raid to me) as one of his 12 great tasks, Penthesilea for whose death Achilles mourned, and Thalestrias who had an affair with Alexander the Great.
In DC Comics, the famous Wonder Woman is supposed to be Diana, daughter of Hippolyta and Amazonian princess. For whatever reason she apparently did not get the memo about having small breast :)
Factoid to store away next time you're a contestant on Jeopardy: Spanish conqueror, Francisco de Orellana named the Amazon River as such after encountering women warriors among the Indian tribes of South America.
While we're on a run of breast reduction posts, I'd like to highlight the related story of Romanian tennis player, Simona Halep. Ms. Halep is a 17 year old tennis prospect who was good enough to win the French Open junior division in 2008 and is working her way up the WTA rankings (currently at #274). Unfortunately for her, she was attracting as much attention for her breast size (reportedly 34DD) as she was for her tennis talent.
Well word got out in the spring that she was considering a breast reduction (reduction mammaplasty), it took things to a whole other level. Photo spreads in British tabloids, fan sites, "Stop Simona from reducing her breasts" Facebook groups (I'm not kidding, click here), and even the infamous Opie & Andy show on satellite radio got in on the act.
Here's a video clip of her practicing where you can see the problems large breasts would cause with movement. WOW, Does she really hit the ball hard or what!
Well it would appear Simona quietly went ahead with the surgery this summer and is recovering to return to her high level athletic career. Resuming the training and competing after this operation could be tricky. There's real reason to be extremely conservative in clearing her to train. At 2 weeks after surgery the breaking strength of her scar would be about 50%, and by six weeks it would be approaching 90% tensile strength. With the kind of torque, tension, and range of motion she will be putting on her incisions there is real reason to believe she may have issues with poor scarring from her reduction.
Discussing her decision in interviews, Ms. Halep
But Simona's set proved too much to handle during matches and she feared they were stopping her from winning titles.
Last month she admitted: "It's the weight that troubles me - my ability to react quickly, my breasts make me uncomfortable when I play as well.
"I don't like them in my everyday life either. I would have gone for surgery too, even if I hadn't been a sportswoman," she added.
The photo below is purportedly after her surgery in late June or early July.
A breast reduction the size of hers is likely not going to be possible with many of the modern "short scar" techniques that I prefer. I would bet she had a traditional "Wise Pattern" or anchor shaped incision.
Breast reduction surgery presents an interesting issue when we're getting into an era where every health care cost is going to be scrutinized. As a society, is this a procedure we're going to be willing to commit major funding to? Currently there is a patchwork of indications that vary between different insurance companies as to what meets medical necessity for this operation.
In general, most insurers make you do extensive documentation of "conservative therapy" before even considering approval. I'm not sure what conservative management of big breast is exactly anyway! There are differing weight requirements for the tissue to be removed as well. Blue Cross of Alabama for instance requires a minimum of 500 grams (~1.1 lbs) per breast to be removed. Others use a sliding scale called the "Schnur Scale" to correlate appropriate weight removal to a calculation of your total body surface area (TBSA). The Schnur scale came from a paper by a plastic surgeon who was trying to quantify symptoms in his breast reduction patients.
The recommendations from that study by Dr. Schnur were perverted by insurers, written into policy guidelines, and are now used to exclude many patients from having breast reduction surgery. There now exists a great deal of literature showing that reductions much less then prescribed by insurance companies is effective in patients suffering from neck, back, and shoulder pain. In fact, a Finnish study suggests breast reduction surgery seems to improve the health-related quality of life indicators as much or more then surgeries for hip or knee joint replacement.These studies are dismissed by insurers as observational,flawed, or biased by greedy doctors, but if they could speak honestly they would explain that they don't want to open eligibility for the procedure to a whole new class of patients and cost themselves a great deal of money.
Apparently we're not the only country that is having issues on whether to cover breast reduction surgery. Hat tip!
A court in the German state of Hessen has ruled that insurance companies do not need to cover the cost of breast reduction surgery as having a large bust is not a medical problem. The decision means that insurers will only have to pay to correct breasts which are deformed.
The case was brought by a 38-year-old woman who suffered orthopaedic and physical problems due to the weight of her boobs. She had been advised by doctors to have breast reduction surgery.
But her insurance company didn’t see it as a necessity and therefore refused to cover the costs of the operation. It claimed she was suffering from back problems because she was overweight and that her physical discomforts would be reduced if she trimmed down weight and built some muscle up.
The court agreed with the insurance company and the big-breasted woman lost her case.
Two and a half years ago, the court in Hessen rejected the case of a woman who thought her breasts were too small. She wanted her medical insurance to cover a breast enlargement operation and claimed that she was physically harassed for her small boobs. The court declared then that small breasts are not an illness
Computer game publisher Funcom had to do some fixing of their popular online mulitplayer game when apparently a recent update of the game's software code left the female characters suddenly "breast deficient".
The MMORPG Age of Conan: Hyborian Adventures features partially nude female character models. Based on the original stories by Robert E. Howard and brought to the big screen in 1982 by Gov. Arnold Schwarzenegger, the game takes place in the fantasy world of Hyboria, which combines fantasy elements with strong sexuality.
This issue has caused controversy all over nerd-dom with hundreds of messages left by players demanding Funcom bring their boobs back. Seen below is a pair of images whose player felt like they'd had a mastectomy.
"Funcom can confirm that some of the female models in the game have had the size of their breasts changed. This is due to an unintended change in data that was introduced in an earlier patch, data which controls the so-called morph values associated with character models and the size of their respective body parts. We are working on a fix for this and your breasts should be back to normal soon. The plastic surgeons of Hyboria apologize for the inconvenience."
Well at least they have a sense of humor about it!
In this month's Plastic & Reconstructive Surgery, our profession's flagship journal, there's a study about the symptomatic relief woman receive after breast reduction who fall below the minimum threshold insurers require for coverage. To no one's surprise, even reductions less then half of the average weight removed showed dramatic symptomatic improvement at over 1 year out from surgery.
Most health insurance plans require a minimum of 500 gm (~ 1.1 lbs) of tissue to be removed per side for coverage in addition to documentation of symptoms related to their breast size. Occasionally you get some asinine form letter asking for proof of "conservative" treatment of large breasts prior to surgery, whatever the hell that is!
The authors of this study call for review by insurers of their criteria for coverage. Good luck! Insurers haven't been recording record profits by dramatically expanding their potential exposure for surgical procedures. This study doesn't really offer much that hasn't been presented to these companies for years. They're not interested in the close to three dozen papers with similar findings in the published literature.
The catch-22 here is that when coverage is expanded usually the reimbursement for the surgeon is cut. Breast reductions are long and physically hard procedures which can take 3-4 hours when you do it by yourself on large reductions. What we get paid for these is about 20-30% of what is commanded for mastopexy (breast lift) surgery, a closely related procedure which often may involve a small reduction component. It's gotten to the point for many surgeons that they just won't do it anymore as (depending upon the insurer) these hover right at the break even point for their practice when all the costs and follow-up care are figured. If you don't believe me, try finding a list of providers who will accept Medicaid assignment for these.
