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Plastic Surgery/Would breast reduction surgery help me?


QUESTION: Dear Dr. Engler,

I'm a 23-year-old girl considering breast reduction surgery. My bra size is 30G, I am 4'10 ", and about 95 lbs.

In December 2013, I was diagnosed with Fibromyalgia, which I had been showing symptoms of since September 2012. From the time I first began showing symptoms, I would periodically have pain in my ribs due to the cartilage between them becoming inflamed.

Since the 1st of January, this rib inflammation has become extremely painful. Before, it was just a pain from time to time; now, the acute stages are excruciating, and even when it's not acute, I am unable to wear a bra at all times (I haven't worn one since the beginning of the year; even post-surgery "comfort" bras are too painful). However, with my breasts being so large, they press on my ribs, which adds to the pain, and in general, they are extremely uncomfortable at all times now I can't wear a bra. It feels like they're constantly in the way and they sort of "flop around" all the time. Before this, the only time I didn't wear a bra was when I was bathing; I even wore one to sleep in.

In order to give my ribs any relief, I should think I'd need to have them reduced to about B-cup size. I'm very upset at the thought of having to reduce my breasts, but it's getting to the point where I'm starting to feel that I can't go on this way. Could I have my breasts reduced that small? Do you think that would help? Would they be small enough to stop pressing on my ribs?

Also, weighing up all the risks of surgery against my inability to wear a bra and the pain, do you think it would be worth having breast reduction surgery? I know it's a big operation, and with having Fibromyalgia, I'm not in the best health.

I'm sorry this question is so long, and I'm extremely grateful to you for reading it, and for your help. Thank you so much for your time.


ANSWER: from Dr. Alan Engler

You poor thing!  I'm so sorry that you're suffering to this extent, which is something that many people don't realize is possible.

First, though, I can't comment on how the fibromyalgia will affect this - but I'm not sure how relevant it is.  Because with your frame your breasts are much too large for you, in view of your symptoms.  But why do you think you'd have to go to a B to have relief?  Most of my patients have dramatic improvements in their quality of life even if reduced to a C or small D - which is likely to be more appropriate for your frame.

You need to have consultations with a few plastic surgeons in your area to see what's practical for you.  If you were in New York I'd offer to see you but that's not too logical in view of where you are.

But I would encourage you to go for 2-3 consultations - at least - with qualified board-certified surgeons near you.  Tell them what your symptoms are and then listen to what they advise.  On the basis of that you should hopefully be able to make a decision about which surgeon to use.

I would expect you to have a dramatic improvement in the way you look and the way you feel,

I hope that this helps and good luck - keep me posted?
Dr. E

---------- FOLLOW-UP ----------

QUESTION: Thank you so much, Dr. E.

I was afraid I would have to go down to a B cup to make sure my breasts were light enough not to press on my ribs but it would be great if I only had to reduce them down to a small D or so!

Would you mind if I asked you one more question about the surgery itself? The thing is, I have seen online that a lot of women who have breast reduction surgery also have mastopexy. What I would like to know is, is mastopexy an integral part of breast reduction surgery?
The reason I ask is because I live in the UK, and cannot afford to pay for this surgery privately, so would have to have it on the UK's National Health Service. This means that the surgery they give me will be as cheap for them as possible. I'm concerned that if the mastopexy isn't completely necessary, the National Health surgeon won't do it, and I'm afraid that the result will look terrible.

Thank you again, so much, for your help.


Hi Tess,

A lift is always performed as part of the reduction, but it can also be performed by itself (ie, without a significant reduction).  A little tissue is always removed - including the skin and some breast tissue - even if it's just a lift.  Often the amount of tissue being removed helps determine whether it's a lift (less than around 300 grams from each side) or a reduction (over 4-500 grams per side) with, obviously, a gray area.  In other words, it's largely the same procedure with the only difference being the amount of tissue removed.

Again, though, it's worth it to go for a few consultations to get some ideas about what's recommended for you

Good luck,
Dr. E  

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Alan M. Engler, MD, FACS


Dr. Engler has answered over 6400 questions on social media sites, including over 3500 on AllExperts alone. His expertise includes breast surgery (breast enlargement with implants, breast reduction, breast lifts), liposuction, eyelid surgery, tummy tucks, facelifts, lipomas, skin cancers, cysts, etc. Dr. Engler has been listed as one New York`s Top Doctors, and as "One of the World's Most Famous Aesthetic Surgeons" (Aesthetic Surgery, TASCHEN Books, Angelika Taschen, Editor). He is the author of 4 books, including "BodySculpture" (a best-selling plastic surgery book on breast surgery, liposuction and tummy tucks), "EyeScapes" (Plastic Surgery of the Eyelids), "Restylane," and "The Slim Book of Liposuction." Dr. Engler has two US Patents for surgical instruments that he's designed, and has appeared on numerous television shows, including The Tyra Banks Show, The Ricki Lake Show (four times), the Dr. Keith Ablow Show and Jerseylicious. Videos of his appearances are available on YouTube (search for "DR. ENGLER"), and his discussion of breast implants, also on YouTube is "How to Choose a Breast Implant." His website is Follow Dr. Engler: @AlanEnglerMD


Dr. Alan Engler is a board-certified plastic surgeon in New York and the author of BodySculpture - Plastic Surgery of the Body for Men and Women (ISBN 0966382749) one of the top-selling plastic surgery books on,, as well as EyeScapes - Plastic Surgery of the Eyelids.

Dr. Engler graduated from Yale University (BA, Russian Studies) and the Columbia University College of Physicians and Surgeons (MD). He did his residency training in General Surgery and, after that, Plastic Surgery, at the Montefiore Medical Center in New York. He is on the faculty of the Albert Einstein College of Medicine in New York in the Departments of both Surgery (Plastic Surgery) and Medicine (Dermatology), and is a Special Lecturer in the Department of Dermatology at Columbia University in New York. He has admitting privileges at Beth Israel Medical Center and Montefiore Medical Center, both in New York.

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