Early in February 2008 country songbird Dolly Parton announced the postponement of her North American Tour. But it wasn't an issue of bungled bookings or troubles with the band. Parton's wears her woes on her size DD chest. That trademark bustline, surgically made even more impressive, is ruining her back and doctors have ordered her to rest. Since 2004, Parton has considered breast reduction to take the strain off her back and admits "my boobs are killing me." While breast enlargement is often seen as a matter of vanity or sexuality, breast reduction gets less ink in the popular press. This surgery is, more times than not, a matter of medical necessity and personal comfort to relieve an otherwise inescapable source of pressure on the back. The number of problems associated with an overly large bust are multiple, beginning with chronic pain in the neck, shoulders, and back. This in turn leads to poor posture. Overall the degree of physical activity is decreased and with it, self-esteem often plummets, giving way to embarrassment and discomfort. Some women experience rashes under the breasts and deep grooves form in their shoulders from the pressure of the bra straps. Additionally, women with excessively large breasts often have trouble finding bras and comfortable, flattering clothes. Surgeons counsel putting off breast reduction surgery until after age 20 at which time the bustline has become fully developed. If, however, large breasted teens are suffering severe psychological and emotional effects, usually due to the taunting of their peers, the procedure can be performed at any time. Women who want to have children would do well to postpone their surgery until after they've given birth as pregnancy can alter the surgical result and breast feeding after a reduction procedure may be difficult or impossible. If a patient's primary care physician or back specialist orders the surgery as a medical necessity, health insurance may cover the procedure. For a patient to qualify for coverage, the insurance company could actually set the level to which the breasts are to be reduced, which does take away a degree of personal choice from the woman. Since the procedure can, however, range in cost from $5,000 to $10,000, many patients are willing to meet the company's requirement. Consultation with a surgeon will include photographs and measurements as well as discussions of such factors as the positioning of the aureola and nipple. There is no room for shyness and patients should prepare themselves for frank discussion and a thorough breast exam. As for the surgery itself, typically an incision in the shape of an anchor is made around the aureola, down the breast toward the creased area between the breast and abdomen, and then horizontally across that crease. This gives the surgeon sufficient access to remove excess fat and skin. In extreme cases the nipple and aureola are removed and reattached in the proper position. (This can result in a permanent loss of sensation and can make breast feeding impossible.) The surgery lasts 2 to 3 hours and most people are able to return to work in two to three weeks. Breast reduction surgery is a major procedure that can be both expensive and uncomfortable. The long-term goal, however, is to relieve potentially crippling pressure on the back and in the process to help the patient look and feel better. Many people have the mistaken impression that breast reductions are only done for cosmetic reasons. Parton's public admission about the necessity of postponing her tour has brought to the attention of the public the real medical problem underlying a large bustline. Admitting that she doesn't know if she can stand the back pain any longer, Parton, like thousands of other women, may sacrifice her "trademark" for better back health.
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