Macromastia occurs when breast tissue size becomes a problem for an individual’s musculoskeletal system. This can cause pain and inhibit a person’s function in daily life. Symptoms may include neck pain, upper back pain, shoulder pain, headaches, poor posture, strain on the spine, and limitations with exercise or daily activities. Other symptoms someone may experience are skin irritation, rashes, and excessive shoulder grooving from bra straps.
At The Spine & Health Center of New Jersey, we frequently evaluate patients whose symptoms stem from biomechanical strain on the spine and shoulders related to macromastia.
Surgical breast reduction is a common procedure used to address macromastia. However, not everyone is immediately a candidate for surgery. In many cases, a trial of conservative therapy should be completed first to determine whether symptoms can be managed without surgical intervention.
Conservative treatment is also important for insurance approval. Many insurance providers require documentation of failed non-surgical treatment before approving breast reduction surgery. In these situations, surgery becomes medically necessary when conservative care fails to adequately resolve pain and functional limitations.
Conservative Treatment Options
Conservative treatments aim to reduce musculoskeletal strain and improve posture, strength, and spinal mobility. Common treatment options include:
- Spinal adjustments through chiropractic care
- Soft tissue therapy to address muscle tension and trigger points
- Traction or decompression of spinal joints
- Therapeutic exercise and strengthening of the shoulder blades and spine through physical therapy
- Postural correction and ergonomic training
These treatments can help relieve strain on the cervical and thoracic spine, reduce headaches, and improve functional movement.
In some cases, complementary therapies such as acupuncture may also be used to help manage pain, reduce muscle tension, and support the body’s natural healing response.
When Surgery May Be the Right Option
If conservative care fails to adequately resolve symptoms after an appropriate trial period, and pain or functional limitations continue to affect quality of life, breast reduction surgery may become a medically necessary option.
Proper documentation of conservative treatment—including chiropractic care, physical therapy, and other interventions—can help patients demonstrate the need for surgical treatment when seeking insurance approval.
Working with providers experienced in musculoskeletal care can help patients determine whether symptoms can be managed conservatively or if surgical consultation is appropriate.
References
Laporta R, Long T, et al. Evaluation of the impact of physical therapy on patients with macromastia seeking breast reduction surgery. Aesthetic Surg J. 2024;44(6):NP713–NP720. doi:10.1093/asj/sjae058.
Collins ED, Kerrigan CL, Kim HM, et al. The effectiveness of surgical and nonsurgical interventions in relieving the symptoms of macromastia. Plast Reconstr Surg. 2002;109(5):1556-1566. doi:10.1097/00006534-200204150-00009.
Kerrigan CL, Collins ED, Kim HM, et al. Reduction mammaplasty: defining medical necessity. Plast Reconstr Surg. 2002;109(5):1556-1566. doi:10.1097/00006534-200204150-00008.