Exploring the causal relationships between breast weight and spinal pain

Almost a half million women underwent breast reduction (mammoplasty) surgery in the United States in 2016, many of which were intended to reduce the weight of the breasts and improve spinal (neck or low back) pain. Alarmingly, despite the popularity of the procedure, there is very little evidence to guide some important decisions like: Who is most likely to benefit from reduction? How much benefit can they expect?

Based on research over the past several decades, we now know that spinal pain is far more than a purely biomechanical phenomenon. When considering potential effects of breast size and weight, other variables beyond torque and tension of the spine and surrounding structures are likely to explain part of the pain. Things like sleep quality, clothing comfort, exercise and activity participation, self-esteem or other things may all be at least partly explaining why some women with large breasts experience no spinal pain, while others get little relief after reduction surgery. At the PIRL we also believe that part of the reason that women tend to be more at risk of chronic neck and back pain than men could be due to the weight of the breasts. Breast surgery also offers a very unique opportunity for causal exploration of spinal pain - there are very few other elective surgeries in which people may go in one direction or the other. If the breast weight/spinal pain hypothesis holds true, then breast reductions leading to improved pain should be mirrored by breast augmentation leading new pain. We have partnered with local plastic surgeons to begin exploring this potentially important yet under-studied pain mechanism.