Many people think large breasts represent beauty and femininity. But ask women who have lived with a pair of those envied breasts what it's really like, and you'll hear differently. Some will tell you about constant back and neck pain, gouges in their shoulders from bra straps, deteriorating posture and an inability to participate in certain activities. From their perspective, their breasts represent too much of a good thing. Less would be better.

As technology advances and surgical techniques improve, more women are turning to plastic surgeons to help them adjust their breast sizes to a healthier and more comfortable level. According to the American Society of Plastic Surgeons, about 105,600 breast reduction surgeries (reduction mammaplasties) were performed in 2004.

Breast reduction surgery is for women who have large breasts and want to resolve one or more of the following associated problems:

• Chronic back, neck and shoulder pain
• Poor posture
• Skin rash under the breasts
• Deep grooves in the shoulders from bra strap pressure
• Restricted levels of activity
• Self-esteem problems
• Difficulty wearing or fitting into certain bras and clothing

Women who have breast reduction surgery span a range of ages, from their teens to their 80s. However, for younger candidates, it's usually wise to wait until at least age 20 to make sure the breasts have stopped growing.

If you hope to have children, you need to keep in mind special considerations. Breast reduction surgery may decrease your ability to breast-feed. And the overall appearance of your breasts may change after having a baby.

Your first consultation with a plastic surgeon is a good time to ask questions, get his or her opinion, and find out exactly what breast reduction surgery entails. Make sure you fully understand what you're about to go through and any possible complications. Your surgeon will also talk with you about your expectations of breast reduction surgery.

The American Society of Plastic Surgeons lists a number of things you can expect when visiting your plastic surgeon, including:

• A detailed description of the procedure and resultant scarring
• Examination and measurement of your breasts
• Photographs taken of your breasts for insurance preapproval and for reference use during and after the surgery
• Discussion of factors that may affect the surgery, such as age, size and shape of your breasts and skin condition
• Discussion about the positioning of the nipple and areola — the circular, pigmented area around your nipple
• Explanation of the type of anesthesia used
• Determination of where the surgery will be performed
• Costs and insurance considerations

You'll also discuss your desired breast size. That, along with any requirements of your insurance provider, will factor into how much breast tissue the surgeon recommends to remove.

Your insurance provider might cover the expense of breast reduction surgery. Insurance providers stipulate that the procedure be medically necessary, not cosmetic. For instance, a certain amount of breast tissue may need to be removed. It's a good idea to check with your insurance company beforehand.

If you've never had a mammogram, you may be required to get one before surgery, depending on your age and family history of breast cancer. If you smoke or use other nicotine products, you'll be asked to stop for a period of time before and after the surgery. Nicotine use impairs blood flow to the tiny vessels that supply the nipple area.

Follow your surgeon's directions in preparing for surgery. This might include restrictions on eating, drinking or taking medications.

Surgeons use different techniques, but the most common one involves an anchor-shaped incision that goes around the areola, down the breast toward the crease between the breast and abdomen, and then horizontally in the crease under the breast. The surgeon removes excess breast tissue, fat and skin to reduce the size of your breast.

In most cases, the nipple and areola remain attached to the breast. If the breasts are very large and droopy, however, the surgeon may have to remove the nipple and areola and reattach them at a higher position as a skin graft. In this case, detaching the nipple and areola from their blood vessels and nerves causes them to permanently lose sensation and can result in the inability to breast-feed.

Before surgery, your doctor measures and puts marks on your breasts. Breast reduction surgery usually is performed under general anesthesia that you inhale as a gas or receive through an intravenous (IV) line. It affects your entire body, inducing a temporary state of unconsciousness.

Breast reduction surgery generally lasts two to three hours. After the surgery, you wake up in a recovery room, where you're monitored for any complications.

After surgery, your breasts are covered with a gauze dressing or elastic bandages. A drainage tube may be placed under each arm for one day to several weeks. Medication for pain and nausea as well as antibiotics to decrease your chance of infection will be available for you. You may stay in the hospital overnight, but outpatient surgeries also are common. Make plans for someone to drive you home from the hospital.

During the initial recovery period, your breasts likely will feel very tender and sensitive. They may also be swollen and bruised. Your surgery results in permanent breast scars, but they're typically hidden by a bra or swimsuit.

You may be able to return to work in about two to three weeks if your job doesn't require strenuous activity. It may take up to a month for the pain and sensitivity to disappear. And it may take even longer — six months or more — for your final breast shape to become apparent.

Benefits of the surgery include increased comfort in your upper back, neck and shoulders; less shoulder pressure from bra straps; increased ability to exercise and participate in physical activities; and a more positive self-image. The surgery may also help you breathe and sleep easier. The surgery results in a high satisfaction rate among women who have it done.

As with any major surgery, risks are involved, such as bleeding, infection and an adverse reaction to the anesthesia. Other possible risks specific to breast reduction surgery include:

• Loss of sensation in the nipples and areolae
• Impaired blood supply to the nipples, leading to loss of the nipples and scarring
• Inability to breast-feed
• Asymmetry in size, shape, position and contour of the nipples or breasts, which may lead to further surgery to improve appearance
• Altered body image and a period of adjustment to get used to the change in your appearance

Understanding what's involved in breast reduction surgery and weighing the benefits and risks of surgery can help you decide if it's right for you.