Before her breast reduction surgery, Sheila Graham endured years of people staring and making insensitive comments. Physically, she was equally pained. Her back ached, her bra straps dug into her shoulders and she had difficulty finding clothes that fit.

Despite her anguish, Sheila didn't seriously consider breast reduction surgery until her sister died of breast cancer and her mother was diagnosed with the same disease. She wondered if her breast size might increase her chances of getting breast cancer, too. Although discussion with her doctor began with talk of breast cancer, it soon spilled over into breast reduction surgery.

For someone with enlarged breasts, breast reduction surgery (reduction mammaplasty) can bring relief from many problems, both physical and psychological. Although breast reduction surgery isn't performed to reduce the risk of breast cancer, a smaller breast size may make it easier to detect a cancerous lump.

"A lot of the discussions that I have with women about breast reduction start at the time of a screening visit for breast cancer," says Sandhya Pruthi, M.D., a breast care specialist at Mayo Clinic, Rochester, Minn. "In Sheila's case, she was concerned about her cancer risk. But the conversation evolved into her concerns over her breast size and the effect it had on her self-esteem and body image."

By age 12, Sheila was already developing large breasts. She measured 36E by the time she reached adulthood.

As she started developing, Sheila began concealing her breast size with large, loose-fitting tops to avoid her classmates' teasing. "Over time, I lost confidence in the way I looked. My body wasn't proportioned for my breast size," she states.

Sheila felt isolated growing up because she couldn't be as physically active as other kids her age. Because running caused her breasts to bounce painfully, she shied away from school sports. "I used every excuse in the book — except my breast size — to avoid sports participation," she admits.

Visits to the beach could be a nightmare. Sheila recalls the time she was literally chased off the beach. It was opening day, and some people had brought their cameras along to capture the day's festivities. Seeing Sheila in her bathing suit prompted several people to try to photograph her. Feeling ashamed and embarrassed, she retreated, covered up and eventually decided to leave because of the unwanted attention.

At 5 feet 3 inches, Sheila's small frame didn't support her breast size well. Pain and discomfort were commonplace. Her sore back, neck and shoulders prompted her to pay regular visits to a chiropractor and a massage therapist. Her shoulders were deeply grooved from bra straps strained by the excess weight of her breasts.

"There's no such thing as a comfortable bra that's a size E," Sheila laments. And they aren't cheap, either. Because of her body proportions, Sheila had difficulty finding a bra that fit well and provided the support she needed. Instead she had to have bras custom-made at a premium price — up to $200 each.

Bras weren't her only problem, though. Sheila wanted shirts and blouses that fit properly and masqueraded her breast size. That meant wearing dark colors and loose, baggy, two-piece outfits. She could never wear a dress because if it fit up top, it was too large down below.

During her three pregnancies, Sheila's breasts became even larger and more troublesome. To change sleeping positions, Sheila had to lift and move her breasts one at a time to roll over. She always slept with her bra on — she needed that extra support, even while sleeping.

After the birth of her first child, Sheila considered having surgery to reduce her breast size. But two things held her back: her husband and her doctor.

"My husband at the time was against my having surgery," Sheila explains. "And I was warned that it might impact my ability to breast-feed if I decided to have more children. My doctor thought I was too young."

But 20 years later, Sheila would reconsider her options. And this time she wouldn't back down.

Having her mother and sister diagnosed with breast cancer prompted Sheila to take steps to protect her own breast health. From her regular screening visits evolved a discussion about changing her breast size.

Like many women Dr. Pruthi sees, Sheila initially wanted to learn ways to detect early signs of breast cancer. "Sheila's breast size worried her because of her family history," Dr. Pruthi says. "But breast reduction surgery doesn't reduce your risk of breast cancer. We spent a lot of time discussing the difference between breast reduction surgery and preventive mastectomy."

The difference lies in the amount of breast tissue removed and the degree to which the breast must be reconstructed. With breast reduction surgery, excess breast tissue and skin are surgically removed to resize and reshape a woman's breast. The goal is to alleviate painful symptoms associated with large breasts. With prophylactic mastectomy, about 90 percent of the breast is removed. The breast is then reconstructed using tissue from other parts of the body or breast implants.

To better evaluate her options, Sheila met with a plastic surgeon to learn more about breast reduction surgery. She also met with a genetic counselor to assess her risk of developing breast cancer, given her family history. Because she was found not to be at high risk of breast cancer, Sheila elected to have breast reduction surgery rather than preventive mastectomy.

Still, it wasn't until three years after her first meeting with Dr. Pruthi that Sheila was ready to go ahead with the procedure.

In anticipation of her surgery, Sheila exercised, watched what she ate and drank plenty of water to promote her overall health and fitness. She prepared mentally, too, having decided that she'd lived with her oversized breasts long enough. The procedure went well, and she was released from the hospital the morning after her surgery. Her new breast size measured 36C.

"My surgery was nothing like I imagined. I expected to be black and blue and in a lot of pain," Sheila says. "Of course it was painful the first week. I was able to take medication to manage the pain. After that, I didn't need anything more than a couple of Tylenol at bedtime."

Sheila's discomfort derived in part from the drainage tubes she had in place — one in each breast — after the surgery. It was awkward sleeping with the tubes and difficult for her to get used to sleeping on her back. She also had to drain the tubes each day. But the tubes were removed after four days, and over the next few weeks her condition gradually returned to normal.

"After the first week, the most difficult thing was to restrict my activities," Sheila relates. Participating in strenuous physical activity — such as aerobics or tennis — would put a strain on her stitches and breast tissue, which could cause complications such as increased scarring. On the advice of her doctors, she took it easy for six weeks.

One of her concerns before surgery was that she might lose sensation in her nipples. But so far, she still has the same sensitivity she had before the procedure. Another concern was how effective breast cancer screening would be in the future.

"It really isn't any different from the screening of those women who haven't had surgery," says Dr. Pruthi. "Imaging the breast tissue may be even easier and less uncomfortable because there's less breast tissue to compress."

Six weeks after surgery, Sheila is healing well. For the first time since her teen years, she can see her feet when she looks down. She's been able to work exercise back into her daily regimen. And her scars are fading fast — only a thin white line remains where the surgeon made the incisions.

What's more, the back, shoulder and neck pain Sheila lived with for so long are gone. "I feel as if I've been given a new back," Sheila says. And her confidence has returned. Since the surgery, she's noticed that people look at her face, not her breasts.

Sheila is excited to try playing tennis and golf, two sports she enjoyed but could never play very well due to her breast size. In the past, she tried to keep her breasts out of the way by wearing a sports bra that was two sizes too small. When she would reach down to pick up a tennis ball, for example, she constantly readjusted her breasts, tucking the excess tissue beneath her arms. Now she's hopeful her smaller breast size will improve her game.

And she's busy shopping for new clothes. Gone are the dark colors she felt she had to wear. Topping her list of things to shop for is a swimsuit.

"It will be wonderful to wear a swimsuit and feel comfortable," Sheila says. "This is the best thing I've ever done. The only regret I have is that I didn't do it sooner."

Editor's note: Since sharing her story in 2003, Sheila reports that she's doing great. She hasn't experienced any complications from her surgery. In fact, she's planning on running a half marathon — something she couldn't have done before the surgery. She's still very happy with her decision to reduce her breast size.