Can Large Breasts Cause Back and Neck Pain?

There are many people who have struggled with back and neck pain for years, had physiotherapy, managed with painkillers and never found out exactly why. In some of these cases the cause is breast size.

This article is not intended to make a diagnosis — it explains which findings point to this picture and how the assessment is carried out.

What happens mechanically?

The weight of the breast tissue sits in front of the trunk, outside the spine's axis of rotation. That weight pulls the shoulders forward, forces the upper back muscles to produce a constant counter-force and changes the curve of the neck.

The result is that the muscles never get to rest. That is why the pain increases through the day and eases when lying down — this is the typical pattern.

This load can be measured. In a study published in Plastic and Reconstructive Surgery , women who underwent breast reduction were examined during a lifting movement before surgery and three months after: the peak compressive force at the low back fell by an average of 35 per cent , and the functional disability score improved by 76 per cent. The study included 11 people — a small group, but the measurement was based on motion analysis, not a questionnaire.

Findings that may sound familiar

If several of these findings occur together, the cause of the pain may not be a spinal or muscular problem on its own.

Why is it noticed so late?

There are several reasons, and all of them make sense:

• You cannot weigh your own body. For someone who has carried the same load all their life, it feels "normal".
• The pain is felt elsewhere. Nobody looks for the cause of back and neck pain in the chest area.
• It is assumed to be cosmetic surgery. "This is an aesthetic procedure, my problem is medical" — and so it never comes up.
• It is not talked about. Because the complaint is not voiced, the doctor does not ask either.

This escapes not only patients but doctors too. A review published in The Spine Journal in 2025 reminds spine specialists explicitly: macromastia is usually not the first cause that comes to mind in a woman presenting to a spine clinic; awareness can prevent unnecessary spinal interventions that arise from overestimating how much age-related changes in the spine contribute to the pain.

Tip — Physiotherapy, exercise and a support bra can reduce the pain in this situation but do not remove the cause. If you have been in a course of treatment for a long time without benefit, it is reasonable to ask whether the cause has been correctly identified.

The limits of conservative treatment have also been measured. In a prospective study comparing 179 women who had surgery with 88 women with large breasts who did not, none of the approaches — weight loss, physiotherapy, special bras or medication — provided lasting and adequate relief . In the same study, 50 per cent said they had upper back, shoulder, neck and lower back pain "all or most of the time" before surgery; afterwards the figure fell below 10 per cent.

How is the assessment done?

What is examined at the consultation:

• Breast volume and tissue structure
• The depth and permanence of the strap groove on the shoulder
• Posture, shoulder position and spinal curvature
• Skin findings in the inframammary fold
• The course of the pain: how it changes during the day, what relieves it
• Treatments tried before and what they achieved

An orthopaedic or physiotherapy assessment may also be requested — particularly if there is an accompanying finding in the spine.

What does surgery do in this situation?

Breast reduction removes the mechanical load by reducing the weight being carried. During the operation the volume is reduced and the breast is reshaped at the same time.

But the expectation must be set correctly: correcting years of poor posture and muscle tension takes time, and physiotherapy support after surgery is often needed. The operation removes the load; the muscles recovering is a separate process.

In a study matching operated and non-operated patients with similar characteristics, quality of life improved significantly in every domain in the operated group; in the non-operated group no clear improvement was recorded over the same period. This finding is not in itself a recommendation: for someone with mild symptoms, or who is not considering surgery, watchful follow-up is also a reasonable option.

Coverage under Turkish social security

When this picture is documented, the procedure may be assessed for coverage under Turkish social security. Under the reduction mammoplasty article of Turkey's Health Implementation Communiqué, alongside the clinical finding of macromastia, certain ICD-10 diagnosis codes are required to appear on the medical board report.

Because the report conditions and the code list can change over time, the current text of the communiqué should be checked before applying. This section is for general information; the coverage decision is determined by the medical board report and the assessment of the relevant institution.

It should be added that the numerical thresholds set for the amount of tissue removed are administrative rather than medical limits. In a prospective study of 59 patients, even in operations removing less than 1000 grams in total, upper back, lower back, neck, shoulder and arm pain, along with headaches and strap-groove complaints, all decreased significantly (p < 0.00002).

References

1. Aref Y, Bono CM, Najafian A. Back pain in patients with macromastia: what a spine surgeon should know? Spine J. 2025;25(3):403–410. PMID 39505016
2. Foreman KB, Dibble LE, Droge J, Carson R, Rockwell WB. The impact of breast reduction surgery on low-back compressive forces and function in individuals with macromastia. Plast Reconstr Surg. 2009;124(5):1393–1399. PMID 20009823
3. Collins ED, Kerrigan CL, Kim M, ve ark. The effectiveness of surgical and nonsurgical interventions in relieving the symptoms of macromastia. Plast Reconstr Surg. 2002;109(5):1556–1566. PMID 11932597
4. Spector JA, Karp NS. Reduction mammaplasty: a significant improvement at any size. Plast Reconstr Surg. 2007;120(4):845–850. PMID 17805110
5. Elfanagely O, Othman S, Rios-Diaz AJ, ve ark. A Matched Comparison of the Benefits of Breast Reduction on Health-Related Quality of Life. Plast Reconstr Surg. 2021;148(4):729–735. PMID 34550925

About the Author

Op. Dr. Yasemin Aydınlı is a graduate of Hacettepe University English-medium Faculty of Medicine. She completed her specialization training in Plastic, Reconstructive and Aesthetic Surgery at Ankara University Faculty of Medicine. She practices aesthetic and reconstructive surgery in Istanbul, with breast reduction, breast augmentation, breast lift, abdominoplasty, and body contouring surgeries among her primary areas of interest.

Frequently Asked Questions

This content is for general information only and does not replace medical advice. Every person is different; suitability and the process can only be determined by a personal examination and consultation.

Op. Dr. Yasemin Aydınlı

Plastic, Reconstructive and Aesthetic Surgeon

Offers personalized aesthetic solutions with a priority on naturalness and balance.