When the bra cannot hold

Makena Mugaa's breasts before her surgery.
Makena Mugaa's breasts before her surgery.

The night Makena Mugaa dislocated her shoulder while a student at St George’s Secondary School in Nairobi, was no ordinary one.

It was a sign of things to come. Like a scene from an action movie “the shoulder snapped and when rushed to hospital, I was given a strong pain reliever and it was snapped back in,” she says.

Makena says that she dislocated her shoulder in her sleep and because it was unprovoked “the general assessment was that my shoulder ligaments were weak. No link was made to my breasts.”

This was back in 2002. “I was in form two and my breasts were not too big to raise alarm,” Makena explains.

She weighed 75 Kgs and her bra cup size was a fairly normal 38c.

But in her second year at the Catholic University of Eastern Africa things took an interesting turn for the 28-year-old banker cum lawyer.

“My breasts were now growing uncontrollably, it seemed like overnight, I had moved from a 38c to a 42gg which is a very big bra size,” she says.

So big that she could not find bras locally and had to have them imported from Europe “and I would have to change bras every four months because my breasts were still growing.”

Needless to say, this not only affected her self-esteem but made it difficult for her to engage in the extra curriculum activities that she loved including swimming.

“I would draw a lot of attention because while my weight remained more or less the same, my bust was very big, and I did everything I could to make it appear smaller,” Makena explains.

Her efforts were nothing medical and included hunching her back to hide her breasts which experts say can in itself result into serious health complications.

Although often big breasts are dismissed as genetic, Makena says that every woman in her family has normal sized breasts.

As her breasts continued to grow, her shoulders did not fair too well and she underwent surgery to strengthen the joints around her shoulders.

But that was not enough, in 2010, she underweight her second surgery.

“It was during this time that an orthopedic surgeon suggested that I consider having the weight of my breasts reduced,” she says.

This came as a surprise to Makena.

“Not only had I not realised that I had an actual medical condition relating to my breasts, but that breast reduction surgery could be done without going abroad,” she says.

According to Prof Stanley Khainga, a consultant plastic and reconstructive surgeon at Aga Khan Hospital who performed the operation, Makena was suffering from macromastia or gigantomastia.

“These are abnormally enlarged breasts in the females, it could be genetic or hormonal due to hormonal imbalances,” he says.

According to Prof Khainga, Makena’s breasts were very heavy “we removed more than three kgs of breast tissue on each side. Removing more than six Kgs of breast tissue is no small matter.”

But the 2010 operation that took seven hours changed Makena’s life “on my left breast, 3.4 Kgs of breast tissue were removed and 3.9 Kgs on my right breast.”

Makena now says that she can walk upright, can undertake heavy tasks without the risk of snapping her shoulders and all the suffering she underwent is now a distant memory.

But this change did not come cheap. Makena says that it cost her Sh500,000 at a private hospital in Nairobi.

“I meet many women who would like to have their breasts reduced but it is indeed expensive because insurance will not cover this surgery. They consider it cosmetic,” she says.

Prof Khainga says that this is where insurance companies have gone wrong and they need to re-evaluate this caveat.

“If you are reducing more than a kilo of breast tissue, it is an indication that the condition is serious,” he says.

According to Prof Khainga, in the Western world, for any breast tissue reduction 400grams upwards, it is covered by insurance.

“Reason being that the person is likely to have respiratory and cardio-vascular problems which will ultimately cost the insurance more,” he says.

A woman with heavy breasts could also fracture her spine, which would cost even more to fix.

But Prof Khainga says that though the procedure is being carried out at Kenyatta National Hospital, accommodation is a problem.

“A female with such heavy breasts has to stay in the hospital for three to four days because the drains have to come out,” he says.

This is a problem because they would need to share the ward with patients suffering from burns and infected wounds, and due to congestion, they risk infection.

As a result, Makena says that she is working towards establishing a foundation to raise awareness on this condition and to support those suffering from it.

Understanding macromastia or gigantomastia

Experts say that while the condition is quite common, there is very little awareness around it. Most of them assume its genetic.

Medical doctors such as Daniel Kioko say that macromastia is a disabling condition caused by excessive growth of breast connective tissue.

“It is defined by breasts that contribute at least three percent of a person’s total body weight,” he says.

As ladies grow, Prof Khainga says that the target organ, in this case the breasts, respond differently to the normal hormones and at times they can respond excessively.

He says that obesity can cause this abnormal growth. The condition can also be enhanced by a pregnancy due to the hormones released in preparation for breastfeeding.

Common signs are neck, shoulder and back pains. Big breasts can also cause the backbone to fracture or bend sideways, a condition referred to as scoliosis.

“The bra straps also dig into the shoulders causing laceration. If you pull the straps in some ladies, you will see old scars,” he says.

He also says that in some cases, where the breast sits on the abdomen, “the place becomes moist, fungi infected and has a bad odor.”

Some have to sleep in a semi-sitting position, because their breasts are so heavy that they cannot lie flat.

Experts also say that the weight of the breasts can also exert a lot of pressure on the cardiac system and lead to heart failure.

After breast reduction, “they have to undergo physiotherapy to help them resume normal posture, and to walk normally,” Prof Khainga says.

There are no side effects to the breast reduction surgery and the women can breastfeed. However, when the breasts are too huge, breastfeeding may be out of the question.

For instance Makena Mugaa cannot breastfeed as a result of

the technique used in her case, known as a nipple graft.

“When the breasts are so huge, the blood supply to the nipple is affected so we just do a nipple transplant, as opposed to carrying the nipple with the breast tissue,” he says.

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