Breast reduction surgery can help with sleep apnea.

In an article by the Mayo Clinic, it mentions that many women experience breathing issues after breast reduction. For example, they may have difficulty breathing at night because the “reduction of breast size and removal of excess skin can cause changes in breathing patterns.” If a woman has sleep apnea, then this could be a problem for her as well.

The Mayo Clinic states that “your surgeon can help you decide whether to undergo a breast lift or reduction first,” which would be helpful if their patient had sleep apnea and wanted to undergo surgery because of it.

They also mention that after the surgery, one should go back to their doctor for “a follow-up examination and monitoring.” This is important because it allows doctors to make sure that everything is going well with your body after the surgery—including your breathing patterns.

can breast reduction help sleep apnea

According to the American Academy of Sleep Medicine (AASM) guidelines, obstructive sleep apnoea (OSA) is considered a chronic disease, and long-term multidisciplinary management is recommended¹. OSA is a common disorder characterised by repeated respiratory disturbances due to total or partial obstruction of the upper airway during sleep². The prevalence of OSA in Korea is 4.5% in men and 3.2% in women, similar to that in western countries^3,4. OSA is associated with various harmful mechanisms (e.g., intermittent hypoxia, hypercapnia, increased sympathetic activity, sleep fragmentation, and variation of intrathoracic pressure)⁵. Eventually, OSA causes many symptoms (e.g., excessive daytime sleepiness, reduced concentration, memory loss, decreased libido, non-refreshing sleep, insomnia, and morning headache) and serious consequences (e.g. hypertension, coronary artery disease, arrhythmia, heart failure, insulin resistance, and cerebrovascular disease)⁶. Furthermore, recent clinical investigations propose that OSA is associated with diverse cancers^7,8. According to a study by Nieto et al., OSA was associated with total and cancer mortality even after adjusting for age, sex, body mass index, and smoking. Moreover, as the apnea-hypopnea index increased, the association increased. In severe cases, cancer mortality increased 4.8 times compared to the normal group⁷.

Breast cancer is the most common cancer in women and the second most commonly diagnosed malignancy worldwide⁹. Further, breast cancer is internationally accepted as the fifth most common cause among the total cancer deaths¹⁰. Similarly, breast cancer is the second most common cancer diagnosed in women, and the incidence of breast cancer has elevated steadily for decades in Korea¹¹. It is known that hypoxia is strongly involved in oncogenesis, tumour angiogenesis, and metastasis¹². Recent basic researches suggest that intermittent hypoxia, but not chronic hypoxia, may be related to the promotion of breast cancer survival and metastatic growth^13,14.

In addition, clinical researches have reported that OSA may be a risk factor for the occurrence of breast cancer in women^15–18. However, other studies suggest that incidence of breast malignancy in OSA patients is not significantly higher than that in control individuals^19,20. Therefore, the purpose of this clinical investigation is to evaluate associations between OSA and the incidence of breast cancer based on the Korea National Health Insurance Service (KNHIS) database.

Materials and Methods

Data source

The KNHIS covers the entire Korean population²¹. Both outpatient and inpatient claims are reviewed by the KNHIS and include data on diagnoses, procedures, prescription records, demographic information, and direct medical costs. The KNHIS identifies its members by their Korean Resident Registration Number, which removes the potential risk of duplication or omission when accessing the data. The KNHIS database manages claims using the Korean Classification of Disease, sixth edition, a modified version of the International Classification of Diseases, 10^th edition (ICD-10), adapted for the Korean healthcare system. Any researcher can use the KNHIS data if the study protocols are approved by the official review committee. The KNHIS data from 2002 to 2017 is available now.

Study population and design

We defined the OSA group as that including women aged ≥20 years with newly diagnosed OSA (G47.30) between 2007 and 2014. We selected a 5-fold, age-matched control group that had not been diagnosed with OSA. People diagnosed with any types of cancer within five years prior to enrollment were excluded. Therefore, data were available since 2007. In addition, to ensure follow-up of at least 3 years from study participation, only data before 2014 were used. Breast cancer that occurred within one year of enrollment was excluded from the analysis because breast cancer that occurred before or immediately after OSA diagnosis cannot be related to OSA. The primary endpoint of this study was the incidence of newly diagnosed breast cancer. A flowchart showing the enrolment process for this study has been presented. (Fig. 1).

Enrollment flowchart.

Data collection

We collected the following baseline data from the KNHIS database: age (years) and income level (four quintiles). Data on comorbidities including diabetes, hypertension, dyslipidaemia, stroke, chronic obstructive pulmonary disease, and ischemic heart disease were also collected. These comorbidities are defined in the Table 1.

Table 1

Working definitions derived from insurance claims data.

Disease	Working definition
Obstructive sleep apnea	at least one claim under ICD-10 code G47.3
Breast cancer	at least one claim under ICD-10 code C50 and registered as a cancer patient in the National Medical Expenses Support Program
Diabetes	at least one claim per year for the prescription of anti-diabetic medication under ICD-10 code E11-14
Hypertension	at least one claim per year for the prescription of anti-hypertensive medication under ICD-10 code I10-13 or I15
Dyslipidemia	at least one claim per year for the prescription of anti-dyslipidemic medication under ICD-10 code E78
Stroke	at least one claim under ICD-10 code I63 or I64
COPD	at least one claim under ICD-10 code J41, J42, J43, or J44
IHD	at least one claim under ICD-10 code I20, I21, I22, I23, I24, or I25

ICD: international classification of diseases, COPD: chronic obstructive pulmonary disease, IHD: ischemic heart disease.

Statistical analysis

Data are presented as the mean ± standard deviation (SD) for age and as proportions for the remaining categorical variables. Comparisons between two groups were made using the Student’s t test for continuous variables or Chi-squared test for categorical variables. A Kaplan-Meier plot without covariance correction is presented to analyse the risk of breast cancer according to the presence or absence of OSA. The incidence of breast cancer was calculated by dividing the number of events by the product of number of persons at risk and time. To determine the hazard ratio of OSA on the relative incidence of breast cancer, the Cox proportional hazards model was used after stratifying for covariates including income level and diabetes, hypertension, and dyslipidaemia statuses. Two different models were applied. Model 1 was not adjusted by any covariate. Model 2 was adjusted for income level and diabetes, hypertension, and dyslipidaemia statuses. In addition, differences in the hazard ratio were also analysed according to age groups. The results are presented as the mean, and 95% confidence interval (95% CI). All statistical analyses were performed using SAS version 9.4 (SAS Institute, Cary, NC, USA) and R version 3.2.3 (The R Foundation for Statistical Computing, Vienna, Austria).

Ethical approval

The study was exempted from the requirement for informed consent by the Institutional Review Board of Soonchunhyang University Hospital because of the use of publicly available data (SCHBC 2019-08-018). All experimental protocols were approved by the same Institutional Review Board. And all methods were carried out in accordance with relevant guidelines and regulations

Results

A total of 49,570,064 subjects enrolled in the KNHIS in 2007. The research data for the first year are available, and the numbers are comparable with that of each subsequent year up to 2014. Between 2007 and 2014, there were 45,699 female patients who were newly diagnosed with OSA. A total of 228,502 subjects were selected as controls (Fig. 1). An enrolment flowchart is summarised in Fig

How much does breast reduction cost?

The average cost of breast reduction (aesthetic patients only) is $5,913, according to 2020 statistics from the American Society of Plastic Surgeons. This average cost is only part of the total price – it does not include anesthesia, operating room facilities or other related expenses. Please consult with your plastic surgeon’s office to determine your final fee.

A surgeon’s fee for breast reduction will be based on his or her experience, the type of procedure used and the geographic office location.

Your surgeon may offer patient financing plans, so be sure to ask.

Breast reduction costs may include:

• Anesthesia fees
• Hospital or surgical facility costs
• Medical tests
• Post-surgery garments
• Prescriptions for medication
• Surgeon’s fee

When choosing a board-certified plastic surgeon for breast reduction, remember that the surgeon’s experience and your comfort with him or her are just as important as the final breast reduction costs.

Is breast reduction surgery covered by health insurance?

Many health insurance plans cover breast reduction surgery. Your plastic surgeon may need to obtain authorization from your insurer for the surgery. This may require a letter and the submission of photographs. Once authorization is obtained, you will be able to schedule your surgery.

You will be responsible for any copays or deductibles required by your insurer. If your health plan does not cover breast reduction, you may decide to pay for the surgery yourself.