October 12, 2026, 11:59 am | Read time: 7 minutes
Particularly large and therefore heavy breasts are known to contribute to back and neck pain. The additional weight shifted forward can mechanically affect posture, increasing the strain on the back, neck, and shoulders. A study has now examined the link between macromastia, a pronounced enlargement of breast tissue, and various neurological and sleep-related disorders. According to the results, women with large breasts are more often affected by several of these conditions, including migraines.
Mechanical and Neurological Complaints Due to Macromastia
Macromastia (also called breast hypertrophy) refers to excessive growth of breast tissue. There is no uniform weight threshold for diagnosis, but a rough guideline is a weight of more than 500 grams per breast. The presence of macromastia is determined by possible physical complaints in addition to individual characteristics.
It is generally known that macromastia can contribute not only to musculoskeletal complaints but also to nervous system issues–such as headaches. Therefore, health insurance companies also consider headaches as a possible indication for breast reduction.*
So far, the connection between large breasts and certain types of headaches, neck pain, and sleep-related disorders has been little researched. The authors point this out at the beginning of the present study.1 The study aimed to better understand the relationship between macromastia and various neurological and sleep-related conditions.
Also of interest: Gynecomastia–Causes and Treatment of Male Breasts
Study Details
The study focused on five conditions or complaint forms:
- chronic migraine,
- neck pain,
- cervical radiculopathy,
- occipital neuralgia
- and obstructive sleep apnea.
Cervical radiculopathy refers to complaints that can arise from nerve root irritation or damage in the cervical spine area. Additionally, occipital neuralgia is a nerve pain disorder–it leads to sudden pain in the back of the head. In obstructive sleep apnea, the upper airways can narrow or close during sleep, leading to breathing interruptions, and it can also have unwanted health consequences beyond that.
Also of interest: This Diet Can Prevent Snoring and Sleep Apnea
The researchers wanted to determine whether women with macromastia are more often affected by the described conditions. They were also interested in the role these complaints play in the decision to undergo breast reduction. To this end, they compared the surgery rates of women with and without the respective diagnoses within this group.
Study Design and Methods
The study was designed as a retrospective cross-sectional study, meaning existing medical data within a specific dataset were evaluated retrospectively. These came from medical records of patients who received treatment at an academic neurological specialty practice between January 1, 2017, and December 31, 2024. The researchers included 347 women diagnosed with macromastia based on the ICD-10 diagnosis code N62–which stands for excessive enlargement of breast tissue–and 340 women without the diagnosis in the analysis.2
A special statistical method called propensity matching was used to make the groups more comparable. This allows individuals to be matched based on selected characteristics. In this case, the matching was done by age, ethnicity, and body mass index (BMI). In their statistical analyses, the researchers also considered whether depression or anxiety disorders were present to account for their possible influence on the results.
More Neurological and Sleep-Related Disorders
The analysis showed that women with macromastia, after statistical adjustment, suffered more frequently from several neurological and sleep-related disorders than women without the diagnosis. The most significant difference was in complaints in the neck area and cervical spine.
To understand the results at a glance: The adjusted prevalence ratios (aPR) below describe how often a condition occurs in a specific group compared to a reference group; possible influencing factors are statistically considered.
- Chronic Migraine: In women with macromastia, the adjusted prevalence was 1.40 times higher–equivalent to a 40 percent higher prevalence (aPR 1.40; 95 percent confidence interval 1.16–1.68; p = 0.003).
- Neck Pain: Here, the adjusted prevalence ratio was 2.04. Neck pain was thus about twice as frequently documented in women with large breasts (aPR 2.04; 95 percent confidence interval 1.65–2.53; p = 0.003).
- Cervical Radiculopathy: For this condition, the adjusted prevalence was 2.38 times higher (aPR 2.38; 95 percent confidence interval 1.39–4.06; p = 0.026).
- Obstructive Sleep Apnea: The adjusted prevalence was 1.54 times higher (aPR 1.54; 95 percent confidence interval 1.23–1.95; p = 0.003).
- Occipital Neuralgia: Here, the difference was not statistically significant.
After statistically accounting for various influencing factors, differences between women with macromastia and the control group remained. Women with large breasts had a higher average BMI, and depression and anxiety disorders were more frequently documented in this group.
It was also found that women with macromastia were more likely to undergo breast reduction if they suffered from neck pain than women with large breasts without those complaints. However, this correlation was not confirmed for the other pain diagnoses studied.
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Macromastia Favors Secondary Conditions
At this point, it should be acknowledged that due to the study’s nature as a cross-sectional study, which did not systematically track the temporal course of diseases, no definitive statements about cause and effect can be derived.
Nevertheless, the results suggest that certain neurological and sleep-related disorders occur more frequently in the presence of macromastia than in women with normal-sized breasts. Chronic migraine and obstructive sleep apnea were more frequently documented in the group with large breasts. However, the most notable connection was with neck pain and cervical radiculopathy.
The observations suggest that for women with pronounced breast growth and recurring complaints, it may be sensible to have the various possible causes medically clarified. However, they should not be understood to mean that headaches are automatically due to high breast weight.
Nor can it be inferred from the results that breast reduction is the solution to combat migraines or sleep apnea. Further studies are needed to determine whether the complaints improve after treatment of macromastia, which should follow patients over a longer period. The complaints before and after treatment must be systematically recorded.
In summary, the study provides a solid impetus for further research into the health connections. In the discussion, the authors write that other factors such as physical strain and comorbidities could play a role. The present analysis does not indicate the mechanisms by which the observed connections occur.
Limitations
Due to the study design, the results should not be interpreted as indicating that large breasts caused the associated conditions. It should also be noted that the data evaluated came from an academic neurological specialty practice. They documented women who specifically sought neurological care. This makes it difficult to generalize the results to all women with macromastia, especially those who do not have or have not treated such complaints.
Moreover, despite statistical matching, differences between the groups remained. Among other things, the average BMI was generally higher in women with macromastia, and mental illnesses were significantly more frequently documented in them. Although these factors were considered in the analyses, it cannot be ruled out that additional, unrecorded influences affected the results.
Finally, the diagnoses documented in the medical records were used for the evaluation. If entries were missing or incomplete, this could have influenced the results. Additionally, absolute numbers of how many women were affected by each condition are missing. Thus, the results indicate which conditions were more common in women with macromastia. However, they do not provide a reliable statement about the personal risk of a single woman with large breasts, for example, for migraines.
*For cost coverage, a single symptom is usually not sufficient–generally, additional medical findings must justify the necessity of the procedure.