NEW YORK TIMES
The women walk into the surgeons’ offices with photos cued up on their phones. Miley Cyrus. Keira Knightley. Bella Hadid. I want my breasts to look like this, they say. They’ve already spent hours on YouTube watching plastic surgeons’ infomercials, on Instagram poring over before-and-afters, and on TikTok, where an army of ordinary women post about their breast reductions. “Ask me,” they say. Whether their nipple sensation has changed. What their boyfriends said. Whether they cared.
Sometimes a woman walks into her initial consultation with the bralette she hopes to wear. Or she’ll say, “I can’t wait for my braless summer.” Or that she looks forward to shopping for a $15 bikini top at Target, something cute and bright or floral, signaling a life so carefree its wearer might never need fat straps or eye hooks again. Breast reduction patients use words like “fit” and “strong.” They talk about “yoga boobs.”
Friends tell friends about their breast reductions. A surgeon named Donald Mowlds, in Newport Beach, Calif., sees a photo on his feed of a group of women at lunch and realizes he’s operated on all of them. Kelly Killeen, a surgeon in Beverly Hills, says one of her patients flashed her breasts to a friend at the makeup counter at Neiman Marcus and the friend walked across the street to make an appointment. Jamie Hanzo, who is 26 and lives in New Orleans, uses the same plastic surgeon as her mother.
Tiffany Dena Loftin, who is 35 and a labor organizer in Atlanta, was emboldened to undergo breast reduction after scrutinizing the naked breasts of her friend Jamira Burley, 36, over FaceTime: her bandages, her incisions, her bruised nipples. Loftin doesn’t like hospitals. Needles terrify her. But, Burley said, “Tiffany, the relief and the joy that I’m feeling is also available to you on the other side of your fear.”
After liposuction, breast augmentation is the most popular cosmetic surgery procedure in the country, with about 300,000 women choosing implants each year. But the growth area in cosmetic breast surgery is in making them smaller. In 2023, more than 76,000 American women had elective breast-reduction surgery, a 64 percent increase since 2019, according to the American Society of Plastic Surgeons. (That number doesn’t include gender-affirming top surgeries or breast reconstructions after illness.) The increase is reflected across all age groups, but especially among women under 30, who are enthusiastic consumers of plastic surgery in general, including face- and forehead lifts, procedures favored mostly by women their mothers’ age. Girls younger than 19 represent a small but fast-growing part of the market.
“I had big breasts my whole life,” a teenager’s mother will tell Dr. Mowlds in his office. “Here’s my daughter. She has questions.”
Reduction surgeries deemed “medically necessary” and covered by insurance represent a far smaller group than cosmetic operations, but the broad trend lines — a recent, sudden increase, especially among younger women — are the same, according to an analysis by the Health Care Cost Institute.
Not only do more women want to be small; they want to be smaller. Jerry Chidester, a plastic surgeon in Salt Lake City, said his patients used to ask for C cups. Now, they want Bs. He often does five breast reductions a week, mostly on young, postpartum mothers.
American women are perpetually at odds with their bodies, which reliably fall short of the perfection embodied by models and influencers. Seventy percent of women worldwide dislike the size of their breasts. This may be because a woman’s breasts are subject to constant evaluation and critique. Always on view, breasts allude to a woman’s naked body. They evoke in others thoughts and feelings about her femininity, her sexual availability, her age, her weight, her attractiveness, her maternal role. Breasts can be objects of fascination, desire and fetishization. Also revulsion and derision. Large breasts draw more attention — positive and negative — than smaller ones. A 2013 market survey by a lingerie maker put the average American cup size at DD, a factoid that circulates widely online. The majority of breast-reduction patients are bigger than that. The weight of large breasts can cause back, neck and shoulder pain. They can impede mobility and fitness.
So to decide to reduce them, to make them lighter, smaller, easier to carry and cover — more discreet — can be seen as an act of self-love and empowerment, a woman’s prioritization, finally, of her own comfort and independence over what others have traditionally found sexy. Or it can be interpreted as self-loathing, an agreement with a sexist culture that can also regard larger breasts that aren’t youthfully round and upright as repulsive: droopy, flabby, jiggly, hard to contain.
Or the choice to undergo breast reduction can be, in some paradoxical way, pragmatic. Perceiving, rightly, that she can’t change the culture she lives in, a woman might find that the easier path to loving her body is to alter herself.
Doctors say their patients seem willing to live with the scars, which encircle the nipple, course down the lower part of the breast like a longitude line, and sometimes trace the ribs under the breast where an underwire might sit. During their FaceTime sessions, Loftin talked to Burley, who lives in Oakland, about what she was sacrificing — being conventionally pleasing to men — and about whether her boyfriend would recoil from the scars or privately resent the dramatic change in her shape. But Burley just seemed so much brighter, Loftin said, that she was inspired to call a surgeon, too. Loftin is grateful to her partner, who paid for her consultation and accompanied her to every appointment and through her recovery. If he had conflicting feelings, he kept them to himself.
And many women are undeterred by the possibility that the surgery might impede breastfeeding. According to one research review, women who have had a reduction are more than three times more likely to be unable to breastfeed. Cheyenne Lin, who is 26 and a substitute teacher in Fresno, Calif., is married and said she probably wants children someday, but most women in her family have struggled to breastfeed.
“So when they said, ‘You might not be able to breastfeed,’ I was like, that was not even on my list of concerns,” Lin said. She had her reduction surgery in July.
The ‘Ideal’ Breast
In 2012, an English plastic surgeon named Patrick Mallucci published in a medical journal his article “Concepts in Aesthetic Breast Dimensions: Analysis of the Ideal Breast,” an attempt to define breast perfection. He compared the effort to Leonardo da Vinci’s delineations of the human face into thirds and fifths. How could surgeons hope to reshape and upgrade women’s breasts, Mallucci argued, without knowing what they were aiming for?
It was the era of aspirational voluptuousness: The Kardashians were peaking and the celebrity gossip site TMZ reported that “Kate Upton’s Boobs Defy Gravity!” In 2007, plastic surgeons performed nearly 350,000 breast augmentations, a record, and the procedure remained the most popular in the nation until 2021.
Mallucci based his analysis on an examination of 100 photos of topless women that ran on the website of the tabloid The Sun, reasoning that their breasts reflected a consensus on attractiveness. Many Sun readers considered the photos to be soft porn (and The Sun later ceased publishing them), but Mallucci pushed back when I called him and pointed that out.
“Those girls were selected by an editorial board,” he said. “You can critique, but all they represent are naturally attractive breasts.”
In his article, Mallucci described, in the language of poles, curves and angles, what these breasts had in common. They were rounded below the nipple, not too round above it and the nipple sat high on the breast. On “unattractive” breasts, he wrote, the nipples pointed downward.
Dr. Killeen remembers learning about Mallucci’s standard as a medical resident, and fuming. Most women’s breasts just don’t look like that. “I hate the word ‘ideal,’” she said in an interview. If an ideal breast is attainable only through surgery, she added, “Should it be ideal?”
“Listening to men tell us what our body parts should look like was disgusting,” she said. “I was like, What is happening here? Is there any situation where there’s a bunch of women discussing — with no input from men — what their personal, sexual body parts should look like?”
Only about 20 percent of plastic surgeons are women, and patients considering breast reduction describe frequently encountering a sexist professional culture. On the Reddit board r/Reduction, women post about surgeons who make comments about their weight, express their own preferences for “cute and round” breasts and defer to husbands or partners in the examination room. Suma Kashi, who is 41 and lives in Los Angeles, recalled talking to a prospective surgeon who said, “I don’t think your husband is going to like this.”
“What does my husband have to do with this?” Kashi said in an interview. “Come on, man. Please.”
These ideas about breast perfection infuse the worlds of young girls. Teenagers with large breasts frequently struggle with low self-esteem and eating disorders. When Cheyenne Lin was in sixth grade, she said, she was standing in line at recess when a teacher yanked her shirt collar, which had drifted down her shoulder, up to her neck. Rae Wolk, a college student from Bedford, Mass., joked with her friends in high school that she was “drawn wrong.”
Young women learn to cover themselves up under extra-large hoodies and T-shirts. They compress with double jog bras and stop figure skating, dancing and running track. They hear the negative words directed at their bodies — droopy, deflated, “stretched the hell out,” in the words of one plastic surgeon I spoke to — and turn these descriptions on themselves. Before her reduction, Lin’s breasts were “kind of pancake-like, kind of flat and saggy,” she said. She began to hate them so much that she averted her eyes when she toweled off after the shower.
Since puberty, Loftin said, she has had “this notion, this sort of stigma, that growing breasts was a bad thing.” When her body started to develop, her mother accused her of having sex — she wasn’t — and “I felt like I was being punished,” Loftin said. Even when her friends admired her body, Loftin shrugged them off. “Any attention was bad attention,” she said.
What clinched her decision to get a breast reduction was the day she saw herself as she imagined others saw her. On the morning after her 35th birthday, a friend texted her a short video of her party the evening before. In it, Loftin was singing and twerking at a Los Angeles karaoke bar. She was wearing a halter top. And all Loftin could see in the video were her own breasts.
“I was watching how much movement my breasts had, when I was intending to shake my ass,” she said, starting to laugh. “The point of the dance is not to move your titties. But that’s where my gaze was drawn because of how large they were. And I wasn’t sick of myself, but it made me feel” — here she paused for a moment — “over it.”
The video, she said, was the push she needed — a reminder that “I’m actually large and top-heavy. I’m uncomfortable with it. And I don’t like it. And it’s in my way.”
Who Pays?
If a single procedure can alleviate back pain and headaches, promote mobility and fitness, and also enable a woman to un-selfconsciously wear a tube top, is it a medical procedure or a cosmetic one? For the patient, of course, it can be both. But from the point of view of an insurance company, it’s one or the other, reimbursable or not.
Most insurers want proof of medical necessity: back, shoulder or neck pain; grooves in the shoulders from bra straps; skin rashes. They require evidence that the patient has tried nonsurgical remedies, including pain relievers, physical therapy, and custom support bras. And most plans include minimums for the number grams of breast tissue that must be extracted based on a woman’s breast size, height and weight.
Suma Kashi is 5 feet 2 inches tall and before her reduction was wearing an H-cup bra. When she was initially considering surgery, she weighed 178 pounds, and her insurance company told her that she would have to get 755 grams — more than a pound and a half — per breast removed to qualify for reimbursement. But to get her to her desired C cup, her surgeon estimated that she would need to remove much less: 415 grams per breast. Kashi tried to reduce what the insurance company called her “B.S.A.” — body surface area — by losing 25 pounds. Even so, her claim was denied.
“They just kind of set impossible guidelines,” she said. She ended up paying out of pocket: about $23,000. Jamira Burley, on the other hand, was 5 feet 5 inches and weighed 185 pounds before her reduction. She wore a 34DDD bra and her insurance covered her surgery. She now wears a B cup and, after additional weight loss, weighs 155.
Cheyenne Lin couldn’t have paid for her breast reduction on her own. She hated the way her breasts hung down to her belly, how one was a full cup size larger than the other, and she hated the limitations on what she was able to wear. “When you go bra shopping for bigger boobs, they’re like, ‘Here are your options. Black and tan,’” she said. “I guess they don’t want us to feel pretty.”
But mostly she was hurting. Starting around her sophomore year in college, she had constant searing pain between her shoulder blades. The difference between the size of her breasts had affected her posture, placing uneven weight on her back. She couldn’t go hiking with her friends or snowboarding with Jaylen Lin, the exchange student who became her husband. Lin began to feel that she couldn’t participate in her own life; Jaylen even had to help her remove her clothes from the dryer. At 21, she said, “I felt like I was trapped in the body of someone in their 70s.” She was diagnosed with depression.
Lin does not come from an affluent family. She was covered by Medi-Cal, California’s Medicaid program, and her general practitioner wasn’t interested in helping her navigate the route to the reduction surgery, she said. When she Googled the surgeon who accepted her insurance in Fresno, his ratings were so low she didn’t make the call.
Jaylen’s parents in Taiwan stepped in after he spoke with them on the phone. They helped the couple find an insurance plan with an out-of-network option and gave the Lins a credit card to pay Dr. Killeen’s $15,600 fee.
Before the surgery, Jaylen’s father sent the couple a text. “It said, ‘Don’t worry about anything. Dad will take care of it.’” Lin expects her insurance to reimburse between $2,000 and $4,000 and considers the gift from her in-laws life changing. Her back pain is gone. She hasn’t taken antidepressants since her surgery.
‘I’m Not Doing This for Men’
What does it mean to want to be small? Do smaller breasts reflect a refusal to inhabit any longer the fantasies of men? Tiffany Loftin believes her breast reduction is a signal of her confidence and autonomy. To spend her own money to live in a body that works better for her is power, no matter what the older women in her life tell her about how beautiful and perfect she was before.
Women in her friend groups “don’t need the expectations of Western beauty or male beauty to live up to. This is my body. I’m not doing this for men,” she said. An earlier generation might have needed male approval for their physical selves. But for her, “that’s not true. And I don’t want to look like that.” A month after her surgery, Loftin went to the E.R. with a breast infection, leading to additional surgeries. Even so, she has no regrets.
Cheyenne Lin considers her reduction an explicitly political act, a salvo in the culture wars around reproduction and motherhood. By potentially sacrificing her ability to breastfeed, she is prioritizing her own health and happiness over the evolutionary role she is expected to play.
More than half of women ages 18-34 say they don’t want kids or aren’t sure. With the Supreme Court and state legislatures curtailing reproductive rights, “we already have so many people trying to take our bodily autonomy away,” Lin said.
Sarah Thornton, 59, a sociologist who lives in San Francisco, was a B cup before her double mastectomy. After breast reconstruction she had Ds, which felt huge to her — “bulky and cartoony,” she wrote in “Tits Up,” her recent social history of the breast. Eventually, she had another surgery to reduce the size of her implants. But she wouldn’t call the decision a liberation, necessarily.
“I went from an uncomfortable implant that I really hated to a smaller one that’s placed slightly differently,” she said.
Having immersed herself in women’s ideas and feelings about their breasts during the four years she researched her book, Thornton supports whatever decision a woman wants to make about her top half. But she worries about casting breast reduction solely as feminist emancipation. For one thing, she said, “plastic surgery is a consumer option. There’s usually a lot of money involved.” For another, women’s body dissatisfaction, circulating virally online, is “pernicious” and “contagious,” Thornton said, contributing to the idea that there’s always something about women’s bodies that needs to be fixed.
“Nothing you do will ever be good enough, and if you’re doing anything for purely aesthetic reasons, you’re never going to be completely content with how you look,” said Rae Wolk, the college student.
Small breasts may not draw as much attention on the subway or the street as bigger breasts do, but they are also a fashion. Whereas big breasts signal motherhood and sexual availability, smaller breasts can convey youth, girlishness, puberty, thinness, androgyny. Bralessness, an uncovered nipple, can titillate as much as cleavage can. Wolk feels that her smaller breasts make her more feminine, more like a “coquette,” she said.
They can also indicate class. In March, a meme circulated on X and has been viewed 32 million times. “MEN,” it said. “Which do you prefer? The aristocratic elegance of the small breasted woman OR the Nietzschean pro-sex, pro-beauty large breasted woman?” Thornton agrees that smaller breasts signal the self-assurance of affluence whereas breast augmentation can signify social ambition — a desire to attain wealth and status via the attention of men.
“Upper middle class women have different kinds of value they can draw from,” she added. “They may have a college degree. They may come from a little bit of money or support. They can call Mom or Dad. They have ‘taste.’”
For a woman to withdraw from the male gaze, to assert herself in her refusal to be ogled, to relieve her own pain, to be able to comfortably train for a marathon or dance at her own birthday party — that is liberation. But it’s a personal, individual one, said Thornton.
“If women are going to have an emancipated rack,” she said, “then men need to change.”
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