The Daily - The Appeal of the Smaller Breast

Episode Date: November 20, 2024

For decades, breast augmentations have been one of the most popular cosmetic surgeries in the United States. But in recent years, a new trend has emerged: the breast reduction.Lisa Miller, who covers personal and cultural approaches to health for The Times, discusses why the procedure has become so common.Guest: Lisa Miller, a domestic correspondent for the Well section of The New York Times.Background reading: Are women asserting their independence or capitulating to yet another impossible standard of beauty?For more information on today’s episode, visit nytimes.com/thedaily. Transcripts of each episode will be made available by the next workday.  Unlock full access to New York Times podcasts and explore everything from politics to pop culture. Subscribe today at nytimes.com/podcasts or on Apple Podcasts and Spotify.

From the New York Times, I'm Rachel Abrams, and this is The Daily. For decades, breast augmentations have been one of the most popular cosmetic surgeries in America. But in recent years, a new trend has started to emerge, the breast reduction. Today, my colleague Lisa Miller, on understanding the appeal of the smaller breast. It's Wednesday, November 20th. Hi Lisa. Hi Rachel. Hi, Lisa.

Hi, Rachel. So you recently wrote a story about something that I am pretty sure we haven't covered on the daily before, and that topic is breast reductions. And I'd really love to hear, before we get into it, why you wrote about it and why it interested you. Sure. I work on the Well Desk at the New York Times, and Well is the area of the Times that covers health and wellness, nutrition, fitness. I am particularly interested in the subject

of women's bodies and how it feels to be in a female body walking around in the world. So those are the kinds of stories that I do. So my colleague, Stella Bugby, who is the editor of the styles desk, handed me these numbers one day. And the numbers were from the American Society of Plastic Surgeons, and they showed this dramatic increase in breast reductions over the last five years, driven by women under 30. And she was just like, what do you think is going on here? So I just set about sort of exploring both why the trend and also sort of what was in women's heads as they were making these decisions. Can you tell us a little bit about those numbers specifically?

What did they show and what were they? So in 2023, which is the last year for which data are available, more than 76,000 women had breast reductions. And these are not surgeries that have to do with cancer and they're not gender-affirming surgeries. These are surgeries that insurance companies deem to be cosmetic. It was just an astonishing jump from pre-pandemic when the number was more like 40,000.

To be sure, the most popular cosmetic breast surgery in the country is breast augmentation still. These numbers are tiny in comparison to the numbers of women who are getting augmentations, 300,000 about get an augmentation every year. But those numbers are creeping downward and the reduction numbers are going upward, not just among young women,

but among women in every age group. You know, it's funny, I feel like I too have noticed this trend towards smaller breasts in popular culture. I can't really put my finger on it exactly, but I feel like I've walked into stores where you see dresses that you really can only wear if you have small breasts. It feels like there are more models with small breasts on the runway. And I've noticed this sort of anecdotally here and there, but I didn't realize at all that that trend was actually something quantifiable and showing up in data somewhere. Totally. I mean, I was thinking about this before I came to record this session, and I was like,

it's a little bit like learning a new word, and then you hear that word everywhere. Yes, totally. So, you know, I saw these numbers and I was like, hmm. And then I went out into the world and like in Brooklyn where I live, so many young women are wearing like tank tops and camisoles without bras, slip dresses without bras. In a way where I went to report the story, I saw all these women wearing these smock dresses where you couldn't wear a bra.

I'm well aware of the smock dress. And so it really did feel like it was everywhere all at once. And also, I mean, it just sort of runs counter to, I think, a lot of the imagery that we've grown up with in terms of what was on television. There's a reason why breast augmentation surgeries got so big. I mean, you know, when I was growing up, being flat-chested was a mortification. Nobody wanted to be flat-chested. I remember this distinctly from high school.

Everybody admired the girls with bigger boobs. The girls with bigger boobs, like, showed off in the locker room. This was the 80s. And you know, that was the era of silicone breast implants. That was the era of big breasted models. Dolly Parton. Dolly Parton. I'd be remiss if I didn't bring up Hooters, which I do not feel like you could have launched that now. But that is a big restaurant chain that launched I I think, in the 80s or 90s. Totally, it was all okay.

And not only was it all okay, it was all desirable. I mean, as one of the women I spoke to for the story said to me, like, when you have big breasts, you're winning. She's like, that's what culture thinks about big breasts. And when you go back, that goes back to post-World War II voluptuousness, right? Like Marilyn Monroe leads into Baywatch, leads into Kardashians. It's this kind of

ostentatious display of femaleness. Big Breasts meant power. They meant sex. They meant motherhood. They were something that men wanted, and if you had them, you know, it was money in the bank. And so by the 2010s, breast augmentation, which had gotten more and more and more sophisticated, the implants had gotten more and more and more natural looking, was the most popular cosmetic surgery in the country. 350,000 women a year were getting a breast augmentation.

Everything you're saying, I mean, all of our experiences, I think, add up to the idea that it's not groundbreaking to say that Americans have been pretty obsessed with the female breast, right? No, not at all. It's not groundbreaking. I mean, there's been this obsession with breasts in culture for, you know, ever.

But what surprised me as I was doing the reporting was the extent to which this obsession not only extended into the medical community, but actually originated with it. I had a conversation with a plastic surgeon who was a woman, and she was telling me about this paper that was published in 2011 in a plastic surgery journal in which an English plastic surgeon described the contours of the ideal breast. The ideal breast. Just one. I mean, and he used that language in the paper, in this medical journal. And this text became foundational.

It became like a training text for generations of doctors. And in the introduction to the paper, he talks about how, you know, Leonardo da Vinci defined the contours of the ideal human face, and he put this effort into that context. He was helping the profession of plastic surgeons create and improve breasts for the world. He had this idea that the ideal breast was sort of concave below the nipple and sort of flat above the nipple. So he was very specific in the shape of the ideal breast.

But no one has breasts like this. No one has breasts like this. And yet the conventions around what a breast should look like are so strong and so established that when a woman walks into a plastic surgeon's office and remember, you know, four-fifths of them are men, she says, I want something smaller. They say, well, your husband might not like that. Or you should try losing some weight first, or I like them rounder. And there's a whole Reddit thread where women tell these stories to each other about walking

into plastic surgeon's offices and asking for smaller breasts and the feedback they get. It makes them feel like what they're asking for is crazy. So obviously, Lisa, breast reduction sounds like a very self-evident term, but just for the sake of it, can you walk us through what the surgery actually entails? Yes, sure. So the surgery usually involves making an incision around the nipple and then from the nipple down the length of the breast, the curved part of the breast, and then removing

a lot of breast tissue from inside the breast. A thing that's really important to say here is that most of the women who go in for breast reduction have double D cups or bigger. And these days, the plastic surgeons told me, most women are asking for a B cup, whereas five years ago they were wanting a C cup. So they're asking for more breast tissue to be removed. And Kelly Colleen, who was one of the surgeons I spoke to for my story, I was talking to her in her office, she was wearing her scrubs,

and I was like, but how much breast tissue are we talking about actually? And she reached down and picked a Coke can up out of her garbage can, and she was like, I just took this much breast tissue out of one breast in a patient. Oh my God. You know, it's a lot. And so it's a much more invasive surgery than augmentation. And it has all of these potential consequences that are enduring. It can affect a woman's ability to breastfeed.

There are not great data on this, but the best study says about a third of the time. It can affect nipple sensation. And there's permanent scars that frequently go around the nipple, down the breast, under the breast. And the women are really making a big trade. You know, they're saying, I'm willing to do all of these things in order for my breasts to be smaller.

And so when they decide to make, as you said, that big trade and get the surgery anyway, what does it end up costing them? The American Society of Plastic Surgeons says it costs about between $7,000 and $8,000. I spoke to a lot of plastic surgeons for the story and none of them charged that little. Most of them charged somewhere between 10 and 15,000 with the high-end surgeons in New York and LA charging as much as 20.

So it's a lot. And this is a surgery that can technically be covered by insurance, but the algorithms and formulas involved are extremely complex and the bar is really high, and most women don't end up being covered. And so what that means is that there are women with very large breasts who may be experiencing some to a lot of pain who have to pay for this surgery out of pocket, and that is very frustrating to them and to their doctors. And the more I talked to the women, the more I understood that in every woman there's some

combination when she walks into a surgeon's office asking for this surgery of pain, discomfort, and a desire to have a different shaped body that is really different from what you had before. We'll be right back. So, Lisa, tell us more about what you actually ended up learning about people's motivations when you started talking to them. Yeah. I mean, what I learned was that every individual woman has a variety of reasons for wanting this surgery. That there is no single reason.

And the question is really like, which is the thing that tips the scale and makes the woman decide to do it? And so I talked to a lot of women in person and on the phone, but I also spent a lot of time on social media. And- Yeah, I'd love to talk about my boobs on the Internet, so let's go ahead. There is a huge breast reduction conversation happening on TikTok, on Instagram, on YouTube.

I'm getting a breast reduction because it's just always been a struggle. And from immersing myself in all of this conversation over many, many weeks, I would recommend a breast reduction to anyone considering it. I would say that there are three main reasons why women decide to reduce their breasts. And the first one is just physical pain, okay? Physical pain. Straight up pain. My back was constantly in pain.

I could not walk for more than a mile without having to stop. A woman with very large breasts often has back pain, shoulder pain, neck pain. I used to actually get chest pain sometimes because I used to feel like I was getting suffocated by my chest when I would lay down or wear tight clothing. Often there's rashes underneath her breasts. She can get headaches from the pain. It can be a real struggle.

It is physically painful to wear most types of bras, tops, tank tops, anything that supports them, pain. So there is a medical need. Pain aside, I also used to find it hard to find clothes sometimes. Another is a sort of a fashion impulse. I could not really shop at regular department stores because none of the clothes really catered to my body. Which is just that if you've grown up with bigger breasts, you've been wearing constraining clothes

for your whole life. Wearing swimsuits. That was always hard. Getting the right swimsuit, finding the right bra. It's so difficult to find bras that fit you. And almost every single woman I talked to for the story said that her aspiration going in was to buy a bra or a bikini at Target. Like spend $15, buy something off the rack, have it be cute and sexy and carefree.

Any store you can think of, I've probably gone there and like they didn't have my size because they don't really carry 32 and under. Finding clothes that fit comfortably, that's it. That's the reason. that fit comfortably. That's it. That's the reason. I was a 30-H when I was 15. So you can imagine the stairs I got. And I think, you know, this is a third bucket, but it really encompasses everybody. When you grow up with very large breasts, especially if you're very young, Just weird, weird men. And just stares all the time, which as a 15-year-old being self-conscious anyway, was not nice. You are objectified and sexualized from an incredibly young age.

At 16 years old, you have these jugs that grown men are looking at and sexualizing. People look at you, people have thoughts about you, people think you're sexually active when you are not. Everybody said this to me. People always say you look like a whore, you look like a slut because I constantly have my boobs out. And honestly, I won't try to have my boobs out. I am wearing... A lot of women talk to me about shame they felt from their moms, from their teachers, from their siblings. I was bullied because I taught this guy I didn't want to be his girlfriend and he didn't

a fun of my chest. One woman told me that everybody in her neighborhood called her fast because she had very large breasts as a child. And she had a lot of older brothers, and they basically didn't let her out of the house alone. And I went to the bathroom and I cried. And I was in sick... So, I think, you know, I think it's intuitive

that it's hard to be that girl, but talking to these women really brought that home for me. They're carrying a lot, and they're carrying a lot for a long time. And so, when they have a chance to change that home for me. They're carrying a lot, and they're carrying a lot for a long time. And so when they have a chance to change that, they do. But also just listening to you tick off the reasons why a woman might want the surgery, I can kind of imagine people reacting with different levels of acceptance depending on how quote unquote legitimate they decide the reasons are.

For example, if somebody has an aesthetic desire versus a medical need, you can see how people would respond differently about whether they personally felt that the surgery was, like I said, legitimate. And it kind of reminds me of how people lie about having a nose job. Like they say, I had a deviated septum because people are not super open about this stuff always, about plastic surgery. And so I'm curious, for all of these reasons, do women who get breast reductions, do they feel pressure to justify their decision in some way?

Is this something they talk about openly? I can't even say how much not at all. Hello, booby besties. I've been calling you guys. Really? Like, not at all. So I am a one month post-op and I only have positive things to say. Instead of being embarrassed about plastic surgery or lying about it or hiding it.

All of the girlies that said that your confidence skyrockets could not be a truer statement. Women tell women about their breast reduction. So I just took my three month post-op photos and I'm gonna show you. Literally like showing their breasts to each other. Here they are. I cannot believe how they look.

My girls are perfect now. They're the same size. They're nice and perky. They're not bothering me now. They're just doing their thing. Love them. It was the best decision I've ever made. There are of course women who are unhappy with the results.

I'm here to be that person to tell you that there are negative things and they're not worth having smaller boobs. Women have gotten terrible infections, takes a long time to recover from them, but the vast majority expressed no regret or doubt. If you are thinking about getting that breast reduction, do it. If you have chattel tities,, do it. Yes, shout out titties, you know. What else can I say?

And why do you think that is? I think it's a lot of reasons. We are in a post-MeToo moment, and young women are really determined to get in charge of how they're perceived in the world and not let their particular body parts be their introduction into any room. They wanna control their presentation, they wanna be able to cover up or expose as they wish, they don't want to be part of the sort of

male gaze industrial complex at all. So that's one reason. And the other is that especially young women like Gen Z women have a very different relationship to their bodies than my generation does. They are really avid consumers of plastic surgery in general. They do arm reductions and fillers and eyelid stuff and stuff I haven't ever even heard of, not being a consumer of plastic surgery really. They have just a much more open idea about being able to change their body as part of self-expression that is not an idea I grew up with. What do you mean by that? We grew up feeling ashamed,

embarrassed that we were flat-chested or skinny or whatever, not voluptuous or whatever, whatever. Then we became enlightened as young women. At that moment, we were like, no, no, I'm perfect. All of my cellulite is perfect, and my gray hairs are perfect, and my big nose is perfect. And this sort of aligns with the body acceptance movement, right? Like, you don't have to be some kind of ideal going back to the plastic surgeon in the medical journal.

Like, you don't have to hew to that. That is not your problem. That is not your business. Stand up and like love yourself in every shape that you have. And so, you know, when I approached the Gen Z women and I was like, why do you want to do this, stipulating that, you know, there's pain and health concerns here, what I was

probing for, what I was poking at is like, don't you think you're perfect already? Why do you want to change your body? And what they said was surprising, which was like, no, no, I am doing this for me. This is autonomy. And if I want a different kind of breast in order to wear a different kind of outfit or present in a different kind of way, that's not an admission that I'm capitulating. That's an expression of autonomy and independence and freedom, liberation.

I just can't help but think, like, as you're talking about this, that this feels both new because we're talking about a trend of breast reductions, which is a new thing, but it also feels like kind of an age-old argument. As long as plastic surgery has been around. It's been this debate of like, are you doing it for you as truly empowering? Even if you think it's truly empowering and you're doing it for you, you're actually doing it for somebody else. What do we think the right answer is for like who's allowed to do what?

Even if a woman says that she's doing it for one reason, we can't always trust her that she understands her reason. So it feels like what's old is new again, I guess, a little bit. I completely agree with you and I thought about that a lot as I was reporting the story. Like, why am I second-guessing the reasons that they're telling me? Yeah, exactly. Yeah. And one of the most revelatory conversations I had was a conversation I had with a plus-size

model who sort of confessed that she was considering a breast reduction. And, you know, she makes her living being a person in a different body than the conventional ideal. And yet she, too, was attracted by this idea that she might be able to unencumber herself by reducing her breasts. I presented this dilemma to her, like, aren't you supposed to just love who you are? She was like, yes, yes, but we all live in the world. We all take our bodies out into the world, and we get catcalled, and we get looked at, and we get judged, and people think things about us. And it is impossible to be a female person in the world

and not absorb those signals. And so, although in some ideal universe, we're able to live in our, you know, God-given bodies with happiness and ease, in the real world, that is impossible. So given all of this, where did you actually land you, yourself, as the reporter, who happens to be a person in the world,

on this question of who is this for and whether this is just yet another way to make women feel inadequate about our bodies. Yeah. Yes to both. Yes. Yes. Plus one. Yes. Like, I think that the minute you try to make women choose, you're missing the point.

And I see this in my own life, right? Like, I have a daughter and I made sure always to tell her how beautiful she is. No matter what. And I want her to grow up with a sense that like nothing about her body is a thing to be ashamed of or corrected or fixed or inadequate. That is the identity I hope that she carries through the world. At the same time, I had breast cancer several years ago, and I had a breast reconstruction.

And so, as I think I alluded to, I am not a plastic surgery person. That is not my natural choice. And yet the breast cancer forced me to have a breast reconstruction. And what I will say about that is that my breasts look better. They just do. They just do. They just do. I'm, you know, a middle-aged, late middle-aged woman. They had some miles on them. I breastfed my daughter. I ran two marathons. Like, the

lifted breast is like nice. And so, although I wouldn't have chosen it, and I formerly would have had all kinds of judgment about it, I feel that it is an enhancement. So who am I to judge? Well, Lisa, it's been a pleasure. Thank you so much. It's been a pleasure. Thank you so much. It's been a pleasure. I love being here. We'll be right back.

Here's what else you need to know today. President-elect Trump continued a series of surprising choices for top roles in his second administration, picking celebrity physician Dr. Mehmet Oz to oversee the Centers for Medicare and Medicaid Services and Howard Lutnick, a Wall Street executive who's leading Trump's transition team, to serve as Commerce Secretary. Lutnick, the head of financial firm Cantor Fitzgerald, would be in charge of an agency with an $11 billion budget and wide influence over broad swaths of the economy. The choice of Dr. Oz, who's faced criticism for his sometimes dubious medical advice,

comes after Trump chose Robert F. Kennedy Jr., a notable vaccine skeptic, to lead the Department of Health and Human Services. In his announcement, Trump said that the two men would work together to, quote, take on the illness industrial complex. Today's episode was produced by Olivia Natt, Eric Krupke, and Rachelle Bonja. It was edited by Mark George with help from Chris Haxel, contains original music by Lea Shaw-Dameron, Alicia Be'etoop, and Marian Lozano, and was engineered by Alyssa Moxley. Our theme

music is by Jim Brunberg and Ben Landsvort of Wonderly. That's it for the daily. I'm Rachel Abrams. See you tomorrow.