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Episode: The Appeal of the Smaller Breast

Author: The New York Times
Duration: 00:29:14

Episode Shownotes

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.

Summary

In this episode of 'The Daily,' the trend of breast reduction surgeries in the U.S. is explored, especially among women under 30. As breast reduction figures rise to over 76,000 in 2023, cultural shifts are evident as smaller breasts gain acceptance. The discussion contrasts past ideals of larger breasts, which symbolized power and desirability, with current motivations that include physical discomfort, societal scrutiny, and personal empowerment. The episode raises questions about autonomy and beauty standards, as women navigate complex motivations for their choices regarding body image and self-expression.

Go to PodExtra AI's episode page (The Appeal of the Smaller Breast) to play and view complete AI-processed content: summary, mindmap, topics, takeaways, transcript, keywords and highlights.

Full Transcript

00:00:01 Speaker_06
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.

00:00:25 Speaker_06
Today, my colleague Lisa Miller, on understanding the appeal of the smaller breast, It's Wednesday, November 20th. Hi, Lisa. Hi, Rachel.

00:00:46 Speaker_06
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.

00:01:02 Speaker_05
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.

00:01:12 Speaker_05
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.

00:01:24 Speaker_05
So my colleague, Stella Bugbee, who is the editor of the Styles Desk, handed me these numbers one day.

00:01:32 Speaker_05
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?

00:01:49 Speaker_05
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?

00:02:05 Speaker_05
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.

00:02:22 Speaker_05
These are surgeries that insurance companies deem to be cosmetic. And it was just an astonishing jump from pre-pandemic when the number was more like 40,000.

00:02:33 Speaker_05
And, you know, 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.

00:02:55 Speaker_05
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.

00:03:07 Speaker_06
You know, it's funny. I feel like I, too, have noticed this trend towards smaller breasts in popular culture.

00:03:13 Speaker_06
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.

00:03:24 Speaker_06
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.

00:03:33 Speaker_05
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.

00:03:46 Speaker_05
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.

00:03:57 Speaker_05
In LA, where I went to report the story, I saw all these women wearing these smock dresses where you couldn't wear a bra. As I'm well aware of the smock dress. And so it just, it really did feel like it was everywhere all at once.

00:04:14 Speaker_06
And also, I mean, it just sort of runs counter to, I think, a lot of the imagery that, like, we've grown up with in terms of what was on television. Like, there's a reason why breast augmentation surgeries got so big.

00:04:25 Speaker_05
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.

00:04:38 Speaker_05
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.

00:04:58 Speaker_06
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 think, in the 80s or 90s.

00:05:06 Speaker_05
Totally, it was all OK. And not only was it all OK, 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.

00:05:21 Speaker_05
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.

00:05:46 Speaker_05
They meant motherhood. They were something that men wanted. And if you had them, you know, it was money in the bank.

00:05:58 Speaker_05
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.

00:06:18 Speaker_05
350,000 women a year were getting a breast augmentation.

00:06:23 Speaker_06
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?

00:06:33 Speaker_05
No, not at all. It's not groundbreaking. I mean, there's been this obsession with breasts in culture for, you know, ever.

00:06:42 Speaker_05
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.

00:06:56 Speaker_05
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.

00:07:16 Speaker_05
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.

00:07:34 Speaker_05
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.

00:07:49 Speaker_05
Like, 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.

00:08:09 Speaker_05
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.

00:08:20 Speaker_05
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.

00:08:37 Speaker_05
They say, well, your husband might not like that, or you should try losing some weight first, or I like them rounder.

00:08:49 Speaker_05
And there's a whole Reddit thread where women tell these stories to each other about walking into plastic surgeons' offices and asking for smaller breasts and the feedback they get. It makes them feel like what they're asking for is crazy.

00:09:07 Speaker_06
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.

00:09:18 Speaker_05
So the surgery usually involves, you know, 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.

00:09:39 Speaker_05
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.

00:09:50 Speaker_05
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.

00:10:04 Speaker_05
And, you know, Kelly Killeen, 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?

00:10:19 Speaker_05
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.

00:10:35 Speaker_05
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.

00:10:54 Speaker_05
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.

00:11:09 Speaker_06
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?

00:11:17 Speaker_05
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 charge that little.

00:11:28 Speaker_05
Most of them charge somewhere between $10,000 and $15,000, with the high-end surgeons in New York and L.A. charging as much as $20,000. So it's a lot.

00:11:37 Speaker_05
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.

00:11:49 Speaker_05
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.

00:12:06 Speaker_05
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 she had before.

00:12:42 Speaker_01
We'll be right back.

00:13:00 Speaker_06
So Lisa, tell us more about what you actually ended up learning about people's motivations when you started talking to them.

00:13:07 Speaker_05
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.

00:13:19 Speaker_05
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.

00:13:35 Speaker_05
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.

00:13:46 Speaker_00
I'm getting a breast reduction because it's just always been a struggle.

00:13:50 Speaker_05
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.

00:14:05 Speaker_07
And the first one is just... Physical pain, okay? Physical pain.

00:14:09 Speaker_05
Straight-up pain.

00:14:10 Speaker_07
My back was constantly in pain.

00:14:12 Speaker_05
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.

00:14:21 Speaker_07
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.

00:14:28 Speaker_05
Often there's rashes underneath her breasts. She can get headaches from the pain. It can be a real struggle.

00:14:35 Speaker_09
It is physically painful to wear most types of bras, tops, tank tops, anything that supports them, pain.

00:14:43 Speaker_05
So there is a medical need.

00:14:45 Speaker_07
Pain aside, I also used to find it hard to find clothes sometimes.

00:14:49 Speaker_05
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,

00:15:06 Speaker_05
clothes for your whole life.

00:15:08 Speaker_06
Wearing swimsuits, that was always hard, getting the right swimsuit, finding the right bra. It's so difficult to find bras that fit you.

00:15:16 Speaker_05
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.

00:15:32 Speaker_09
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.

00:15:41 Speaker_00
That's it. That's the reason.

00:15:47 Speaker_08
I was a 30H when I was 15. So you can imagine the stairs I got.

00:15:55 Speaker_05
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.

00:16:04 Speaker_08
Just weird, weird men. And just stares all the time, which as a 15-year-old being self-conscious anyway, was not nice.

00:16:14 Speaker_05
You are objectified and sexualized from an incredibly young age.

00:16:19 Speaker_09
At 16 years old, you have these jugs that grown men are looking at and sexualizing.

00:16:26 Speaker_05
People will look at you, people have thoughts about you, people think you're sexually active when you are not. Everybody said this to me.

00:16:33 Speaker_11
People always say, you look like a whore, you look like a slut, because I constantly have my boobs out. And honestly, I don't try to have my boobs out.

00:16:40 Speaker_05
I am wearing... A lot of women talked to me about shame they felt from their moms, from their teachers, from their siblings.

00:16:48 Speaker_00
I was bullied because I told this guy I didn't want to be his girlfriend, and he made fun of my chest.

00:16:56 Speaker_05
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.

00:17:09 Speaker_00
I went to the bathroom and I cried.

00:17:12 Speaker_05
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.

00:17:26 Speaker_05
And so when they have a chance to change that, they do.

00:17:29 Speaker_06
But also, just listening to you tick off the reasons why a woman might want this surgery, I can kind of imagine people reacting with different levels of acceptance depending on how quote-unquote legitimate they decide the reasons are.

00:17:43 Speaker_06
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.

00:17:53 Speaker_06
And it kind of reminds me of how people lie about having a nose job. Like, they say, oh, I had a deviated septum because, you know, people are not super open about this stuff always, about plastic surgery.

00:18:05 Speaker_06
And so I'm curious, for all of these reasons, do women who get breast reductions, do they feel pressure to, like, justify their decision in some way? Is this something they talk about openly?

00:18:16 Speaker_05
Like, I can't even say how much not at all.

00:18:21 Speaker_00
Hello, boobie besties, as I'm calling you guys.

00:18:25 Speaker_05
Really? Like, not at all.

00:18:27 Speaker_03
So I am a one-month post-op and I only have positive things to say.

00:18:35 Speaker_05
Instead of being embarrassed about plastic surgery or lying about it or hiding it.

00:18:42 Speaker_03
All of the girlies that said that your confidence skyrockets could not be a truer statement.

00:18:49 Speaker_05
Women tell women about their breast reduction.

00:18:53 Speaker_02
So I just took my three month post-op photos and I'm gonna show you.

00:19:00 Speaker_05
Literally like showing their breasts to each other.

00:19:03 Speaker_10
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.

00:19:18 Speaker_05
There are, of course, women who are unhappy with the results.

00:19:22 Speaker_04
I'm here to be that person to tell you that there are negative things and they're not worth having smaller boobs.

00:19:30 Speaker_05
Women have gotten terrible infections. It takes a long time to recover from them. But the vast majority express no regret or doubt.

00:19:40 Speaker_02
If you are thinking about getting that breast reduction, do it.

00:19:42 Speaker_03
Yeah, shout out to these, you know. What else can I say?

00:19:50 Speaker_05
And why do you think that is? I think it's a lot of reasons.

00:19:54 Speaker_05
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 want to control their presentation.

00:20:14 Speaker_05
They want to 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.

00:20:28 Speaker_05
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.

00:20:44 Speaker_05
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.

00:20:55 Speaker_05
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?

00:21:13 Speaker_05
We grew up feeling ashamed, embarrassed that we were flat chested or skinny or whatever, not voluptuous or whatever, whatever. And then we became enlightened as young women. And at that moment, we were like, no, no, I'm perfect.

00:21:28 Speaker_05
all of my cellulite is perfect and my gray hairs are perfect and my big nose is perfect. And this sort of aligns with like the body acceptance movement, right? Like you don't have to be some kind of ideal

00:21:45 Speaker_05
going back to the plastic surgeon in the medical journal. You don't have to hew to that. That is not your problem. That is not your business. Stand up and love yourself in every shape that you have.

00:21:59 Speaker_05
And so when I approached the Gen Z women and I was like, why do you want to do this, stipulating that 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?

00:22:16 Speaker_05
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,

00:22:31 Speaker_05
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.

00:22:49 Speaker_06
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.

00:23:01 Speaker_06
As long as plastic surgery has been around, it's been this debate of, like, are you doing it for you? Is it truly empowering? And even if you think it's truly empowering and you're doing it for you, you're actually doing it for somebody else.

00:23:10 Speaker_06
And what do we think the right answer is for, like, who's allowed to do what? Even if a woman says she's doing it for one reason, we can't always trust her that she understands her reason.

00:23:19 Speaker_05
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.

00:23:32 Speaker_06
Yeah.

00:23:32 Speaker_05
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.

00:23:47 Speaker_05
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.

00:24:07 Speaker_05
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.

00:24:23 Speaker_05
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,

00:24:44 Speaker_05
We're able to live in our, you know, God-given bodies with happiness and ease. In the real world, that is impossible.

00:24:55 Speaker_06
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?

00:25:11 Speaker_06
Yeah.

00:25:12 Speaker_05
Yes to both. Yes. Yes. Plus one. 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.

00:25:34 Speaker_05
And I want her to grow up with a sense that 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.

00:25:51 Speaker_05
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, like, I am not a plastic surgery person. That is not my natural choice.

00:26:08 Speaker_05
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. I'm, you know, a middle-aged, late middle-aged woman. They had some miles on them.

00:26:31 Speaker_05
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?

00:27:04 Speaker_06
Well, Lisa, it's been a pleasure. Thank you so much. It's been a pleasure. I love being here.

00:27:27 Speaker_01
We'll be right back.

00:27:39 Speaker_06
Here's what else you need to know today.

00:27:42 Speaker_06
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.

00:28:00 Speaker_06
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.

00:28:09 Speaker_06
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.

00:28:22 Speaker_06
In his announcement, Trump said that the two men would work together to, quote, Today's episode was produced by Olivia Natt, Eric Krupke, and Rochelle Bonja.

00:28:37 Speaker_06
It was edited by Mark George with help from Chris Haxel, contains original music by Leah Shaw Dameron, Alicia Baetoupe, and Marion Lozano, and was engineered by Alyssa Moxley. Our theme music is by Jim Brunberg and Ben Lansford of Wonderly.

00:29:04 Speaker_06
That's it for The Daily. I'm Rachel Abrams. See you tomorrow.