This may seem a little strange, but have you ever wondered why women - aka human females - are the only mammals to have full breasts at all times, even when not pregnant or nursing?
Now I could go into the evolutionary or adaptive theories as to why this is so, but your eyes would begin to glaze over and you’d toss this article aside.
So let’s just assume that women have permanent breasts for good reason, including nourishment, pleasure, and attraction. Are they, alone, what makes a woman - a woman? Obviously not, but to many of my patients, breasts play a big role in their feeling feminine.
Post-Mastectomy, Support is Critical
This is very evident when I consult with cancer patients who will require a mastectomy. So often I hear, “I don’t care if you just put an expander in, I just don’t want to wake up without a breast.” These women are often still reeling from the whirlwind of hearing their diagnosis and learning of the planned surgery and possible oncologic treatment afterwards, and so we spend a good amount of time determining what the optimal reconstructive options are for them.
During these talks, it’s clear that most have good support at home and the concern of being “less a woman” after mastectomy isn’t a major factor. Unfortunately, there are also women who fear - sometimes, accurately - that losing a breast will mean losing the “love” of someone. These patients can be challenging to accommodate if they are not good candidates for immediate reconstruction (when I form a breast at the same time of their breast removal), because their personal and medical goals are not necessarily aligned.
What, then, about more elective or cosmetic breast surgeries? Breast augmentation has been one of the top five cosmetic procedures in the U.S. for more than ten years running, and the numbers increase nearly every year. Here, the women I see are of all ages, ranging from early twenties to early seventies (who are usually replacing previous implants). Whether they are looking to replace lost volume after childbirth or have always been smaller than desired, these women have chosen to enlarge their breasts. Why?
Self-Esteem Rises With Augmentation
Studies have been done looking at those reasons and, just like the women being asked, the answers vary dramatically. One over-arching theme, however, is the boost in self-esteem experienced by many. For instance, prior to augmentation, women with small cup sizes may experience the same fears as those post-mastectomy - loss of another’s affection. For others, it may be as simple as wanting to fill out a bathing suit or to be able to buy a blouse or top that is proportionate to the rest of her body.
Probably the next largest group who choose augmentation are those who once had full breasts and then “lost” them after pregnancy and nursing. These women may have been a certain breast size and shape, usually for 10-20 years, and now look with dissatisfaction at the changes wrought by childbirth. (A related group are those who lose excessive breast volume after massive weight loss.). Their desire is not so much to be larger than previously, but rather to go back to where they used to be - to regain their original, youthful contours.
On the other end of the spectrum are my patients who have been blessed with “too much” and have large, heavy breasts. These women suffer from neck and back pain, rashes, and deep shoulder indentations. It’s hard for them to run or play sports. They have difficulty with mammograms and often can’t breastfeed because of their breast size and density.
Final Decision on Breast Size Belongs to the Patient
It’s amusing how often when I sit with a woman and her male significant other during the initial discussion about her breast reduction that the man watches me with a baleful expression, arms crossed - a non-verbal challenge to me not to make her breasts “too small.” Rather than worry about this, my patient and I determine the size that shewants. Invariably, after the surgery and healing period, that same, initially skeptical man comes back with a wide smile and a happy wife.
In all three types of breast surgery - augmentation, reduction, and reconstruction - most of the women who come to me are coming for their own well-being, not at the request of spouses and partners. And that’s the way it’s supposed to be. While it’s important to have the support of others, a woman’s body is her own and she, alone, should make the final decision on what to do with it.
I’ve often seen that when a woman finally gets the breast size and shape that fits her frame, desires, and lifestyle, she experiences happiness and a satisfaction that spills over into her relationships, work, and play. So, while it’s clear that breasts are not all that make a woman a woman, it’s just as clear that for many, changing their breasts can change their life.
Choosing plastic surgery is a big decision. Please feel free to review a few important articles we've written. We're here to answer your questions.