The Rise of the Teenage Breast Reduction

A growing number of young patients are opting for the procedurebut their age comes with its own set of medical and insurance challenges.

Elizabeth Livermore / Reuters

I was sitting topless on crinkly paper in a room with white walls and toothpaste-green privacy curtains hanging from the ceiling to separate the hospital beds. “Women pay thousands of dollars for breasts like these,” the plastic surgeon told me. Were doctors supposed to say that? I didn’t think so, but it didn’t matter. In a few hours, he would be carefully, meticulously making incisions along the anchor-shaped lines he’d drawn on my breasts. I was 18 and getting a breast reduction, or medically, a reduction mammoplasty.

Together, my 34DDs weighed in at more than four pounds, a heavy burden for my five-foot-one frame. I knew long before I decided on surgery that I wasn’t built to carry around that much weight. And my body reminded me of that fact every day—with neck aches so painful I couldn’t turn my head; with the deep grooves my bra straps made in my aching shoulders; with the chafed skin that sports bras left under my bouncing breasts, raw skin stinging before scabbing over.

Study after study names these as common discomforts among women with big breasts, but when you’re a teenager with DDs surrounded by As and Bs, the last thing these problems seem is common. How could I explain to my smaller-chested friends why I didn’t want to try out for the cross-country team? “My breasts bounce too much” might seem laughable to someone who’d never experienced intertrigo, the fancy name for the painful, oozing infection that exercise caused in the skin under my breasts.

Regardless of the negative effects of macromastia, the medical term for excessively large breasts, insurance providers consider it a cosmetic operation unless patients meet a lengthy list of symptoms—all physical, none psychological—and many require doctors to try fitting patients with a better bra and other therapeutic measures before resorting to surgery. Perhaps that explains why, when I emphasized the emotional baggage of my breasts during consultations with my surgeon, he guided our conversations back to the physical issues.

Despite the insurance difficulties, breast reductions increased by 157 percent between 1997 and 2013, according to statistics from the American Society for Aesthetic Plastic Surgery. Anecdotally, Brian Labow, the director of the Adolescent Breast Clinic at Boston Children’s Hospital, tells me that he’s seen an uptick in teenagers wanting breast reductions over the past 11 years. He used to see two or three teens a year for symptoms of macromastia, he says. Now, he sees more than 100, though not all of them opt for surgery. Originally a hand surgeon, Labow says that when he first went into pediatric plastic surgery, he didn’t imagine he would ever have to do breast surgery.

Doctors don’t know why more women, and in particular more young women, are opting for breast reductions. Some studies suggest that people are reaching puberty earlier, and the obesity epidemic is affecting breast size, Labow says. “And then there’s the whole environmental estrogen story,” he adds. Environmental estrogens, often called xenoestrogens, are substances that mimic the hormone our bodies naturally produce, which is known to influence breast size. These chemicals are often found in pesticides, plastics, and meat from animals that have been given steroid hormone drugs to speed up growth. “Is there estrogen in our soy? Is there estrogen in our various food products, chicken or cows? Are we putting in artificial or synthetic estrogen? I really don’t know.”

Perhaps it’s that the surgery itself is getting easier. “This is almost a day surgical procedure,” Labow says, recalling a patient who came in at 5:30 p.m. for her reduction and went home the same night. When I had my reduction done nine years ago, surgery lasted approximately four hours, and I stayed in the hospital for another 24.

“I really did not think that this was as big of an issue as it is,” Labow says. “As I got more patients, I began to ask myself, ‘Am I doing the right thing?’ I’d go look at the literature; there was nothing there.” Breast reduction was one of the 10 most common operations in the U.S. in 2013, with 122,838 women undergoing procedure. But the average age of the reduction patient in the U.S. is around 40, according to Labow, perhaps because women are often encouraged to wait until they’ve had children, as pregnancy and childbirth can affect breast size.

With little literature to guide him, Labow set out to study adolescent breast reductions himself. His research, published in Pediatrics in 2012, found that adolescents (defined as girls ages 12-21) with macromastia have decreased quality of life, lower self-esteem, more breast-related pain, and increased risk for eating disorders compared to their peers, even after controlling for body-mass index. (Macromastia is often linked to obesity.)

But many plastic surgeons, pediatricians and parents are hesitant when it comes to breast reductions for teens. For younger girls, one concern is the potential for regrowth. Dr. Julie Park, an assistant professor of surgery and the director of breast reconstruction at the University of Chicago, says she works with pediatric endocrinologists, who use X-rays of growth-plate closures to determine if patients have finished puberty. Growth plates allow adolescent bones to grow and typically close after puberty is complete.

Park recalls a patient whose pediatric endocrinologist documented that at 14, she was finished with puberty and, biologically, no longer an adolescent. Still, because of her age, the patient’s insurance company denied coverage for a breast reduction. When she came back at 18, Park did the operation. “It was life-changing to her, and I saw the difference,” Park says. “When she would see me in the clinic prior to her surgery, she was hunched over, looking down, wearing bulky sweatshirts. And when she came back [for a checkup after her surgery], she was wearing color. She walked in, head up, shoulders back. Just a different person.”

I knew the feeling firsthand: In high school, I usually stuffed myself into a sports bra, sometimes two, to flatten my chest. One time I even duct-taped my breasts apart to spare myself from revealing an obscene amount of cleavage in my prom dress. “Sexuality is such a confusing thing to navigate, even if you don’t stand out,” says Niquie Dworkin, a clinical psychologist based in Chicago. “If you have big breasts, it’s just that much more of this confusing attention.”

Even in situations like mine, though, it’s not uncommon for parents, pediatricians, or insurers of very symptomatic 15- or 16-year-olds to tell them to wait a few more years, Labow says. Growth plates typically close around 12-14 for girls, but when doctors evaluate a young breast-reduction patient, they also look at when she started her period, whether she’s still getting taller, and if her shoe or bra size is still changing, Labow says. “There’s no rule that says as soon as your growth plates close, your breasts don’t grow anymore,” he says.

Because of this, he tells most of his 15-year-old patients that if he makes them a size-C today, they may be a D by the time they graduate college. “Is that a reason to make them wait?” he asks. “It’s the minority of patients that will want surgery again.” While there may be some regrowth, Labow says that it’s unlikely that a patient’s breasts will grow back to their original pre-surgery size. He estimates that, out of his hundreds of teenage patients, only two or three have returned for a second operation.

“Because of the absence of data and because the breast in this society is very sexualized, [breast reduction surgery for teens] is something that makes people a little bit squeamish,” Labow says. As a result, some doctors encourage their younger patients to first try other, less drastic ways of dealing with their breasts. “You could argue that maybe a patient should get counseling instead,” Park says. “You don’t always treat a psychological problem with surgery.”

But now that Labow has the data to show macromastia’s negative effect on social and emotional quality of life, he’s pushing for just that. While he’s quick to agree that surgery is not the answer for everyone, Labow encourages people not to discount the benefits of reduction mammoplasty. “We do a variety of operations that are designed to improve quality of life all the time. If this was your shoulder or your knee, I assure you no one would raise a flag here,” Labow says.

* * *

When I woke up from surgery, my torso was wrapped in skin-colored elastic bandages with deep crimson stains seeping through. A deep pain radiated from my chest, no surprise considering the amount of extra skin, tissue, and fat that had been removed from my deeply bruised breasts: 450 grams from the right, 490 grams from the left. Stitches covered with gauze held the incisions together, except for two small spots on the underside of each breast where plastic tubes about eight inches long drained excess blood and fluid.

I spent the night in the hospital, and in the morning, the doctor carefully unwrapped my bandages and removed the drainage tubes. Sitting up for the first time since surgery, I marveled at the lightness of my chest. I laughed out loud. I hadn’t even realized the effort it took to sit up before, I said, and my doctor smiled. “Well, we took out two pounds, you know,” he said. “That’ll weigh you down.”

When I saw my new, smaller breasts for the first time after a week of initial recovery, my reflection showed two green, yellow, and purple bruised squares with dried blood around stitches. “I look like Frankenstein,” I told my mom, laughing. I’d been warned that the fullness and roundness of my breasts would come back gradually.

I wore a surgical sports bra that zipped up the front for the next three months, avoiding exercise and lifting anything heavy. To minimize scarring, I wore silicone gel sheets that stuck to my breasts and held the incisions together, preventing them from spreading. Today, my scars are barely noticeable.

It’s been nine years since I became a size 32C. Luckily, I didn’t experience any breast regrowth— I now wear sports bras only when I’m working out, and they no longer leave my skin raw. My neck doesn’t hurt, and my shoulders don’t ache. I can wear dresses that fit, no duct tape necessary. For some teens, maybe counseling or a better-fitting bra is the right answer, but, as Park tells me, “breast reduction patients are some of our happiest patients.”