There was a time when bigger was considered better. Hello the 80s’. Big hair, big shoulder pads, big breasts. It was a time of excess, and breast implants were relatively new on the scene. Plastic surgery was still somewhat taboo, but it was also considered the ultimate luxury item; so if you had something done, you wanted it to be noticed.
For decades, plastic surgeons have been advising their trainees to place the biggest implants possible into their patients, because a common postoperative complaint that they would receive was that “I should have gone bigger.” Add to that celebrities like Dolly Parton and Kim Kardashian, and things quickly went from braless to busty. The number of women with implants became so high that mammogram questionnaires had to adjust, with “do you have breast implants” becoming one of the first questions on the form. But as much as we have gotten used to the augmented look, this, as most trends do, has started to shift.
Personally, I have always valued the aesthetics of a smaller breast. I also perform many breast reductions, and I can tell you that many women with very large breasts are nearly crippled by them, both physically and socially. Reductions have one of the highest patient satisfaction rates in all of plastic surgery; and in my patients, the smaller I go, the happier they are.
When it comes to augmentation, patients often end up with the size recommended by their surgeon, and many practicing surgeons are used to very large implants. The tendency often is still to go bigger “just in case,” despite all of the risks associated with large implants. But the same things that create problems for women with naturally large breasts can quickly become an issue for women with artificially large breasts, and bigger is often not better.
For one, large breasts are hard to carry. They strain the neck and the back, and make exercise nearly impossible. Large breasts also require completely different clothing, usually in at least on size bigger than the patient’s general size. They can also garner unwanted attention, and can make suggestions about a woman’s personality or abilities. I have had patients request small implants because they were concerned that they would not be taken seriously at their high-powered jobs if all you saw was chest at the conference table.
The other, newer, idea behind this trend, is the concept of being “natural.” As we focus more on natural foods and healthier living, it makes sense that we would want to look more natural as well. Smaller breasts are also culturally associated with patients in higher socio-economic classes, making that a target for patients who want a more refined look. And current celebrities are removing their large implants in favor of “mini” breast augmentations.
As a surgeon who specializes in cosmetic breast surgery, I can tell you that when an implant really fits a patient properly, it is often undetectable. Whatever the motivation, it seems that this (in my opinion very welcome) movement is quickly becoming the new norm. The itty-bitty-committee is trending, and shoulders everywhere are sighing with relief.