James' World 2

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The women walk into the surgeons’ offices with photos cued up on their phones. Miley Cyrus. Keira Knightley. Bella Hadid. I want my breasts to look like this, they say. They’ve already spent hours on YouTube watching plastic surgeons’ infomercials, on Instagram poring over before-and-afters, and on TikTok, where an army of ordinary women post about their breast reductions. “Ask me,” they say. Whether their nipple sensation has changed. What their boyfriends said. Whether they cared.

Sometimes a woman walks into her initial consultation with the bralette she hopes to wear. Or she’ll say, “I can’t wait for my braless summer.” Or that she looks forward to shopping for a $15 bikini top at Target, something cute and bright or floral, signaling a life so carefree its wearer might never need fat straps or eye hooks again. Breast reduction patients use words like “fit” and “strong.” They talk about “yoga boobs.”

Friends tell friends about their breast reductions. A surgeon named Donald Mowlds, in Newport Beach, Calif., sees a photo on his feed of a group of women at lunch and realizes he’s operated on all of them. Kelly Killeen, a surgeon in Beverly Hills, says one of her patients flashed her breasts to a friend at the makeup counter at Neiman Marcus and the friend walked across the street to make an appointment. Jamie Hanzo, who is 26 and lives in New Orleans, uses the same plastic surgeon as her mother.

Tiffany Dena Loftin, who is 35 and a labor organizer in Atlanta, was emboldened to undergo breast reduction after scrutinizing the naked breasts of her friend Jamira Burley, 36, over FaceTime: her bandages, her incisions, her bruised nipples. Loftin doesn’t like hospitals. Needles terrify her. But, Burley said, “Tiffany, the relief and the joy that I’m feeling is also available to you on the other side of your fear.”

After liposuction, breast augmentation is the most popular cosmetic surgery procedure in the country, with about 300,000 women choosing implants each year. But the growth area in cosmetic breast surgery is in making them smaller. In 2023, more than 76,000 American women had elective breast-reduction surgery, a 64 percent increase since 2019, according to the American Society of Plastic Surgeons. (That number doesn’t include gender-affirming top surgeries or breast reconstructions after illness.) The increase is reflected across all age groups, but especially among women under 30, who are enthusiastic consumers of plastic surgery in general, including face- and forehead lifts, procedures favored mostly by women their mothers’ age. Girls younger than 19 represent a small but fast-growing part of the market.

“I had big breasts my whole life,” a teenager’s mother will tell Dr. Mowlds in his office. “Here’s my daughter. She has questions.”

Reduction surgeries deemed “medically necessary” and covered by insurance represent a far smaller group than cosmetic operations, but the broad trend lines — a recent, sudden increase, especially among younger women — are the same, according to an analysis by the Health Care Cost Institute.

Not only do more women want to be small; they want to be smaller. Jerry Chidester, a plastic surgeon in Salt Lake City, said his patients used to ask for C cups. Now, they want Bs. He often does five breast reductions a week, mostly on young, postpartum mothers.

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Credit…Maggie Shannon for The New York Times

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