Breast reduction surgeries have increased dramatically. What's behind the rise?

Why breast reduction rates are increasing across the country. (Getty Images)
Why breast reduction rates are increasing across the country. (Getty Images)

Breast reduction surgeries are on the rise, according to the latest findings from the American Society of Plastic Surgeons (ASPS).

The organization, which represents 92% of all board-certified plastic surgeons in the United States, reported a 54% increase in cosmetic breast reduction surgeries since 2019.

ASPS member surgeons reported 46,340 cosmetic breast reductions performed in that last prepandemic year, before seeing a decrease to 33,574 in 2020. By 2022, the number jumped to 71,364.

Why are more people getting breast reductions?

Post-pandemic lifestyle changes
Dr. Gregory Greco, ASPS president and chairman of the division of plastic surgery at Monmouth Medical Center in New Jersey, credits post-pandemic lifestyle changes for the overall increase in breast reductions as plastic surgeons observe a greater trend of "body contouring." He views it as a response to the different ways that people's bodies changed with the emergence of COVID, whether that's weight gain or weight loss over the years.

Larger breasts can be a hindrance
Larger breasts have been an "unintended consequence of weight gain" in some patients, Greco says, while other women have come to view their chests as a hindrance to "becoming more fit and active." This has been proved by a study published in the Journal of Plastic and Reconstructive Surgery. Dr. Jerry Chidester, a plastic and reconstructive surgeon based in Utah, offers anecdotal evidence: "I've had women who say, 'My natural breasts are so big and heavy, I just want to be able to play pickleball or play tennis and not have to worry about it.'"

Personal comfort
Renewed interest in overall well-being has also shifted priorities. "They just want to have smaller breasts to feel more comfortable, they want to be able to wear clothing comfortably, they want to not have to worry about going to four different shops to buy the right bra," says Greco. "They also have the bad back, neck and shoulder pain, they have the bra strap grooving. We have evidence-based proof that the majority of patients experience dramatic lifestyle improvement from breast reduction surgery."

Mental health
As for mental health, Greco adds: "It's really transformative when it comes to the psychological effects of having size H breasts."

"People can be very self-conscious about the way they look," Dr. Ashley Amalfi from the Quatela Center for Plastic Surgery in Rochester, N.Y., previously told Yahoo Life. "Plastic surgery for some of these things can have a dramatic and positive impact on mental health."

Social media
There's increasing awareness of surgery as a part of a "holistic solution" to mental health concerns, thanks to social media.

"There is more of an awareness, partly because of social media and celebrities talking openly about their breast reduction surgery and how it's helped them functionally," says Chidester. "Women now know what's available and out there."

The ASPS report also credits Instagram and TikTok as platforms that allow candid conversations on the topic. Greco notes that advancements in technology and surgical techniques mean "minimal downtime and shorter scars" for patients, making breast reductions more manageable and attractive.

Does insurance cover breast reductions?

Insurance coverage, however, remains an obstacle.

"A lot of patients now are going the cash route, or what we call a cosmetic pay route, because insurance isn't really covering it anymore," says Chidester — hence the staggering rise in cosmetic rather than reconstructive surgery.

Cosmetic vs. reconstructive breast reduction

Breast reductions are broken down into the two categories: cosmetic and reconstructive, based on the objective of the surgery. Reconstructive surgery is performed to restore function and correct deformities from birth defects, trauma or medical conditions. Cosmetic plastic surgery, by contrast, is done with the primary goal of enhancing aesthetics.

"Unlike reconstructive surgery, cosmetic surgery is not considered medically necessary," according to the ASPS. But even if a surgeon deems a breast reduction medically necessary, it's up to the insurance company to dictate it as such, says Chidester. Simply put: A breast reduction is officially considered reconstructive only if insurance agrees to cover it.

Greco explains that there are "firmly established insurance criteria" for breast reduction surgeries to be covered, which include a required minimum of breast tissue to be removed. Beyond that, Greco says there's an "administrative burden" placed on patients and surgeons that he deems "criminal."

"[Insurance companies] require the patients to go through a minimum of six months of physical therapy; they need to have documented chiropractic care, physical therapy. They need to have multiple visits to their physicians for documented infections under the breast," he says. "With the increasing difficulty from the insurance companies placing all these barriers to care, patients just kind of give up and they just pay for the operation, unfortunately."

Chidester explains that regardless of the medical terminology, "as plastic surgeons, our end goal is for the patient to have an improvement in symptoms but also look good."

The rising rates of insurance denial for breast reductions were reviewed in a 2020 study that looked at preauthorizations for reduction mammaplasty at a single institution from 2012 to 2017. The ASPS states that the average surgeon fee for a cosmetic breast reduction is $5,913, which excludes the cost of anesthesia, operating room facilities or other related expenses.

Nevertheless, the end result is worth it for many. "Satisfaction's really high and quality of life is high," says Chidester, referring to breast reduction patients. Adds Greco: "And, of course, that's why those numbers are so high."