Amanda Chatel
Updated March 02, 2020
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Having been born with a concave chest wall (when your breastbone sinks into your chest), New York City-based personal trainer Bec Donlan felt self-conscious her entire life. At 22, she made the decision to get breast implants. When she finally got her Biocell textured implants which, according to her, were “sold to me as the Rolls-Royce of breast implants,” she not only fell instantly in love with them, but her confidence sky-rocketed. No longer would she have to endure looks or questions about her concave chest. At that point, a breast reduction was the farthest thing from her mind.

But, she told RealSelf News, just three years into having her breast implants, things started to go terribly wrong. When she woke up one morning to excess fluid in one breast and not the other, the doctors couldn’t give her an answer about what was happening. Instead, they gave her antibiotics and sent her on her way. But then it happened again and again, and, like a champ who truly loved her implants, Donlan did what the doctors recommended, and kept her implants in. But still, she was getting sicker, and when her implants were recalled in 2019, she knew something had to be done despite being warned against it. It was only after another episode of an inflamed implant that put her in the ER, that a new doctor said enough was enough; the implants had to come out immediately.

Donlan had reached a point where her health was far more important than the implants she loved so much. Even when she made the decision to have them removed, there were doctors who wouldn’t do it. As Donlan explained, one doctor actually had the nerve to say to her, “You’ve got a Sports Illustrated body and I’m going to leave you looking terrible, so I’m not doing it.” In other words, her choice for her body was dismissed by a professional for aesthetic reasons.

Donlan eventually thought she might have something called BII (breast implant illness). According to Dr. Salvatore J. Pacella, M.D. MBA FACS, the symptoms women who claim to have BII often experience range anywhere from fatigue and rashes, to depression and neurologic issues, as well as chronic pain. As Donlan dug deeper, she found that every symptom she had aligned with BII, and she was far from being the only one. While there are no medical tests or studies that can give this illness an official diagnosis, BII is a common complaint among women who seek breast reduction surgery.

According to Dr. Kevin Brenner, M.D., FACS, a board-certified plastic and reconstructive surgeon, who was the doctor behind Ariel Winter’s breast reduction surgery, reductions that remove implants like Donlan’s are called explant surgery.

“Conditions such as recurrent capsular contracture, refractory implant rippling, breast implant rupture, and increased breast size over time, are all common reasons that women seek explant surgery,” Dr. Brenner says.

Capsular contracture, according to BreastCancer.org, occurs because the body sees the implant as a foreign entity, so it creates a protective capsule around it. Although the capsule is usually soft and acts as a protector, sometimes it can become hard and can actually squeeze the implant. Not only can it be very painful, but it can distort the look of the breast. Implant rippling, is just that: rippling that can be seen on the exterior of the breast.

Dr. Brenner also acknowledges that for some of these women BII is a factor for removing implants, but because of its proximity to other medical conditions, the medical community has been reluctant to recognize it.

“However, over the past few years, awareness and treatment for this condition has become more common, especially in my practice,” Dr. Brenner says. “The treatment for women with breast implant illness is breast implant removal with total capsulectomy,” meaning not only are the implants removed, but so is the capsule that surrounds it, including any related scar tissue. Dr. Brenner also states that if you think you are suffering from breast implant illness, a consultation with your surgeon is a must.

Dr. Brenner says that outside of getting a reduction for implant issues, there are typically three categories of individuals who typically seek breast reductions—teenagers who develop too big too quickly, women whose breasts increase during pregnancy and stay that size, and women who have had smaller sized breasts throughout their lives but end up with a significant increase after going through menopause. According to the American Society of Plastic Surgeons, breast reduction surgery is incredibly common—plastic surgeons perform up to 90,000 per year.

“Breast reduction surgery provides immediate relief to women who suffer from symptoms related to overly large breasts, such as breast rashes, and upper back and neck pain,” Dr. Brenner says. “Not only do breast reduction patients experience symptom relief, but they also commonly enjoy a huge bump in their self-confidence. Following breast reduction, my patients’ clothes also fit them better as a result of their breasts being in better proportion to their bodies.”

For many women, like Donlan, the decision to get a reduction isn’t just a matter of what is happening to you physically, but mentally too. Breasts, small or large, can affect your mentality in a society that tends to be so boob-obsessed—and many women seek reductions for this reason as well. For others, large breasts can create an inability to do things they want to do, pain and discomfort aside. “[Some patients] prefer smaller breasts for a more active lifestyle,” Dr. Bill Kortesis, M.D., FACS, board-certified plastic surgeon and co-owner & managing partner at HKB Cosmetic Surgery, tells HelloGiggles.

As someone who’s a 36DDD on a 5’ frame, I experienced initial issues with my breasts when they grew too big as a teenager. Because of this, I have seriously considered getting a breast reduction. I’m never without pain in my lower back. If I wear a bra all day, I have pain across the middle of my back, as well as deep indentations on my shoulders from where my bra strap sat—and those indentations linger there for a while. Even when my weight fluctuates, as it does often, my breast size does not.

My reason for not going through with the surgery is because breasts can grow back after a reduction, and I didn’t want to sign up for such a procedure more than once. “Breast tissue is responsive to changing estrogen and progesterone levels in the body,” Dr. Brenner says, which means not only can there be regrowth, but that regrowth can result in even big breasts after reduction surgery.

For others who have gotten breast reduction surgery, though, their decision was the right one. Here’s what three women said about their choice to have breast reduction surgery.

Jaime Huffman, 35:

“I had a breast reduction last spring. I have been beyond satisfied with my results. The reduction literally felt like having a weight lifted off my chest. It has relieved me from shoulder and neck pain.

When I was in college, I got breast implants. I went from a small B to a full C. Initially, I was happy with my new size. Then several years later I had my son, Harper. During my pregnancy my breasts got huge—bigger than double D’s huge. I thought their size would drastically reduce once I had my son. They didn’t.

The new size was overwhelming on my body. I started noticing neck and back pain. I even had sharp shooting pain in my chest periodically. And my boob sweat was out of control. Honestly, my breasts were so large that it made me look heavier than I actually was. I decided to move forward with the surgery in hopes of relieving the pain and fitting into my clothes better. The surgery was an outpatient procedure and was quick—about 3 hours. I was up and moving around regularly the very next day.

The procedure was actually a twofer because [my doctor] removed excess tissue and skin to make my breasts smaller. He also put in new and smaller implants, and moved my nipples up in position to give them a lift. I do have scars but they improved significantly over the past year. Overall, I am thrilled with my results and I would recommend a breast reduction to anyone considering it!”

Andrea B., 57:

“I had breast reduction surgery last September. It was the best thing I ever did! After lugging around size 40DDD breasts for all my life, and not fitting into anything I wanted to wear, I am so happy I finally did it.

It has taken so much pressure off my shoulders and back, and I can now wear size mediums instead of XXLs.

I’m 5’4″ and am a size 10, but for years I had to wear really big, loose tunics and everyone thought I weighed twice my actual weight. Wearing anything tucked in was an impossibility.

The actual surgery was easy, fast, and outpatient. Recovery only took about a month. My scars are almost totally gone and I’m wearing all my favorite fashions. Best decision I ever made.”

Kelly K., 49:

“I had a reduction, from DD to C, in 2002 when I was 32 and then another in 2008—they grew back.

Through my teens and 20s I always felt horrible physically—they were heavy and hurt my back and shoulders—and even more so, mentally. Clothes never fit right. I was a size 4 on the bottom but at a 34DD, a 12 on top. Dresses were not an option. Buttoned shirts puckered at the breast-line. Bikinis were also impossible to find with enough support. Men stared at them and talked to them and not me. Everyone saw my breasts before my face, or my personality.

Finally, I went to a plastic surgeon and thankfully insurance paid for the surgery. I was not daunted by the 400+ stitches or the week off from work. I remember how happy I was a few weeks later when I could try on a strappy size 4 dress for a wedding I was attending and didn’t need a bra. Life became so much better and the surgery opened up so many new possibilities for me. I didn’t have to wear only black tops anymore!

Still, I had told my surgeon to make me a small C. But after the surgery I was still a very big C and by the end of that year was back up to a D. While they were higher and less saggy, they just kept getting bigger and bigger and at the end of a few years I was in a minimizer and very matronly type bra again. I was still thin but the boobs grew back.

For my 38th birthday, I did the surgery again—this time I had to pay. It was worth it. I told the surgeon I wanted to be a B and even though he counseled against it, I held firm. I knew by the next year I’d be a C. And here I am all these years later a full C and very, very happy.”

Ultimately, for each person who gets a breast reduction, or even implants for that matter, the reason is personal. But as Donlan points out in her essay, we need to talk about these issues, these procedures, and the aesthetics they involve, if we’re to normalize women prioritizing their health above enforced beauty standards. It is hard enough to love your body in a society that likes to dictate how people—especially those who identify as women—should look. So if we address the topic head-on, we can have a realistic dialogue about why health and feeling good are sometimes more important than having the body society wants you to have.