By Lisa Miller

Lisa Miller tells stories about how people care for themselves for the Well section.

Fashion is cyclical, and so are fashionable body types. Katharine Hepburn gave way to Marilyn Monroe, who gave way to Twiggy. Madonna was overtaken by Kate Moss. Then Kardashian voluptuousness blew up heroin chic. But when Stella Bugbee, the editor of the Times’s Styles section, pointed me to data showing a 64 percent surge in elective breast-reduction surgeries since 2019, we both knew this was more than a fad.

I wanted to find out what was happening. Breast reductions have risen in every age group, but especially among patients under 30. Why would more than 70,000 women each year submit to anesthesia, a painful recovery and possible changes to nipple sensation? Why would they risk their ability to breastfeed?

It’s hard to pinpoint exactly why fashions change. The reason can be a simple rejection of what came before. But sometimes fashion reflects massive political and cultural shifts. Punk manifested the populist fury of anti-Thatcher Britain. Vintage and thrift styles reflect Gen Z’s environmentalism. Women’s suffrage, the sexual revolution, the entry of women into the professional work force, #MeToo — all these history-making moments have changed not just how women think of themselves but their outward presentation as well.

I wrote a story about the new preference for small-breastedness, which The Times published today. In today’s newsletter, I’ll explain.

Lifting a burden

Plastic surgeons say their breast-reduction patients are propelled by social media and word of mouth. They’ve consumed breast-reduction content online, in graphic and intimate detail, and now these young women regard the procedure as a liberation, attainable for a four- or five-figure fee. (Getting insurance to cover any elective breast reduction is a struggle.) “I am more than my baby-making and -feeding parts,” is how they put it to Kelly Killeen, a plastic surgeon in Beverly Hills.

The patients talked about the psychic and physical toll of growing up with bigger breasts: constant male attention, disapproval and shaming from parents and teachers who push girls to cover themselves up. Cheyenne Lin, 26, told me about standing in line during recess in elementary school when a teacher reached down and pulled her shirt collar, which had slipped down her shoulder, up to her neck. “I thought I was doing something wrong, but it was just — I had boobs,” she said.

They lamented being unable to comfortably run track, figure skate, snowboard, hike or dance at their own parties. They bind their breasts with double sports bras. They can’t shop in regular retail stores. They’re mortified by having to wear special bras and bathing suits with thick support straps.

Before her reduction, Lin’s breasts were asymmetrical. Starting in her sophomore year of college, she had such constant, searing back pain that she felt trapped in the body of a 70-year-old. When I met her in Los Angeles the week after her surgery, she spoke about her former breasts in derogatory terms, having turned the negative attention of the world on herself. They were “kind of flat and saggy,” she said. She began to hate them so much that she averted her eyes when she toweled off after the shower.

‘Men need to change’

Still, I wondered. We have been living through a revolutionary era of body acceptance. I sent my own daughter to a sleepaway camp where the rule was “no body talk”: Girls were not to comment on other girls’ physical appearance, for any reason. In my friend groups, we are scrupulously careful not to pass down a previous generation’s damaging obsession with thinness and dieting, and we tell our daughters how beautiful they are, whatever their shape.

So the idea that breast reduction is a liberation puzzled me. Isn’t it just another tool that helps women conform to a body type that is endorsed by the wider culture and is amplified by influencers on TikTok wearing bikinis on yachts? Isn’t it an expensive way to be able to wear tube tops and smock dresses in a flattering way? Maybe reductions are mirror image of breast augmentation, still one of the top plastic surgery procedures in the country, at about 300,000 per year.

The answer, or a partial answer, came in a series of conversations with the sociologist Sarah Thornton, who in May published “Tits Up,” a social history of the breast. As desirable as it may be, it is actually impossible to exist as a woman in the world without absorbing all the thoughts and feelings everyone else has about her body, she reminded me. And breasts, especially bigger breasts, draw a disproportionate amount of attention. Starting at puberty, girls with larger breasts are both oversexualized and critiqued for being droopy, saggy, flabby — and other adjectives associated with aging.

“We all want to live in a world where we’re not bothered by our appearance, but that’s not the reality we’re living in right now,” Thornton said. “If women are going to have an emancipated rack, then men need to change.”