By Jill E. Duffy
Lorilyn Alden’s breasts had always been on the large side, D or DD, but they hadn’t interfered with her life. In her early 20s, she had a baby, breastfed, and after, her chest shrank to a C. Then she had a second child, her breasts swelled to triple Gs, and they never went back down.
“They were just tremendous,” she says. “I was completely shocked.” The weight became unbearable. It pulled her forward, causing pain in her back and neck. Her bra straps dug into her shoulders and left marks. She struggled to find clothes that fit and had to special-order bras that cost more than $100 a pop and wore out within a few months. “It wasn’t attractive, either,” she says, although that didn’t stop uninvited male attention.
At 42, after her oldest son went off to college and her youngest could drive, Alden had breast-reduction surgery. “It was the best decision I ever made in my life,” she says, “and my only regret was not doing it sooner.”
Patients over the age of 40 make up more than half of the total number of breast-reduction surgeries on women in the U.S, according to 2024 data from the American Society of Plastic Surgeons. The largest segment (34%) are between the ages of 40 and 54. (The report counts “aesthetic” breast reductions only, although here that means surgeries done without billing health insurance.) Doctors say that as long as it’s safe for a patient to undergo anesthesia, they can have a breast reduction at any age.
Why do so many women wait?
Dr. Ashley Steinberg is a plastic and reconstructive surgeon who performs breast reductions, among other procedures, in Houston. “A lot of women think that they have to wait until after they’re done having kids to have any sort of surgery on their breasts,” she says. “It’s kind of a misconception.” Worries about breastfeeding are common, for example. It’s possible to breastfeed after a reduction, though it depends on the style of surgery and how the incisions are made. Another reason some choose to wait is because their breasts may continue to change through child-bearing and breastfeeding years, as Alden’s did. That said, if large breasts are interfering with your ability to live a full life, it’s not strictly necessary to wait.
Perimenopause and menopause can be another factor. Breasts are made up of fat and glandular tissue. During perimenopause and menopause, glandular tissue can change to fat tissue, according to Dr. Sergio Alvarez, a plastic surgeon and founder of Mia Aesthetics. “When this happens, even small changes in your weight can lead to big changes in breast size,” he explains. Hormonal changes can also cause breasts to soften, enlarge, and change shape.
Thoko Kachipande delayed her breast-reduction surgery for years. She wasn’t sure if she would have children and wanted to wait. Also, her insurance wouldn’t cover it.
The cost of a breast reduction is based on several factors, from the surgeon you choose, to whether they’re affiliated with a hospital or have a private practice, to whether your health insurer is willing to pay for it. Many are. When insurance covers the procedure, the out-of-pocket expense to the patient is estimated at $500 to $3,000. One private plastic surgery center on Long Island says its patients who are fully covered pay on average $870. Out of pocket without insurance, however, some estimates put the top-end cost at nearly $20,000.
When it became clear to Kachipande that she wouldn’t have children, she researched her insurance options and switched providers to one that would cover a reduction.
Like Alden, Kachipande suffered from back and neck pain, as well as the inability to do some activities. Bras didn’t fit. Clothes didn’t fit. She tried so many things to make her body feel better, from stretching to yoga. It took an emotional toll, too.
The results were immediate after surgery. “It’s ridiculously satisfying,” she says. “If you can get rid of a health issue so easily, why wouldn’t you?”
Kachipande wants other women to know they don’t have to suffer, and that breast-reduction surgery is a health and quality-of-life issue. She says she wished she had more information from other women who had been through it, especially during recovery.
For support, she turned to a subreddit for breast-reduction patients, where she and other women of color shared their experiences to help figure out what was normal post-op, what wasn’t, what could help with scar-tissue healing, and so forth. For example, the pigmentation drained from her nipples after her surgery, which she didn’t know was a possibility. She says she felt like a burn victim looking at this skin that didn’t match the rest of her. When she asked her doctor, he told her, “sometimes it comes back, sometimes it doesn’t,” which wasn’t helpful. Having a community of people who had been through the same thing and could offer their experiences helped Kachipande feel reassured that she’d be okay.
The recovery is another reason some women put off the surgery until their later years. Patients can’t lift anything for several weeks, which makes childcare difficult. Monitoring and cleaning the drains placed at the surgery sites is tricky to do alone, too. Alden had an adult living with her at the time who helped with her aftercare, though when pressed, she says she would have made it work alone. “I wanted it so bad it didn’t matter what I had to do afterwards to recuperate,” she says.
Dr. Steinberg says the attitude of her older patients is quite different from the younger ones. “The older they get, the less they care really and truly about how they look,” she said. “There are risks to this surgery, and one of those risks — and it’s a low risk, less than three percent — is you could lose your entire nipple and areola. …The older they are, or the more children they have, or the longer they’ve been married, they’re like, ‘Just take them off. I don’t even care if I have nipples. I don’t care.'”