Why aren’t we talking more about boobs in mental health?

I’d sit cross-legged on the shaggy rug next to the bathtub as she soaked. Sometimes I’d tell her about my day, but mostly I just watched as she let the hot water rise high and dragged the wash cloth across her coppery skin. 

I gazed at the curve of her breasts, struggling to imagine that those one day could be the shape of my own. I already shared in her soft belly, and had been cautioned enough that we had an unforgiving metabolism. But these rounded orbs seemed like they belonged to a body I’d never know. 

As fate would have it, I never did develop my mother’s breasts. Or my aunts’. Or my grandmother’s. While they ranged in size, they all filled – overfilled, actually – the white, wiry bras they wore. 

In my own Are You There God? It’s Me Margaret moments, I’d send my prayers up to heaven and will my cups to overfloweth. But I wasn’t looking for miracles, exactly. A nice B-cup would be perfectly acceptable. Something that might distinguish my chest from those of my younger brothers. And for the love of all things holy, could I please just be a little more even up there?

Desperate to move beyond what I saw as the confines of young girlhood, bleeding and boobs seemed to be the golden key to a new, more magical world. My copies of Seventeen were earmarked for dresses I longed to wear and dating advice I longed to need. 

The bleeding came. The hair and hips and moodiness came. The nasty mother-daughter fights did too. The boobs never did. 

I was lucky, I was assured. I could exercise without pain – barely even a sports bra required. But I wasn’t athletic and the idea of running being somehow a perk didn’t register. Boys weren’t ogling my chest. But at the time, feeling painfully invisible, I wanted nothing more for a boy – anyone, really – to have a reason to look. 

I’m not sure at what point in my adolescence I realized that my chest had officially called it and I committed to my cup size, but I do remember my mom reassuring me that surgical options existed. I filed that option away in my mind while I shifted my focus to what those Seventeen magazines assured me was more modifiable – my weight. If I couldn’t have the chest I wanted, maybe I could at least not have these jiggly thighs? 

My thighs shrank. My breasts of course did too. And with both of them, my sense of myself as a person separate from a body. 

If it seems like almost every woman wishes for different breasts, that’s because it’s not far off. In what is hardly surprising but nonetheless heartbreaking, 48% of women fall in my own camp of desiring a larger size, while another 23% wish their girls were smaller. 

While dissatisfaction with our bodies is essentially baked into our culture for women, this particular point of body shame is notable both in its ubiquitousness and its implications. 

The implications are vast, and they are serious. They also start young. 

Girls and women who dislike their breast size tend to have worse psychological well-being, and they report feeling less confident and less happy. In a study of young women whose breasts are different sizes (which is quite common), researchers found that the asymmetry – even when mild – was associated with significant impairments in emotional well-being, as well as worse attitudes toward their bodies, eating, and themselves. 

Problems are in fact the most pronounced for girls that develop early or have large breasts. Early physical maturation has been associated with a whole host of challenges, which is a growing concern given the creep of younger and younger puberty these days. Growing breasts is hard regardless of the circumstances, but when it’s sooner than peers and before psychosocial development has had a chance to catch up, girls can experience everything from depression to disordered eating to self-harm to increased tobacco use.

It’s almost hard to get anyone worked up anymore about body image problems for women, given that we’ve come to expect it as the norm in our deranged society, but consider another way these issues play out. Women with breast dissatisfaction are less likely to do breast self-examinations, a standard recommendation for early detection of cancer. They may even be less likely to follow through on other recommended self-care and health practices, both related to cancer prevention –  like mammograms – and related to general well-being – like exercise. And there are hundreds of other potential links that could and may eventually be made – from how self-esteem related to breast satisfaction impacts sexual and relationship functioning to how the sexualization of women with varied breast sizes impacts their stress responses. 

The psychological and physical implications start to paint a picture of a public health crisis, but it’s unlikely that we’ll see fundraisers or billboards to support breast acceptance anytime. Even in the #bodiposi world, boobs seem to rarely be a point of focus. And I hear so regularly from larger-bodied but smaller-chested women who feel particularly left out of the movement. 

So where does that leave the large majority of women who find themselves with breasts that feel frustrating or even harmful to their mental health? Some of them will end up with push-up bras in their online carts. Some will find themselves binding their breasts in a desperate attempt to mitigate the physical and emotional pain (n.b. This is highly dangerous when not done correctly.) And many – over 300,000 in the U.S. each year – will end up on an operating table.

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Here’s a sliver of how the “Would I think about getting breast augmentation?” conversation goes in my own head: 

Ugh, it would be so nice to have boobs I really loved. 

But you don’t have to love every part of your body. There are other things you like. This is just something you need to accept. 

Yeah, but I don’t have to just accept it, necessarily. What if it’s just for me? It’s not like I’m trying to impress anyone. 

Oh really? Then why should it matter? If you lived on a deserted island, would you be thinking about this? 

Okay, maybe that’s fair. Maybe I do want to look more attractive. But is that so wrong? I wear make-up and buy clothes to feel like I can look my best. I get my crazy eyebrows waxed. 

You are not seriously comparing putting on foundation to cutting open your body, are you? This is a major procedure that could put you at risk for medical issues. 

Lighten up. It’s a pretty safe procedure. Millions of women around the world have done it, and if it makes me feel better in my own body, it could be worth it. 

But you should feel comfortable in your own skin without surgery that’s not needed. Isn’t that what you are constantly trying to preach? You’d be such a hypocrite!

I worry about that too. I believe so strongly in body acceptance and neutrality. But what if I know in my soul this has nothing to do with my worth or value. I just think I’d like how it looks and how I’d feel. What about supporting women’s rights to make choices for their bodies? 

Yeah, but is it really a choice you’d make if it weren’t for the PATRIARCHY? 

Damnit, now you invoked the fucking patriarchy…

And it continues like that in endless circles.

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The part of my own internal debate that hooks me the most is wondering about where the line exists between making aesthetic choices in a way that’s supportive of our mental health and authenticity and making those choices in a way that further harms our own esteem and sense of value. 

As a spoiler, just as in piece I shared months back about how we assess the desire to lose weight, I have no concrete answers to offer. I’m sorry. I’ll be sure to tweet (oops, um, X??)  about it if I come up with the golden solution. 

But as I continue to wrestle with this paradox, both intellectually and at the checkout counter at Sephora, I keep coming back to this related paradox: I wish there was a way to extract all sociocultural influence out of our bodies so that we could be left with a stripped down version of what we really want. Maybe then we could make sure we are doing things for the so-called right reasons. But we live in a social context and we exist within a culture, so not only would that be impossible to do, but would we even want to? Is there something inherently wrong with wanting to look attractive? We are wired, after all, to seek beauty. 

What makes this question difficult in our own social context is that beauty – a very particular and relatively impossible western ideal of beauty, actually – has been prioritized to such a degree that it seems to box out all of the other qualities and values. When preschool girls start rolling their eyes when you tell them they’re smart because they just want to be cute, we have a problem. 

The pursuit of beauty as an ideal has also been weaponized and commodified in a way that hurts women. Appearance-based insults, body-based discrimination, and the fact that I can end up spending the equivalent of a car payment on products and services each month also means we have a problem. 

And still, nothing is wrong with valuing beauty. Fundamentally, we want it, we inspire it, we create it. Our bodies are our most personal canvas. Can we pursue things like more symmetrical breasts in service of the purest version of that desire? 

To be honest, I’m not sure. It’s all gotten so convoluted that I don’t personally believe any of us can truly excavate our intentions when it comes to these kinds of decisions. And some of us don’t necessarily care. We realize that looking “better” in our culture affords us privileges – rightly or wrongly – and we want that. I get that too. 

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In case you were wondering, I have no surgery date set. I doubt I will go under any knives given that I don’t think the potential benefit – even if I loved the result – would substantially improve my life. 

But there are plenty of women, both cis and trans, as well as trans men, who will pursue surgery as a way to protect or improve their mental health. For some, having a chest that reflects who they are or most want to be is literally life-saving. 

And then there are even more of us who may not be considering making a change, but who have certainly been shaped by our experiences of having breasts in a world that doesn’t seem to know how to feel about them.

Dr. Ashley Solomon is the founder of Galia Collaborative, an organization dedicated to helping women heal, thrive, and lead. She works with individuals, teams, and companies to empower women with modern mental healthcare and the tools they need to amplify their impact in a messy world.

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