Life with the Girls

The Reduction


Constance Costas was hoping for more noticeable results when she went under the knife. The failure to get what she wanted, she realized, lay as much with herself as it did with her surgeon. In this month’s “Life with the Girls,” find out why she felt fooled, and what it took to finally find her voice.


Constance before…

My conversations these days are peppered with photos. Ask about my friend’s wedding and I’ll whip out my phone, scroll to her fabulous dress and play you a video of the first dance. Photos get the message across in ways words can’t always manage.

So it seemed odd when I met with an excellent plastic surgeon to talk about a breast reduction and noticed there wasn’t a photo in sight. After two more consultations, my unease upgraded to concern as I sat across his office manager’s desk. She reviewed my pre-op paperwork before asking brightly, “Any questions?”

“How will he know?” I ventured, trying to assign the right words to the hazy question mark that lingered in my mind.

“Know what?” she asked.

“My size? Why haven’t I seen any pictures?”

I’d always been a modest B-cup, which crept up to a C after having two children. Menopause brought hormonal upheavals and ten extra pounds. By the time a Bra Fit Expert got me into a 36E, my girls had become impossible to conceal. While some women delight in this midlife bonanza, I felt betrayed.

I also felt self-indulgent. Women who deserved breast reduction surgery endured back pain. Their bra straps dug troughs into their shoulders. Was it too much to ask that my shirts button neatly? Compounding my guilt, I knew friends who had survived breast cancer, mastectomies, reconstruction. “Just be thankful you’ve got healthy breasts!” one told me. Was it selfish to want my body back?

In our first meeting, I had greeted Dr. X saying, “Just cut them off!” He had chuckled, assuring me that would only trade one problem for another. We struck a compromise: I’d go for a B-cup or C-cup, and Dr. X assured me that my post-surgery breasts would be proportionate to my body. Looking back, I had handed over my power with the ease of a Kardashian tossing her car keys to a parking valet.

“I had handed over my power with the ease of a Kardashian tossing her car keys to a parking valet”

“Dr. X doesn’t use pictures,” the office manager explained gingerly, as if I had committed a faux pas.

“Then how do I know we’ve got the same size in mind?” Everything I had read insisted that cup size wasn’t a reliable guide for surgery, and if cups and photos were out, what was in? Mind-reading?

“He can’t duplicate a photo, but he knows what you want. You’ll look proportionate. You’ll be happy with your results.”

That word again, proportionate. It had lulled me into compliance, but the patronizing tone still rankled. The message was that I was supposed to assume this man knew what I wanted. As a plastic-surgery rookie, I put myself into someone else’s hands and hoped for the best.

The surgery went beautifully. I healed easily. I couldn’t wait to trade in my D- and E-cup bras.

…and after her breast reduction.

“When will the swelling go down?” I asked three months out at a follow-up. The nurse quickly became engrossed in her clipboard while my surgeon mumbled about some people healing faster than others. By six months post-op, I was furious. Technically, Dr. X had done exquisite work. But my chest was only slightly smaller, still firmly in the D-range.

This wasn’t a surgical problem; this was a listening problem. A photo serves as a visual means of communication. Why had we skipped something so fundamental to the process? I realized my surgeon eschewed photos for the same reason a hairstylist might scoff if I showed up with a glamour shot of Jennifer Aniston: No amount of scissor-wielding genius could turn me into Jen. But I had known that from the start—did my doctor think I couldn’t possibly understand?

I felt muzzled. Deeply pissed. Not once had Dr. X invited me into his office, dressed like an equal. A one-on-one conversation across his desk, I now knew, would have erased our power differential. Instead, I had sat on an exam table in a paper top while a nurse with pumped-up implants stood quietly to the side, bearing witness. Had I tiptoed around my preference for small breasts to avoid offending? Did Dr. X think he knew better than I did? Either way, I had fallen into line.

That summer, I came across a photo of me in my thirties, dressed for a party. With my size Bs, I looked feminine, not busty. I looked like me. I wondered why hadn’t Dr. X suggested I bring in a photo of myself. Why hadn’t I insisted on bringing one?

I called to schedule another conversation. “I’d like to meet in his office this time,” I told the receptionist. When I was ushered into the exam room, I wanted to cry.

“That spot didn’t serve me well before,” I explained when Dr. X entered, surprised to find me in the room’s only chair. He pulled up his rolling stool to face me.

My complaint, I made plain, wasn’t about his skill. But without clear communication, what good is skill? How can you possibly know what your patients want, I asked him, without literally getting on the same page?

At first, Dr. X gave me that patented line: We’ve-never-had-this-problem-before. Like a lot of men, his first instinct was to fix things but to his credit, he sat and listened, eventually softening. Finally, he offered me a surgical re-do.

“Surgery,” I shot back, “is not a lifestyle for me!”

“Surgery,” I shot back, “is not a lifestyle for me!” All I cared about was his process. I wanted him to stop silencing the women who came to him for help. “I’ve had my shot. It’s over.”

“Well,” he said, finally, “if you change your mind, I’m here.”

“Can I think about it?” I conceded. “Maybe a year down the road?”

“Take eight years if you want,” he said, flashing a relieved smile. “My offer stands for as long as I’m practicing.”

This was something. Maybe, just maybe, he had heard me. When I left, every seat in his waiting room was full—our talk had run long, and I’d obviously blown his schedule.

Six months later, when I went for a mammogram, I asked the technician to compare this year’s measurements with last year’s. How much tissue had my surgeon taken off? She studied my chart. “Not much,” she said, laughing.

Are my breasts a bit smaller? Sure. Would I have undergone surgery for such a subtle result? Never. I’ve bought a few pretty new bras since then. But mostly what I’ve taken from this experience is the gut-check: Pay attention when a hazy question-mark pops up in my mind instead of a clear image. If a picture is worth a thousand words, make sure you paint it. If you don’t, someone else will.

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Constance Costas

Constance has written for Self, Shape, Health, Worth and Ladies’ Home Journal, and she loves helping authors write un-put-downable books. She lives in Richmond, Virginia.
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