Life with the Girls

The Reduction

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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.

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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 Costas

Constance has written for Self, Shape, Health, Worth and Ladies’ Home Journal, and she loves helping authors write un-put-downable books. A Virginian, she lives in New York City, where people assume she should still have a Southern accent.
Constance Costas

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5 Comments

  • Reply Sarah April 15, 2020 at 9:21 am

    Hello Constance,
    I have been a size HH most of my adult life. Depending on how much I gain or lose weight. I’m 38 now and I keep saying one day I’ll go in and take care of the gawking, and ridicule I’ve dealt with all my life. See I’m petite. 5’1″ size 6 pant and no trunk if you know what I mean. I’ve waited because of exactly your story. If I go in will I be wasting my time and money for an H? Will the doctor not see my indented shoulders, history of slipped shoulder blades? Will he tell me to just keep working at the gym? So I endure not looking my best and hopefully as I get older I’ll succumb to “just a lift, doc”. Take care and thank you.

    • Bare it All
      Reply Bare it All April 15, 2020 at 9:36 am

      Thank you for reading and writing in, Sarah. Your body is perfect as is (and if you need a bra to do some of the heavy lifting, you know where to find us).

  • Reply Constance Costas April 15, 2020 at 10:03 am

    Hi Sarah,
    Thanks for writing. I hope my experience will help you ask for exactly what you want. And if the surgeon won’t allow photos, just tell her (or him) you’ll be moving on. We’re all smart enough to know that a doctor can’t duplicate a photo, but they’re great tools for clear communication. I also think a separate conversation in his office — outside of the exam room — is a good sign. I did get a small change that helped; just not the one I’d hoped for. But I would encourage you to try a few consultations. Once you feel heard and understood, you’ll know you’re in the right place. Best wishes to you.

  • Reply Lori Craig April 29, 2020 at 6:23 pm

    I truly enjoyed this. I too was comfy 34c most of life till kids..chemos..and hormones. I wound up a 38 JJJ. I’m also 5’3″ . Went from 106 lbs to 198. But then I lost weight….everywhere but THERE. Assumed the Dr knew HER stuff. Ie wound up with drainage problems and it took a year to even get properly healed. I am now…5 years later…56 years old..150 lbs but…i have 2 Boob sizes. One is a solid d if not a dd. The other is a C. The more weight I lose the more obvious. But the after many trips back…i kept getting the shuffle. I had the same gut feeling pre surgery but…they’re the Dr….right? We alone know our bodies best. And our gut feelings.

    • Brooke Glassberg
      Reply Brooke Glassberg April 30, 2020 at 9:08 am

      Lori, thank you so much for taking the time to write about your ordeal. Sounds like Constance’s experience really hit close to home. You’re exactly right: No one knows us better than we know ourselves. Take good care!

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