My relationship with bras was misaligned from the start. Victoria’s Secret didn’t carry my bra size and rather than letting me know this pertinent information, they crammed me into a bra they stocked. Unaware of chestbinding best practices, I relied on minimizers.
Except when I didn’t. A friend’s grandmother rubbed my shoulder searching for straps. Finding none, she was horrified. Within days, I was ushered to a shop where they measured, and relayed, my actual size. This proper fit relieved the strain on my shoulders, by being snug around the ribs, but I still struggled with back pain and unwanted attention. I had been called “top heavy”. A coach had shared that people came to games to see my breasts move up and down as I ran. Bosses offered unsolicited advice that men’s uniform sizes were too small for my chest.
I first considered breast reduction surgery, or a reductive mammoplasty, in my twenties. Back then, in 2000, they told me it might mean losing nipple sensation and the ability to breastfeed. That felt like too much.
This past spring, in my mid-forties, I asked again and my primary care physician referred me to the plastic surgery department. This time technology had advanced, but patient autonomy had not.
As a sociologist, I know that patriarchy and sexist gender norms are the status quo. I know that men in power define women’s lives in every area, from our unconsciously biased thoughts, to international policy such as burning birth control and removing vaginal rings from women who volunteered their bodies for science in the middle of a medical trial. So many times, too many times, there is a very large gap between what women need and what society wants for them and from them.
They asked about my ideal size. I said, “AA.”
The surgeon scoffed, “Not possible.”
The smallest size they would offer was a C cup, ostensibly to preserve the blood supply to the nipple. According to men, this is the smallest preferable breast size. However, women prefer smaller. And, top surgery and mastectomies can preserve or reconstruct nipples.
To convince me, the doctor let me know that my breasts were saggy, lopsided, and that my nipples were too low and that he could right these wrongs. He showed me a picture of the breasts he wanted to make. The plastic surgery C-cups stared back as a surgically enhanced vision that neither I, nor my back wanted. The doctor focused on what my breasts looked like and importantly, what he wanted them to look like. He wanted symmetry, I wanted healthcare.
If removing a fraction of breast mass could help my back, couldn’t removing a bigger fraction help more? When I asked about going flat, the doctor said that wasn’t a reduction, it was a mastectomy, which was only available for cancer patients and those seeking gender-affirming care. He proceeded to tell me that a flat chest was a “man’s chest.”
Having to either conform to traditional cishet gender norms where I should be happy to have big, buoyant breasts or misrepresent my gender identity should not be prerequisites for medical relief. What if the mental health risks of perkier, “more desirable” breasts are greater than the physical ease patients like me receive from this surgery? This gatekeeping felt extreme.
And it exposed a larger truth: we are denied autonomy over our bodies when our choices do not align with patriarchal norms. This doctor reinforced a binary trap; I either needed to be grateful for big, “desirable” breasts or I needed to claim a gender identity that justified their removal. Yet, as a sociologist, I know that both gender identity and chest size exist on a spectrum and that breast-carrying people, regardless of gender, can have and want small or no breasts.
Data indicates that more than one hundred thousand women receive breast reduction consultations per year. How many of us encounter this binary trap disguised as healthcare? How many of us are shepherded towards a male ideal breast or questioned about our gender identity?
To be clear, breast reductions and gender-affirming care are essential and should be more accessible. Breast reductions reduce back, neck and shoulder pain and are on the rise, providing both mental and physical health benefits for tens of thousands of people a year. Gender-affirming care improves and saves lives.
And, still, in 2025 healthcare should not lack behind patient care. In that exam room, where being a breast carrier who wants less is considered a problem, it felt much like Project 2025, where traditional and patriarchal gender norms have more value than patient needs. One in eight women will get breast cancer, with over 300,000 of us diagnosed each year. Breast reductions cut that rate, sometimes dramatically. With statistics like these, why shouldn’t women be able to determine the goals of this healthcare procedure? It’s time our healthcare was in our hands and our breasts.
About the Author: Megan Thiele Strong (she/they) is a Professor of sociology at San José State University and a Public Voices Fellow at the The OpEd Project and a member of the Scholars Strategy Network.
