What Happened to My Breasts? A Plastic Surgeon Explains


Dr. Haideh Hirmand on how — and why — your décolletage changes over time

For a long time, in my 20s and 30s, I never took the issue of the “changing breast” seriously. I mean, after all, how bad could it be? They’re breasts. Something’s always covering them. In fact, I never gave the issue much thought until 1) I started entering my 40s and experiencing some of the changes, and 2) I started my practice in plastic surgery and met many women whose lives were affected by this particular phenomenon. So what happens?

Typically, with time and age, the skin of the breast, much like other skin, loses elasticity and is more prone to stretching and sagging. The breast tissue itself also can thin and involute, causing an emptied-out appearance – especially in the center top part of the breast.

Of course, this does not happen to everyone. Some women experience enlarging of the breasts later in life, which can be due to changing hormones or taking hormonal supplements. Pregnancy has one of the biggest impacts on changes in your breasts’ shape and size. Other “breast changers” include hormonal shifts from menopause and weight fluctuations, which are both common in women in their 40s and 50s. Now that the 50s are the new 40s and the 40s the new 30s, I see more women than ever who want to restore their breasts to their original state — or to a better one.

Breasts, unlike any other organ, are not only defined by their anatomic and functional definitions; they play a pivotal role in both our own femininity and the way our culture defines physical womanhood. That’s why breast reconstruction has had such a vastly positive impact on the lives of women with breast cancer. Let’s face it: breasts —  their shape, size and sensation — play an integral role in how women define themselves as women. And the relationship between women and their breasts has always fascinated me.

Without a doubt, we are currently experiencing a cultural shift toward the classically full feminine breast shape. I believe this is motivated not by the fashion industry, but by real American women who are feeling more comfortable than ever with this breast-feminine dialogue. In the past, I had patients who wanted to be more flat-chested to fit into the haute couture clothing that was their fashion staple. These were not huge-breasted women who wanted to have a breast reduction to be more comfortable doing sports or living everyday life free of back and shoulder pain. Rarely do I see this these days. Cleavage is in!

I see it in my practice. Compared to ten years ago, more women in their 40s want breast enhancement surgery. I also see more women who, after having had their pregnancies, seek to restore their breasts’ shape so that they can fit better in clothes and feel better about themselves.

I see more acceptance on runway shows as well. Diane von Furstenberg’s feminine runway style is in stark contrast to the androgynous overtone of so many high-fashion productions. Last time I saw her show, I was struck by the curves, cleavage and pure feminine quality of her expression — and it is more popular than ever.

Many women whose breasts have significantly changed express a consistent theme of having “lost an integral part of their physique that made them feel whole as a woman.” They didn’t know it until it was lost. These are not topless dancers or those who have to to rely on their appearance to win a date. These are intelligent women who are a powerful part of the workforce, and in many instances run companies, own businesses, are in academics and in politics.

The theme is the same. They look to restore and enhance their breast aesthetics, not out of a desire for youth, but for one of female vitality. No doubt the “fitness, live longer and be more active” trend of our times has something to do with this — as does the ability to live a psychologically and sexually viable and successful life in midlife and beyond menopause.

What a fantastic time to be a woman!

Dr. Haideh Hirmand is a plastic surgeon, academic and thought leader in the aesthetic and beauty arenas. She completed her doctorate in medicine at Harvard and is clinical assistant professor of surgery at the The New York Hospital/Cornell-Weill Medical Center. She specializes in eyelid and facial rejuvenation, secondary breast surgery, and body contouring, and is recognized nationally as a pioneer in injection techniques.

2 Responses so far.

  1. avatar Tobe Halen says:

    Breasts, Boobs, Sweater Puppies, The Girls, Ta Ta’s – whatever you call ’em, I have ’em in abundance…..which was workable in my 20’s and 30’s but at some point they started the long slow trip south and now, without the help of some  industrial strength bras, I can tuck them into the waist of my pants. (no Joke)  I’ve toyed with the idea of Breast Reduction….but, you know, I’m kinda attached to them.  I don’t want them bigger or smaller, I just want them back on my chest where they started.

  2. avatar Jane H says:

    Oh Tobe…. I had the same appendages as you…. I had them reduced and have not regretted it once. Of course, having developed at an early age, I was an oddity among all the other less-feveloped girls and had boys riding by my house on their Stingray bicycles to see if I’d come out and flash them. It was pretty traumatic, so maybe that’s why I didn’t mind trading my double Fs for generous Bs!! ha!