How a woman's boob size can affect her brain

I’ve never been a fan of my breasts. They’re too far apart, they’re not perky enough, and my nipples are bigger than I’d prefer. One time in college, a guy called them “silver-dollar nipples,” and I wanted to curl up into a ball and die. While I’ve grown to tolerate them over the years (thanks largely to my boob-loving partner), I basically ignore them outside of sexy time.

The sad reality is that my boob ennui makes me part of the majority in this country. According to surveys, an alarming 70% of women report being unhappy with their breasts. This figure helps explain why breast augmentation continues to reign supreme as the number one cosmetic procedure in the United States, and why it’s been been steadily on the rise for the past two decades. More women are seeking breast lifts, too, and breast reductions remain popular.

These figures speak to a greater reality that doesn’t always get the attention it deserves: For many women, their relationship with their breasts can have a very real impact on their mental health, with boobs that are anything less than “perfect” torturing and tormenting them. Some of these women are prone to body-image issues more generally, but they fixate on their boobs as the source of whatever is plaguing them in life.

Which makes sense, doesn’t it? Thanks to cultural conditioning, for many women, boobs aren’t just some body part—they are the single most important body part. So it stands to reason that a woman’s boobs and her brain can become perilously linked. But what, exactly, is contributing to this widespread dissatisfaction? I posed this question to breast researchers and surgeons, who shared eye-opening insights about our country’s boob blues.

The most obvious contributor is the fact that pop culture inundates us with images of one particular ideal, sending the message that anything other than that ideal is flawed. “Whether we like it or not, breasts have become the symbol of femininity,” said Herluf Lund, a plastic surgeon in St. Louis, Missouri, who specializes in augmentations. Which is a bum deal, he said, given that most of the images we’re exposed to don’t reflect reality. “There are as many breast shapes as there are women.”

From asymmetrical breasts to tuberous ones, from A-cups to H-cups, boobs are like snowflakes: Every pair a little different. Yet when women want to “fix” their chest, they almost always ask for the same thing: a C-cup or small D-cup, with nice proportions and perky cleavage.

“I think the Victoria’s Secret is kind of what is in most people’s mind as the ideal breast. They’re so perky and full,” said John Zannis, a plastic surgeon in eastern North Carolina who performs several hundred augmentations a year. “We have this idea that upper breast fullness is beautiful, and that is really something that [rarely occurs] naturally.”

For many women, their fraught relationship with their boobs begins before they even have them. Concern about breasts not living up to cultural expectations starts young, said Carl Pickhardt, a psychologist in Austin, Texas, who specializes in adolescent behavior. “Young women who develop very late start feeling like, ‘What’s the matter with me?'” he told me, adding, “If your peers are starting to look more womanly and you still look like a girl, that is ‘different’ enough to get you a lot of unwanted attention.”

On the flip side, for young women who develop early, their breasts often become their identity. “You realize you happen to have this appearance thing that gets you an auto entry into social groups, and it’s hard not to invest in that,” said Pickhardt. Girls who develop large breasts young face a greater risk for depression, eating disorders, lower academic achievement, and drug use, according to various studies.

For teen girls who seek out surgery to reduce or enlarge their breasts—and 3% of breast augmentations in 2015 were performed on women ages 13 to 19—their feelings toward their chests can be all-consuming. “When you say ‘adolescent’ and ‘breast,’ people tend to think, ‘Oh they just don’t like their breasts,’” said Brian Labow, director of the adolescent breast clinic at Boston’s Children Hospital. But the issues can run much deeper.

In 2014, Labow and his colleagues conducted a study that found that young women with asymmetrical breasts or overly large breasts were more likely to suffer from self-esteem, depression, and social issues; they also scored lower on emotional health scales than other women their age without these issues. “In addition to psychological effects, these young women are stigmatized, they’re separated from their peer group and they can’t even find clothes that fit,” explained Labow. “In every metric of quality of life, they scored demonstrably lower in every single category.”

For some of these women, surgery can indeed provide a better quality of life. “For us, the most grateful are the breast reduction patients,” Labow told me. “They get sexualized from a young age—I am shocked by the stories that I hear. They used to run, play soccer, swim, and now they’ve given up their sports.” After the surgery, he said, these young women felt physically and emotionally stronger.

But breast surgery isn’t a cure-all, and some women who seek it out may be searching for a band-aid for deeper mental health issues. According to some estimates, women who undergo breast augmentation are five times as likely to commit suicide than the general population. There have been at least six major studies on this trend and all found an increased risk of suicide among women with breast implants.

Why? One theory posits that women who seek out breast augmentation may already be suffering from depression, anxiety, and body-image issues as a result of being unhappy with their breasts, specifically, or their appearance more generally, said David Frederick, a professor of psychology at Chapman University in California, who has studied breast size and body image extensively. In his research, he’s found that women who were dissatisfied with their breasts were also less satisfied with their overall appearance. For these women, breasts and body image appear to be inextricably linked.

Other studies have also shown that women who undergo breast augmentations have a higher rate of psychiatric hospitalizations prior to surgery than women who undergo other cosmetic procedures. These women often find themselves particularly vulnerable to the surgery’s outcome. “Women who seek breast augmentation report anticipating improved quality of life, body image, and self-esteem as well as increased marital and sexual satisfaction postoperatively,” writes David Sarwer, a clinical psychologist based at Temple University, in a paper exploring the link between breast augmentation and suicide.

When the surgery fails to live up to these expectations, some women suffer further mental and emotional struggles. Which is another reason why Lund, the plastic surgeon in St. Louis, says he counsels his patients extensively to make sure their expectations are realistic.

“I tell my patients what’s possible, and I can tell [this] doesn’t always meet up with their dreams,” he said. “But I sleep a lot better knowing that we’ve got a realistic goal.”

Of course, one reason women have unrealistic expectations for how our breasts’ appearance might impact our lives is because of what we are fed. Not only does popular media place an overemphasis on women’s breasts, but too often, as Frederick pointed out, women are objectified to the point where images edit out women’s faces to show only their breasts. When a woman is portrayed in this way, he said, we are “encouraged to view her only as something that can be used for sex.”

So, if a young woman remains flat-chested through puberty, her self-worth suffers. If she develops large breasts too soon, she can end up sexualized, ostracized, or stigmatized. Then, in adulthood, women are reminded every day that our boobs are too small, too big, too pointy, too far apart, or that our nipples look like silver dollars. There’s always something. We’ve created a system where “perfect” boobs for most people is only achievable through surgery—no wonder it’s so popular.

While there’s no quick fix, nearly every expert I spoke with encouraged helping women understand the true range of breasts that exist. Most women “don’t know what the whole variety of breast shapes are,” said Lund. Actually, nearly every plastic surgeon I spoke to said they had to remind patients that so many images of breasts in the media are photoshopped.

So as our culture moves toward accepting bodies of all varieties, let’s be sure to take special care to include breasts of all varieties, too. In other words? The more boobs we can expose ourselves to, the better.

Taryn Hillin is Fusion’s love and sex writer, with a large focus on the science of relationships. She also loves dogs, Bourbon barrel-aged beers and popcorn — not necessarily in that order.