What Makes Your Breasts Bigger Without Breast Surgery?

I saw a woman in clinic recently who had a large breast change in volume (a B –> D cup). She didn’t like them, and wanted a breast reduction to get her B cup back.  I said until we figure out why they are growing and make sure the growth has stabilized, she should not do surgery.  She puzzled me though, because she had no weight gain, no recent pregnancies, no recent menopause or hormone replacement, no tumor or growth.  What would cause the increase in size?  I did figure it out, but the whole process inspired me to write this blog.

What makes your breasts get bigger without breast surgery?

• WEIGHT GAIN.  I think this is the biggest general cause.  The breast is made up of breast tissue and fat.  As you age and go through pregnancies and breast feeding, generally the breast composition changes and becomes fattier and fattier.  This means when you are 18 and gain weight, you may have little change in your breast size, because it has a lot of breast tissue and less fat.  When you are 60 and gain weight, you may have more change, because your breast is more fat.  I think much of the increase in breast size in older women is due to this – a more fatty breast, combined with the weight gain seen around menopause.
  • This is not new information.  When doing a breast reduction, they base the “medical necessity” of it on body surface area, which is related to your height and weight.  Basically, the heavier you are, the more tissue we need to remove during surgery for insurance to cover it as medically necessary.  They are essentially saying, “your breasts may be large because of your weight.”
• HORMONES.  Again not a new thing.  People talk of their breast size changing with time of the month, birth control pills, and pregnancies.  There are hormones in many things, and older women frequently take hormone replacement.  You can look to this as a potential cause in breast size change.
• LIPOSUCTION.  This is a trickier culprit to identify.  We plastic surgeons do a lot of liposuction.  For years it was the number one surgical procedure.   When we do liposuction WE CHANGE YOUR FAT PATTERN.  How the pattern changes is completely predictable.  And, it can cause your breasts to get bigger.  How?
  • If you gain weight right now, it goes to where you have pockets of fat cells: your inner thigh, your outer thigh, your belly, your love handles, your arms.
  • People don’t think of their breast as a fat pocket, but it is, particularly as you age.
  • If you have aggressive liposuction of the body, those fat pockets are removed.  So if you gain weight in the future, it won’t go to those spots because the fat cells are gone.
  • As an example: if you always gain weight in your thighs and then have aggressive liposuction of the thighs, the fat in your thighs will be significantly reduced.  In the future if you gain 10 pounds it will not go to your thighs. Your natural genetic pattern is changed. Now the weight change will be seen in the areas you still have fat pockets.  There was a study in the NYT which discusses this.
  • So where does fat go? It goes the sites not addressed by your liposuction surgery.  This weight gain fools people, because their pants still fit.  It can be tricky, because the difference in weight may only be a couple pounds.  But if you are thin, with no fat pockets left except for the breast, if you gain 5 pounds your pants will still fit.  But your bra may not.
• BRAVA.  Brava is a suction dome put on top of the breast.  It causes the breast to enlarge, but the results seem to be temporary unless supported by fat transfer.