I asked for A+ boobs and woke up with D cups - what I learned about the breast reconstruction industry in the wake of my double mastectomy shocked me

Opting for a double mastectomy was an 'easy decision,' Sarah Thornton says.

After years of biopsies and amid the continuing threat of breast cancer, she went into the surgery and, without much thought, opted for the reconstruction covered by her health insurance.

To her enormous relief, the rogue cells turned out not to be cancerous.

But when she looked at herself in the mirror post-reconstruction, her new breasts felt like strangers. And none of her favorite jackets fitted.

It was only about three months later - after the bandages came off and the swelling had come down - that she was measured for a new bra and discovered, to her shock, that she had ballooned from a humble B cup to a significantly more generous D.

'I was really clear,' she recalls. 'I literally asked for lesbian yoga boobs. Those were the words I used. 

'Then I followed it up with an email saying, "I do not want to go big, just somewhere between an A and a B." And, because I love a joke, I couldn't help myself. I said, "Think of it as an A plus boob."'

Sarah Thornton was measured for a new bra and discovered, to her shock, that she had ballooned from a humble B cup to a significantly more generous D

In her book, Tits Up, Thornton encounters one male doctor and writes: 'I suspect… he'd established his surgical standards in the 1980s, when Pamela Anderson's bust was iconic'

Liposuction overtook breast augmentation as the world's most popular form of cosmetic surgery in 2022

What had prompted the surgeon to 'go large' against her expressed wishes? As she started asking questions, interviewing hundreds of women as well as professionals in the medical community, she discovered that she was far from alone. 

In fact, she uncovered a male-dominated plastic surgery industry that - in essence - bestows Playboy fantasy boobs on unsuspecting women, based on its perception of what is sexy and attractive.

Fewer than 18 per cent of active plastic surgeons in the US are women, while more than 90 per cent of the clientele is female. And, until 2022, breast augmentation was by far the most common procedure performed globally.

In her book, Tits Up, Thornton encounters one male doctor - 'I call him Dr Moore, because he was literally more and more and more' - who insisted on using 385cc implants (over twice the size of some fellow surgeons' average), because his ideal cleavage had a gap no wider than a pinky finger.

'I suspect… he'd established his surgical standards in the 1980s, when Pamela Anderson's bust was iconic.' 

Others intentionally design breasts with nipples so far above their normal location, they can't help but pop out of the bra.

Dr Kelly Bolden says in the book: 'When I go to plastic surgery conferences, the majority of experts on breasts are still men.

'When they talk about an aesthetically pleasing breast and show their befores and afters, the female surgeons in the audience will cringe because it's obvious that these men find what we call "pseudo ptosis" attractive.'

A male-dominated plastic surgery industry - in essence - bestows Playboy fantasy boobs on unsuspecting women

The choice to 'go flat' and not opt for reconstruction was considered a sign of poor mental health by some male doctors

This term describes a condition where the nipple is in the upper half of the breast, sometimes even pointing upward. 

Thornton even came across one surgeon who refused a patient's pleas for him to remove the implants he'd given her, on the grounds that he didn't like the way breasts looked after. 

'My results are my calling card,' he is reported as saying, 'and I don't want my name on that.'

In contrast, Thornton believes her own doctor was just doing his best, in the face of a flawed industry standard.

'There's a whole profession who write papers... who agree literally on measurements, like the distance between the sternum and the nipple and the areola, and what's the right size of areola.

'It's about a professional standard of beauty, and a professional standard of what is the norm. This is bigger than individual, personal predilections; it is about the male domination of an industry.'

Adding of her own reconstruction: 'Objectively, this was an excellent result.

'Unfortunately, [my doctor] was engulfed in a whole profession that created these protocols and measurements and standards that are at odds with a lot of women's desires for their own athletic self or their own small-chested self.'

Her findings are echoed by Dr Elisabeth Potter, who describes how, during her training at UT Southwestern, the choice to 'go flat' after mastectomy, and not have reconstruction, was considered a sign of poor mental health by her majority male colleagues.

She says in the book: 'The male faculty... were focused on what they personally found sexy and appealing. Natural breasts were criticized. Artificially inflated ones were glorified. They commended the surgeon who asked the husband about sizing up the implants while the wife was asleep.'

'Personally,' Thornton adds wryly, 'I would never have my plastic surgery done by one of my husband's golfing buddies.'

However, despite the fact that not only did she hate her new breasts - they also gave her 'exercise intolerance,' meaning she couldn't swim or do yoga without experiencing pain and stiffness - Thornton never considered suing.

'I'm not a litigious type of person,' she says. 'My mother is British - you know, keep calm and carry on. And also, when I was a kid, she never gave me medicine, I'd have to be on my deathbed to get an aspirin. That's the way I was brought up. So it would have been anathema to me.'

Writing the book was, she says, her healing process. 'And I feel grateful, in a very weird way, because I lost something that I hadn't even really rated as very important. I think I was amongst a general contingent of women who are like, "Boobs, you know, the men like them and whatever." They get in the way.

One doctor insisted on using 385cc implants (over twice the size of some fellow surgeons' average), because his ideal cleavage had a gap no wider than a pinky finger

Dr Elisabeth Potter says the male faculty at UT Southwestern 'were focused on what they personally found sexy and appealing'

'Most women have conflicted feelings around their breasts,' she adds. 'That happens to something that's over-sexualized in a culture.

'There's a big difference between the way men look at them, and the way women look at them, and the way men look at them kind of dominates.'

Finally, however, after she'd finished writing the book, she got the breasts she'd wanted.

Her right boob ('the one I jokingly called Bert') had turned 180 degrees and was now pointing inward.

'Think of it this way,' she explains. 'You've got an egg, sunny side up. And it was flipped. It was like my right boob was over-easy.'

The left breast, meanwhile, had capsular contracture, which is when scar tissue starts to strangle the implant and is extremely painful. When she eventually went under the knife, she discovered the implant had ruptured, after just five years.

Opting for a female surgeon this time - at the same hospital - she repeated her desire for smaller breasts. 'I said, "Please, I love to swim. I love doing yoga, I want to go smaller."

'[The surgeon] did a great job. I actually feel very happy with these,' she says.

She's even renamed them. They're no longer named after the male Muppets Bert and Ernie. 'They're now Glenda and Brenda, which is my mother and her high school friend from Harlow.'

Tits Up: What Sex Workers, Milk Bankers, Plastic Surgeons, Bra Designers, and Witches Tell Us about Breasts by Sarah Thornton is published by W.W. Norton & Company.