In this second post of our seven-part series about breast surgery, we’ll see that many women around the world – including here in Switzerland – seriously think about breast procedures, from augmentation to reduction. But despite widespread breast dissatisfaction, relatively few women take the leap into surgery. We begin to uncover why so many stop at contemplation.

In our previous post, we learned that a great many women around the world and in Switzerland are unhappy with their breasts. It’s only natural that cosmetic breast surgery – such as augmentation, lift, or reduction – crosses the minds of those seeking change. Surveys indicate that many women consider cosmetic surgery at some point in their lives. In countries like the United States and the UK, polls have consistently shown that a significant proportion of women would contemplate surgery under the right circumstances. These insights suggest that thinking about surgery is not unusual – it’s increasingly common. Even in Switzerland, consultations and informal conversations suggest many women toy with the idea of a breast procedure. The curiosity is there; the intent is there.

However, there’s a stark reality check when we look at how many women actually undergo breast surgery. The truth is, only a small fraction of those who think about it end up on an operating table. In 2022, for example, just under 300,000 breast augmentation procedures were performed in the United States according to the American Society of Plastic Surgeons. Globally, breast surgeries continue to be some of the most common procedures, according to ISAPS data – with millions of procedures performed annually when accounting for augmentations, lifts, and reductions combined. Still, when weighed against the hundreds of millions of women who report dissatisfaction with their breasts, the proportion that proceeds with surgery remains relatively small. Despite growing acceptance and access, the vast majority of women won’t go through with breast surgery.

The discrepancy between interest and action is seen in many contexts, but it’s especially pronounced in cosmetic surgery. So why does this gap exist? If so many consider breast surgery, why do so few follow through? There isn’t a single answer; rather, a combination of practical, emotional, and social factors winnows down the numbers. It’s a bit like a funnel: at the wide top are all the women unhappy with their breasts. A smaller subset of those reach the middle, seriously contemplating surgery as a solution. Then an even smaller subset comes out the bottom of the funnel as actual surgical patients. At each stage, some women step back – and they do so for valid reasons.

Internal and external barriers play a role, when women think about breast surgery but hold back. Financial cost looms large – cosmetic surgery can be costly, and in Switzerland it’s rarely covered by basic health insurance unless medically necessary. Fear is another factor: fear of surgical risks, complications, or an outcome that might disappoint. There’s also social stigma; some women worry about being judged if they have «had work done,» or feel that wanting cosmetic surgery might be seen as vain. Then there are personal values – a woman might think about surgery but later decide she wants to try self-acceptance, or that surgery conflicts with her principles of staying «all natural.» All these factors contribute to the funnel effect we described.

It’s important to highlight that considering surgery can itself be a meaningful process even if it doesn’t lead to an operation. Often, when a woman entertains the thought of changing her breasts, it prompts reflection on what she hopes to gain – be it improved confidence, comfort, or conformity to an ideal. Some women find that simply exploring the idea, perhaps through consultations or personal research, leads them to a place of acceptance. «Maybe I don’t need surgery to feel better about myself, » they conclude. In such cases, the act of considering surgery served as a catalyst for internal growth or a change in perspective.

On the other hand, some women linger in the consideration phase for years – sometimes revisiting the idea at different life stages (after pregnancy, for example, or when approaching a milestone birthday). These women might eventually move forward when circumstances change. I’ve had patients who first came for information in their twenties, then returned in their thirties after children, finally feeling the time was right to proceed. So, the gap between considering and following through isn’t necessarily a permanent «no». It can be a «not yet». The data only capture a snapshot (who had surgery this year), but there is a flow over time as individual decisions evolve.

Conclusion: Many are called, but few are chosen – this old adage rings especially true when it comes to aesthetic breast surgery. In this post we saw that while interest in breast enhancement is widespread, the actual number of women taking the plunge is relatively small. What, specifically, are the considerations or concerns that make a woman say, «I’ll pass,» even if she’s unhappy with her breasts? In Part 3, we will take an even closer look at the practical, psychological, and cultural barriers that often keep a wish a wish, rather than a reality.

Dr. med. Borut Banič

Board-certified Specialist in Plastic, Reconstructive, and Aesthetic Surgery (FMH)
Fellow of The European Board of Plastic, Reconstructive and Aesthetic Surgery (FEBOPRAS)