Q: How do I explain my breast reduction surgery to my 6 and 8 year old daughters? I am concerned that they will think having breasts is a bad thing or that it's normal to need this type of surgery. I don't want to be the cause self-esteem issues or poor body image for them.

A: If a woman is having breast reduction surgery for reasons related to physical problems resulting from her breast size, the explanation to her child should focus on that.  So, for example, she can tell her children that this will help her back, neck, and shoulders to not hurt as much; help her improve her posture; and so on, and that this is the reason that she is having the surgery.  The mother should be sure that she stresses that some people have bigger breasts and some have smaller ones, and that breast size per se is not good or bad; everyone is different, and that is wonderful.  She can also use this as a teaching experience about the importance of taking care of oneself and seeking medical attention when one has physical or medical problems.

If a woman is having the surgery for cosmetic reasons, she should be careful to make sure to stress that people can look beautiful in many different ways, and that it is who you are on the inside that matters most.  She also should make sure that she sends the message that she thinks that she is beautiful as she is now, and that ones breast size is not an important factor in how good a person is or how much others will like you, but rather the surgery is just an extra way to make her feel even more beautiful.

In either case, it is important to make sure that you – and all of the woman and men in the children’s lives – send the right messages in general about a woman’s body, because unfortunately children are barraged with messages in today’s society that often are not very beneficial.   Parents should discuss, for example, the importance of eating right and exercising, not because one has to look a certain way but because one should be healthy; that real beauty is about who you are, not how you look; that everyone is a person of worth, regardless of how they look; and that people can look beautiful in all different shapes and sizes (and parents can give examples of loved ones or others who are all beautiful but all look different).  But even more important than talking about these things is modeling them.  Look at the messages that you send through your words and behavior: do your children constantly hear you say that you are “fat”?  Do they hear you put yourself down?  Your actions speak much louder than your words, and a parent needs to make sure that her actions are “saying” what she wants them to.  Finally, this is also a wonderful opportunity to begin (or continue) an ongoing discussion about the human body, relationships, values, sex, and so on.

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Answered by Dr. Wayne Fleisig