Regardless of the negative effects of macromastia, the medical term for excessively large breasts, insurance providers consider it a cosmetic operation unless patients meet a lengthy list of symptoms—all physical, none psychological—and many require doctors to try fitting patients with a better bra and other therapeutic measures before resorting to surgery. Perhaps that explains why, when I emphasized the emotional baggage of my breasts during consultations with my surgeon, he guided our conversations back to the physical issues.

Despite the insurance difficulties, breast reductions increased by 157 percent between 1997 and 2013, according to statistics from the American Society for Aesthetic Plastic Surgery. Anecdotally, Brian Labow, the director of the Adolescent Breast Clinic at Boston Children’s Hospital, tells me that he’s seen an uptick in teenagers wanting breast reductions over the past 11 years. He used to see two or three teens a year for symptoms of macromastia, he says. Now, he sees more than 100, though not all of them opt for surgery. Originally a hand surgeon, Labow says that when he first went into pediatric plastic surgery, he didn’t imagine he would ever have to do breast surgery.

Doctors don’t know why more women, and in particular more young women, are opting for breast reductions. Some studies suggest that people are reaching puberty earlier, and the obesity epidemic is affecting breast size, Labow says. “And then there’s the whole environmental estrogen story,” he adds. Environmental estrogens, often called xenoestrogens, are substances that mimic the hormone our bodies naturally produce, which is known to influence breast size. These chemicals are often found in pesticides, plastics, and meat from animals that have been given steroid hormone drugs to speed up growth. “Is there estrogen in our soy? Is there estrogen in our various food products, chicken or cows? Are we putting in artificial or synthetic estrogen? I really don’t know.”

Perhaps it’s that the surgery itself is getting easier. “This is almost a day surgical procedure,” Labow says, recalling a patient who came in at 5:30 p.m. for her reduction and went home the same night. When I had my reduction done nine years ago, surgery lasted approximately four hours, and I stayed in the hospital for another 24.

“I really did not think that this was as big of an issue as it is,” Labow says. “As I got more patients, I began to ask myself, ‘Am I doing the right thing?’ I’d go look at the literature; there was nothing there.” Breast reduction was one of the 10 most common operations in the U.S. in 2013, with 122,838 women undergoing procedure. But the average age of the reduction patient in the U.S. is around 40, according to Labow, perhaps because women are often encouraged to wait until they’ve had children, as pregnancy and childbirth can affect breast size.