Exactly one year ago, I profiled Junko Kazukawa, a 61-year-old ultrarunner who, like me, had earned a spot in the 2025 Hardrock Hundred after a decade in the lottery. A breast cancer survivor who had a double mastectomy, I asked if she had reconstructive surgery with implants or stayed flat. She answered: “Flat, 100 percent. ... As a runner, I don’t want anything bouncing around. I never had big breasts, but just enough to annoy me when running. The doctor also told me that if I got [implants], I’d have to replace them in 10 to 20 years, and I don’t want surgery again.”

Junko opened my mind and inspired me not only with her dedication to her sport, but also with her commitment to be true to herself and to do what felt right for her, rather than adhering to society’s norms and beauty standards.

I offer the following essay in the same spirit: hoping to inspire other women to be true to themselves and accept their bodies as-is. I hope you might share it with other women you know who face breast surgery because they have old implants that need replacement or removal, or they face mastectomy, or they’re considering augmentation—or they simply but deeply struggle with body image.

For 22 years, I ran around with small bags of saline water on my chest. I told only a handful of my closest friends, because I felt ashamed about artificial enhancement, which is antithetical to my all-natural and athletic aesthetic.

Now those bags are gone, since I had explant surgery (i.e. implant removal without replacement) December 1, and I decided to share my secret here because I hope more women will know about the risks and consequences of implants and the benefits of staying flat.

I hope more women will ask—as I’m asking internally—why the hell do we do this to ourselves? Who are we trying to please, and why?

In early 2004, when I was 34, I went to a plastic surgeon and told her, “I want runner boobs. Like, ballerina boobs”—meaning, I wanted augmentation that looked natural and fit my body. “I want the world’s smallest boob job.” And I got it.

Gremlins of insecurities skewed my thoughts and actions during that period of time. My little A-cup breasts had risen to the occasion to nurse my two babies from 1998 through 2002, and after weaning, they literally vanished, as if my body absorbed every cell of breast tissue. I became flatter than my husband. My fit-runner physique developed a masculine chest with a texture that made me think of beef jerky.

Meanwhile, I was working to rebuild my marriage. I had fallen prey to another man’s flattery after he plugged into my lifelong needs for attention, validation, and reassurance that I’m attractive. I had been conditioned early in life, by the culture of the time and by parents who casually commented on “good tits,” to please men sexually. And my ego was at a low point as a stay-at-home mom with a shelved career.

Suffice to say, 34-year-old me wasn’t in a good headspace. I needed counseling more than cosmetic surgery.

My tenderhearted, respectful husband never suggested that I refill my flat chest, though he wasn’t opposed to the idea; he liked the way B cups would look. It was my decision entirely but influenced by a desire to please him since I had hurt him. I wanted to look feminine for him, because he had fallen in love with a curvy party girl (the pre-runner version of me), not a ripped runner.

My self-confidence had become as deflated as my post-nursing breasts. I framed and justified my decision as reconstruction, not augmentation.

When I got it done, I gave virtually no thought to the surgeon’s admonishment that they’d need replacement in 15 or so years. That time frame seemed way, way far off in the future.

This is what I would tell the 34-year-old me, or anyone considering implants for augmentation or for mastectomy reconstruction:

There’s a good chance your implants will harden over time and feel like hockey pucks, making them rise up and look extra fake with their firmness, and making it uncomfortable to sleep on your stomach. This is called capsular contracture, and I developed it on one side badly and on the other side mildly.

There’s a good chance you’ll lose sensitivity on and around one or both nipples. Yep, I checked that box.

According to testimonials from countless women, but not proven definitively, implants can trigger Breast Implant Illness (BII), an umbrella term for an array of symptoms such as joint pain and autoimmune reactions such as rashes. I elected to get saline rather than silicone implants, which are safer insofar as if they rupture, the body will harmlessly absorb the fluid. But saline implants are encased in a silicone shell, and both types can cause infections and other complications. (Thankfully, I never had BII symptoms.)

Not always but in some cases, implants can interfere with breastfeeding, especially if placed over the muscle, where they can compress milk ducts.

Implants make it harder to get and read a mammogram. Mammography technologists have a work-around, but it’s not perfect, and it compounds the difficulty of detecting tumors in dense breast tissue (which many small-breasted women have). I also suspect—without evidence but based on my experience—that implants may make women less inclined to get routine mammograms. I admittedly avoided mammograms because the process is extra uncomfortable with implants, and I worried the machine might rupture them, which is very rare but not impossible. Psychologically, I didn’t want to fess up to my implants. Even with my medical providers, I felt shame because I was a secret phony who hypocritically advocated authenticity.

Explant surgery (removal without replacement) likely will leave your chest looking altered, even damaged, rather than merely returning it to its pre-surgery appearance of small-breasted or flat. You’ll have smiley-shaped scars, and your breasts may look concave or dimpled in areas because the implant no longer fills out that space. To improve this outcome, some larger-breasted women may opt for a breast lift (removing excess skin to tighten tissue) or a more comprehensive aesthetic flat closure to reshape the chest wall to be flat and smooth. Some may also get a fat transfer (liposuction from one area to inject fat cells in the chest, which is a milder form of augmentation than implants; liposuction can be painful and cause complications). I did not get any of this extra work done because I’m so flat, I don’t have much sag to fill or tissue to sculpt, and I wanted the surgery to be as uncomplicated and low risk as possible.

Our society has normalized cosmetic surgery, but the surgery is significant and, in my view, pretty freaking gruesome and expensive. My bilateral explant with capsulectomy (removal of the scar tissue around the implant) cost $5617 not covered by insurance, and it would’ve been $8403 if I had opted for an exchange (new implants put in). Long plastic tubes with grenade-shaped bulbs exited my rib cage and drained bloody fluid for two weeks, which severely limited movement, disrupted sleep, and made it awkward to be in public (I wore oversized sweaters to hide them). I was instructed to maintain “T-rex arms” with upper arms kept near my sides, and no heavy lifting or reaching, for four weeks, along with no high-impact activity or anything that would significantly raise my heart rate, because high blood flow could trigger blood pooling and harm healing at the surgery site. (I cheated and restarted a small amount of running after three weeks, because my chest felt OK). No push-up or chest-press exercises for longer.

Going flat and staying that way IS an option. If you have a mastectomy, you don’t need reconstruction, even though your doctors may assume that’s what you want and talk about it as if it’s a given. I understand and respect breast cancer survivors who opt for reconstruction; I’m just saying, I hope they’ll consider the alternative as realistic, not radical.

If your breasts shrink after breastfeeding, then you are normal and blessed that they did their job of feeding your babies.

If you get implants and later choose “exchange” rather than “removal,” you’ll face all this surgery and recovery again when the implants reach the end of their lifespan. No thank you!

Mostly, you are fine as is! If you’re feeling down on yourself, you may need to work on your head and heart more than your outward appearance.

Let’s spend time on that last point, because I continue to struggle with self-acceptance and to push back against peer and societal pressure to conform to beauty standards.

Let’s briefly detour to my childhood to marvel at this gem of a photo, which captures the ethos and culture of my 1970s upbringing with bawdy parents. Our family made annual pilgrimages to Vegas, since my dad was a skilled gambler, and my sibs and I took this photo at a casino with this cutout caricature.

I’m the little girl, age 7 if I recall correctly, on the left. My parents thought it was hilarious (and I can’t help but laugh now, too, even as I wince at how the photo evokes material from the Epstein files). A poster-sized blowup of this photo hung in my childhood bedroom for years, subconsciously shaping my view of women’s roles and bodies even more than the ubiquitous Farrah Fawcett red swimsuit pinup. I also daily viewed a ceramic mug on my dad’s bureau shaped as a woman’s large, bare upturned breast (which he used to hold spare change and golf tees).

For these reasons and others, I grew up thinking that well-shaped breasts with cleavage mattered as much as smooth feathered hair, and puberty gave me neither.

As an adult, I have said “no” to the epidemic of Botox-frozen foreheads, brow lifts, and lip injections. I can’t stomach the cost when I think of the more worthwhile things the money could buy, and I want to role model aging naturally for my daughter and her peers. Plus, lifts and injections are a slippery slope, and the more you do, the more hooked you become on misbelieving you need to “get back” to your younger appearance and preserve it rather than embracing the age you are and celebrating the fact that aging equals living.

But let’s face it, being as flat as a door isn’t easy when nearly every female celebrity who is celebrated as attractive is thin, smooth-skinned, and has two well-rounded mounds on her chest—a nearly impossible combo naturally—thanks to cosmetic treatments and implants.

The pressure hits female athletes when role models like Olympic gymnast Simone Biles has multiple cosmetic enhancements, including an obvious breast augmentation, which to me is incredibly sad—as if being the most successful gymnast ever, earning seven gold medals, isn’t enough to feel good about her body. She was beautiful and admirable as her “before” self and looks artificial now.

Where does it stop? You get a boob job, a straight thin nose, an eyebrow lift, and/or cheekbone or jaw implants only to focus on your saggy neck, or your flat or too-large butt, and obsess about “fixing” them too.

“This past year, [cosmetic] surgery crossed the Rubicon,” writes Vanity Fair writer Marisa Meltzer, who covers the fashion and beauty industries, in an excellent essay in the New York Times. “Many famous people who are getting work done do not necessarily look like a younger version of themselves anymore; they simply look expensive. ‘Uncanny’ is an overused word these days, but it’s a good way of describing the inhuman artifice of the prevailing plastic surgery tends. … We are now at a point where forgoing cosmetic procedures is almost remarkable.” (emphasis added)

I’d like to be remarkable in that way. And you know what? It feels easier to give the finger to appearance expectations as I age. At long last, I’m letting go, bit by bit, of caring about being attractive in the eyes of others. I feel more secure in my peer group, community, and body in my mid-fifties than early forties. The rebel in me shouts fuck this! I am not playing that game of pleasing anyone else, trying to look like anyone else, or needing anyone’s admiration anymore.

It also helps to learn that I am part of a growing trend, which emboldens me to speak out as I’m doing here. My plastic surgeon told me he’s doing more explant surgeries because more women are choosing to look flatter and natural. His observation is backed up by studies like this and this about plastic surgeons seeing an uptick in explant surgery, and testimonials like this on TikTok by influencers talking about why they’re removing their implants.

I’m motivated to walk with good posture, shoulders back, and not hide the level surface of my chest. Inwardly I wince when I examine the flatness while undressed and view the scars and a slight indentation. So I close my eyes and remind myself that I feel better. I feel more aerodynamic and boyish when I run. I feel comfortable when I lie on my stomach to sleep. I feel strong and, regardless of what the mirror shows, youthful!

I was at my Berkeley OBGYN’s office in 2002, the year I stopped nursing my son, when I shyly and cautiously asked my doctor what she thought of breast implants. Her reply stuck with me.

She was a graying feminist who remembered life before Roe. “What do I think of it?” she asked rhetorically, her voice ratcheting up a level. “I think it’s self-mutilation!”

Her reply—which promptly ended our conversation—stung and fed my need for secrecy when I got mine done. For years, I resented her judgmental and insensitive comment, because she missed an opportunity to query with compassion and curiosity about why I asked about it and perhaps to steer me toward therapy.

Now, however, having read many articles about cosmetic surgery’s spread to younger ages and to more body parts (like this, “Plastic Surgery Comes for the Waist,” about ribcage alteration to make Barbie-like corseted waistlines) and the horrifying homogenization of “Mar-A-Lago Face,” and having chosen to cut open my body to reshape it and suffered the shitty aftermath of recovery and scars, I look back on my granola doc’s declaration and think, you know, she had a point.

I’ll leave you with this recent poem by Rosemerry Wahtola Trommer, which spoke to me—actually, made me cry—its title capturing the long road to liberation and self-love the way you are.

But Not a Moment Sooner

Eventually we learn to laugh when we drop
the glass and it shatters all over the floor,
finding laughter more fun than a shackle of curses.
We can wiggle our butt more when someone
says it looks big instead of trying to tuck it
tighter beneath our hips. Eventually we learn
there is no way to not be exactly ourselves.
What freedom then. We can listen to the sound
of our own voice without cringing. Can dance
in front of anyone. Can wake up grateful for our aging face
in the mirror. Can wear questions like exotic perfume
and see how they grow us. Eventually,
we can look at each other and say,
I’m so glad you are exactly who you are.

If this story resonated with you, I hope you’ll share it, and I invite you to read these two posts from the past year that touch on similar themes.

On fitting in, feeling ugly or pretty, the sexualization of young women, and why dressing up triggers me:

On how “wellness” has become a repackaging of the beauty and diet industries pushing unproven products and heightening women’s insecurities in the name of “self-care”:

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