What do 700 slang words, strip clubs and breast cancer surgery have in common? They all reveal how society — and medicine — views women’s breasts. In this episode, host Dr. Denise Millstine dives into Sarah Thornton’s provocative book Tits Up: The Top Half of Women’s Liberation with author Sarah Thornton and breast cancer surgeon Dr. Barbara Pockaj. Together, they explore the cultural baggage surrounding breasts, the language we use, and the deeply personal decisions women face in breast health and reconstruction.
What do 700 slang words, strip clubs and breast cancer surgery have in common? They all reveal how society — and medicine — views women’s breasts. In this episode, host Dr. Denise Millstine dives into Sarah Thornton’s provocative book Tits Up: The Top Half of Women’s Liberation with author Sarah Thornton and breast cancer surgeon Dr. Barbara Pockaj. Together, they explore the cultural baggage surrounding breasts, the language we use, and the deeply personal decisions women face in breast health and reconstruction.
This episode was made possible by the generous support of Ken Stevens.
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“Tits Up” Transcript
Dr. Denise Millstine
Welcome to the “Read. Talk. Grow.” podcast, where we explore women’s health topics through books. Our topic today is breasts. Yep, just breasts. I promise it will make sense. Our book is “Tits Up: The Top Half of Women's Liberation” by Sarah Thornton. I'm your host, Dr. Denise Millstine. I'm an assistant professor of medicine at Mayo Clinic, where I practice women's health, internal medicine, and integrative medicine.
My guests today are Sarah Thornton, who is a sociologist who writes about art, design, and people. She's the author of four critically acclaimed books and has contributed to many media platforms including NPR, Netflix, ZDF, and BBC Radio and TV, in addition to holding several academic positions worldwide. She's now based in San Francisco and has been called the Jane Goodall of the art world. Her latest book is “Tits Up.” Sarah, welcome to the show.
Sarah Thornton
I am so glad to be here, Denise.
Dr. Denise Millstine
Our expert guest today is Dr. Barbara Pockaj, who's a professor of surgery and the Michael Eisenberg Professor of Surgery at Mayo Clinic in Arizona. She is a surgical oncologist or cancer surgeon with over three decades of experience, who serves as vice chair of research in the Department of Surgery and co-medical director of the Mayo Clinic Breast Center, where I had the pleasure of working with her for many years. She is a true pioneer in prioritizing breast health and an avid reader. Barb, welcome to the show.
Dr. Barbara Pockaj
Thanks for having me. It's really a pleasure.
Dr. Denise Millstine
“Tits Up” is a nonfiction exploration of a topic that most people think they know about, but have probably spent very little time actually considering in a thoughtful and logical way, which is breasts. Sarah Thornton poses the question in the book, how is it that we look at breasts so much, but reflect on them so little. She then takes readers through different settings in which breasts are used for financial gain appreciated, revered, altered, supported and celebrated.
You both know how “Read. Talk. Grow.” works; we discuss books that portray health topics in an effort to better understand health experiences through story. In this case, we'll talk about breasts, though maybe by several different names. Sarah, will you start by talking about the words we use to discuss breasts, boobs, tits, etc. and how you landed on the title “Tits Up.”
Sarah Thornton
There are 700 words in the English language for this part of a woman's body, and there's actually articles written about it. Various people have crunched the data. Most of those words are used by men. Women, American white women have tended to retreat into using only two words, breasts and boobs. Black women in America lean towards breasts and titties. So whatever the cases, women have retreated into like a very narrow lexicon, which they feel comfortable with.
Whereas you can even talk to a 16-year-old boy and he will rhyme off loads of words with great pleasure, tits, jugs, melons, hooters. And then there are regional variations. And so I thought that there's something wrong with that picture. Who thinks they're defining these things? Who thinks they own them? Why are women feeling shame? Is that why they've retreated into these two words?
Obviously there are exceptions and one exception is when I was doing research in a strip club. Early on in my research, I realized I needed to go to a titty bar and understand this version of breasts, which is an eroticized and to some degree commodified body part. And of course, there's a myth in America that women have breasts to attract men, and that is not a universal, In many places, breasts are not sexualized, and certainly it's a recent phenomenon. So the only biological reason why women have breasts, evolutionarily speaking, is to hydrate, immunize and nourish the young. And why is it that this prevailing notion that breasts are sexy and their number one job is to be sexy prevails in America, not within medical circles, but basically everywhere else.
So that's how I came to use the word tits. Actually, it was not a word that rolled off my tongue. I was not comfortable using it at all. But that is the word that women working in late night nightclubs, strippers and sex workers use. And it was only after doing my participant observation in those environments and doing a lot of in-depth interviews, that I eventually became comfortable using the word tits.
The reason I chose it for the title of my book and it's not just tits, it's “Tits Up,” which is a different kind of expression. There are a lot of reasons for that. First is, tits is the number one word for breasts on the internet. I'm like, if we're going to reclaim our breasts, well, then we've got to tackle that somehow.
Tits is also a very old word. It’s at least a thousand years old. It used to be synonymous with teats, and it likely derives from the Proto-Indo-European word tata. Imagine is kind of like a 6000-year-old word, and it was not always considered profane or lute. And so that's another reason why I felt like I can't erase that word. I got to figure out a way to reclaim it.
And so my sister was an actress, and there's this show biz expression Tits Up, which is what one woman might say to another as she went up on stage. Is kind of like, break a leg, Tits Up, Chorus Girls, is that kind of an expression. A lot of women today know it through the TV show “Mrs. Maisel,” because they used it on that program. Anyway, so that's how I ended with up with the expression tits up because it's a sisterly positive, put your shoulders back and succeed expression. And it felt like a comfortable way to reframe this word that is usually considered lewd.
And if I could talk about the word boobs and also the word jugs, it's interesting. Breasts for a lot of people feels a little medical. And it's not the word that two girls talking to each other in the changing room are generally going to use. And it interests me that boobs is this number one slang word in the Anglo-American world. And boob means an idiot. It means stupid. We talked about booby traps and booby prizes and the boob tube. And for me, why would women be describing their own bodies with such a basically derogative term?
And there is a long history of associating big breasts with a lack of intelligence. It's crazy, but there's actually documentation and sociological studies from the 90s. Big breasts might correlate with sexually available and not very smart. Whereas small breasts be associated with intelligent and believe it or not, lonely. There's like a lot of cultural baggage on this part of women's bodies, which of course is an emblem of our femininity, is an emblem of our womanhood.
So another word that intrigued me was jugs. And that's partly because in certain languages, like Chinese, the number one slang word is something like milky. So the kind of like lactation function of breasts is not erased by the culture. It's part of slang parlance in America. There are not many slang words that talk about the hydrating function of breasts. And jugs is one of the few.
And so I felt like for me anyway. And I never want to be prescriptive because it's such a personal thing and we all have our different comfort zones. For me, I decided that my chapter about breastfeeding that revolves around the oldest human milk bank in America would be called “Lifesaving Jugs.” And it was just another way of me trying to find another word that I could be comfortable using and just expanding the positive associations around breasts.
Dr. Denise Millstine
Then all the other words that we use. Barb, tell us your reaction to the book and also what it's like to spend so much of your professional time helping women with breast health issues and concerns.
Dr. Barbara Pockaj
Well, I love the book. I thought it was a great read. I liked it looked at various different aspects of breasts from as we talked about how we would name them. How we different people look at them, the historical perspective of breasts and how society now looks at bras. It's all different, right? And it's evolved over time and it evolves in different cultures. Different cultures have different thoughts and we see that with our own patients, right.
So when I see someone, how they view their breast is all different. And when we look at a patient, we have to see how important is how she looks and how that becomes part of her persona. And I think this is very important as physicians, we can't negate that. And we have to look at what's important to her.
Mostly I'm dealing with patients who have breast cancer. So we have to do something to those breasts, some sort of surgery to actually get rid of this cancer. And we want to do it that fits her needs as much and keeps her whole. Feels that she's whole. They feel they lose this body part and they no longer feel whole.
And this is an important to kind of remember and make sure how someone looks for certain people. They go, I don't care what they look like. Do whatever you got to. No problem. That's not true for other people. They want to look as good as they can be, to minimize the reminder that they had cancer. Their breasts are very important to them, and they want to make sure that they look the same or as good as they can. And I take that very personally.
I do tell them we are sometimes limited by what we are dealing with. So yes, I know you want this, but I can't give you that. Maybe we can do this instead. But I think it's very important. And luckily I work at a place that's very multidisciplinary. I have excellent plastic surgeons who help me, and we come up with all kinds of innovative ways to do that and hopefully make her cancer journey as easy as possible, knowing that it's not an easy thing to go through as it is.
And the only other word I was going to say that I hear the most, which is interesting. So maybe in a different context of what people call their breast is they call’em, the girls. So I think that's very interesting is more a term of endearment.
Dr. Denise Millstine
That connects so much to what Sarah is saying is the feminization, how it's tied. I just love and want to highlight Barb, what you said about every woman at the end of her breast surgeries, particularly in cancer, you want her to feel whole at the end. That is different. And you can't bring your values to that. It's what the patient values.
But in the context of what's the original size of the breast and what is the size of this tumor? So sometimes the things that need to be done to remove all of the cancer isn't going to achieve the cosmetic result that she would have hoped for. So it's just so powerful how you approach that and I know there are thousands of women who are grateful to you over your career for leaving them whole when they've had to go through that journey.
Sarah, you had a personal inspiration for really thinking about breasts. In the book's intro, you write, when I stood in front of a mirror, I thought the rack on that woman looks pretty good. However, when I put on clothes and moved around, I felt estranged from my chest, which was in reference to having implants placed after your bilateral mastectomy. Will you share that experience with our listeners?
Sarah Thornton
I had a nipple preserving double mastectomy, and for whatever reason, it was just kind of assumed that I would get reconstruction. And the biggest problem for me, perhaps, is that I ended up with breasts much larger than my original set. And I felt incredibly uncomfortable with this larger set. And also because you have no sensation, I would bump into people with them in this tight elevator in this condo I used to live in, and I would actually end up kind of bashing them against, like doorframe sometimes when I was like, quickly moving through rooms and I couldn't fit into my clothes. And I really did not feel myself.
And so this experience sometimes happens. I think it's maybe a dated experience, but I think there was a period where particularly male plastic surgeons, definitely not at the Mayo Clinic, would do what they thought was best, do what they thought looked great. And so it's true objectively. And I went to another plastic surgeon afterwards and she said, these look great.
Like they look great, but they don't look like mine. And I don't feel myself. So it's interesting. I might have felt alienated from the implants anyway, maybe because they're kind of don't really feel like breasts and you've lost sensation. But what really struck me was the size.
And so after the book was written, I was having problems with the implants, and it turned out one had slipped out backwards, so the flat side was facing out. So it really looked weird. And on the left side it had ruptured. So I went and had a revision of the reconstruction, and I went to a different surgeon and really explained to her and got a smaller bust, which is not like a 36, 24, 36 kind of hourglass ideal. It's but it's my kind of personal sense of self, weirdly, when I or not.
So weirdly, when I went in to see my original plastic surgeon, an older gentleman, very senior in his field, very well-meaning person trying to explain, hey, I asked for lesbian yoga boobs, I wanted placeholders, I didn't, I wanted an athletic look. I didn't want to be “boobacious.” It just wasn't me.
I have so much respect for women who are comfortable to show off this generous cleavage. It's a great party outfit. I see that is very pro-social. I'm just a bit prudish. It's not me.
That is how I started writing the book. First of all, I was very confused about what I'd lost. I was not someone who kind of really relished my breasts like I had breastfed two children. They'd served their purpose. I was pretty pragmatic about them. In my mind, I didn't see them as a great asset to my beauty. I've always thought my back was a better asset, but then when they were gone, I was like, oh my God. I really felt a sense of loss that I wasn't expecting. And I felt very confused. I couldn't even put my finger on it. It is a very personal thing and there's no one size fits all.
Weirdly or interestingly, I had a few kind of friends, academic feminist friends who were like, well, why didn't you just go flat? Isn't that, like, the kind of correct thing to do? And like, I, I'm full of admiration for women who go flat. I mean, I think that is like a very smart decision. You don't have to worry about the implants that last ten years or 15 years and having to redo it and all of that, and you don't stretch your pectoral muscles. You can maybe gain back your strength faster. And there's like a lot of intelligent reasons to do that. For me, having the mastectomy was so much easier knowing that I would have some placeholder breasts in symbolically in their place. It just is about my femininity, my sense of self. Those things are nuanced.
Dr. Barbara Pockaj
That was beautiful how you explain that. And I think this journey is really hard and it's different for so many people. And you bring that out and we have to remind ourselves. Hard for me to relay some of this change. And I try to talk to patients if they're going to be different. It's not the same. And anytime you have surgery, it is not the same. And I don't think sometimes people realize how much difference it may be.
So it's an interesting point, but I think you bring up the point that we, as physicians have to listen to what the patient wants. I think this is super important. And I always tell my patients when they go to plastic surgery, really explain to them what you want. You're telling me, but I'm the removal person, right? I need to get the cancer out with the negative margin. You need to really make sure the plastic surgeon understands your goals. That's really important.
Sarah Thornton
I just wanted to add, I see breast cancer as a rite of passage, actually equivalent to giving birth in a lot of ways. It changes your sense of your body, and it changes your horizon lines and the landscape of your life in a way that you cannot predict. You often talk to a pregnant young mother to be, and they're going to write their book on maternity leave, and you're like, well, that would be a miracle, but go for it.
And I think that breast cancer survivors have a different perspective on life, and it kind of depends how gnarly your experience was. I was very lucky. I had loads of stage zero. I had no invasive cancer.
I'd been monitored for seven years. I kept having these, like everything was very dynamic. Every time they I got a mammogram, they're like, oh, that's different from the last time. But I didn't have to have chemo or radiation. For me, I feel like I dodged a bullet. That's how I think about it. I don't like to think maybe I had a mastectomy unnecessarily.
That's not kind of something I want to consider. And honestly, the kind of stress of the constant monitoring and biopsies for me, especially because most of my atypical cells were right by the chest wall. So I'd be like, I had bruised ribs. I’d feel like I had hematomas every time I had one. There was like a side effect that was unpleasant. And so, yeah, I do feel like it's it's a, I don't know, a bodily rite of passage. Not all of us have to go through it. But it's really hard to explain how your consciousness shifts, partly because it's different for everyone. But there is a major shift there.
Dr. Denise Millstine
Hey listeners, we hope you're enjoying this episode of “Read. Talk. Grow.” If you find our discussions helpful and insightful, please take a moment to subscribe to and rate “Read. Talk. Grow.” on your preferred podcast platform and don't forget to tell your friends to listen. Your support will help us reach more readers and those eager to learn about health through books. As always, feel free to drop us a line at readtalkgrow@mayo.edu with suggestions for books, topics or any comments. Thanks for listening.
Dr. Denise Millstine
Maybe we can even start with the surgery. So she's saying that she had mastectomy. And this is something that is a decision women will have to make when they come to you with a new breast cancer diagnosis, whether they'll have mastectomy or other surgery is like what's typically called a lumpectomy. Will you kind of talk about those differences?
Dr. Barbara Pockaj
Sarah had what we called ductal carcinoma insight two. We call it DCIS, which I tell my patients because that's too long to keep saying every time. So we just use the acronym. And it takes multiple genetic aberrations or mutations to go from one part to the other. What those are, I tell people I don't know, how long does that take? We don't know. So when we look at the DCIS, we want to prevent breast cancer. And then once we have our real invasive cancer, we want to treat that invasive cancer.
One part of the treatment now for invasive cancer, it's usually a multidisciplinary approach. Surgery is just one piece of the treatment of that. And really the decision to what surgery you can or cannot get is just a technical one. Doesn't matter the type of cancer. And we have a couple different types of invasive cancer. So it's just a technical one. That's the first question. Can I remove the tissue with the normal rim of tissue around it. Can I leave a cosmetic breast behind and can the patient receive radiation? So that's a lumpectomy; taking out the tumor with the normal rim of tissue around it.
If I can't do that then the other option is mastectomy. Mastectomy is removal of the breast tissue. This can be done with or without reconstruction. Occasionally we have to add radiation to that. When we do that with or without reconstruction, if we do no reconstruction, then we try to do what is called an ecstatic flat closure, meaning we like this to be nice and flat so someone could wear clothes and it's not a problem. They could wear a prosthesis and it's easy, like a form that you could put in your bra to give you, in clothes, you look well.
When we do the mastectomy with reconstruction, we usually do this either nipple sparing, meaning we leave the nipple areola in place or we take away the nipple and we save most of the skin. Then we could fill. It's like a skin envelope. But one of my patients explain how mastectomy is done. She goes. It's like taking a melon baller and scooping it that out, I go, it's a very good visual. I think it's a little more technical than that. It's a little harder than just a melon ball and scooping it out. But I think if you think about it in that way, it's a very good visual. So I actually like it. And I use, I steal this line. I wish I could credit the patient. I can't remember who told me that, but it's very perfect. And then we could fill it either with an implant or your own tissue. And there's a variety of ways we do that.
If you can get a lumpectomy. So then the difference in overall survival, meaning did we cure your cancer is equal. Doesn't matter which one you pick. Because I couldn't give you both options if one was better than the other. And we look at local recurrence, they go, well, what about coming back in the same spot that is also equal could come back in the mastectomy site or in the remaining breast. And that is equal because when we do a mastectomy, we never remove a 100% of all the breast tissue. So there's still some there. And there's other reasons why that could happen.
Then we talk about the pros and cons of each approach for the patient. And many times it's a decision between a lumpectomy and a bilateral mastectomy as a rule is is what kind of I think in modern societies what we think about. And we talk about the pros and cons, and from a cancer perspective, one is not better than the other. And there are downsides to doing more surgery or less surgery. There's pros and cons.
I would say the cons are no cancer perspective. You do bigger surgery, you get higher complication rate. That is just the way it goes. Bigger surgery doesn't matter what kind of surgery, you do lose sensation. And I think Sarah spoke about the sensations not there. Now we have started doing nerve grafting. So we do graft nerves to give there some sensation. It's not going to be the same as normal.
When we look at bilateral mastectomy we do then remove both sides. So the risk of developing cancer on that other side goes down by 90%. No more imaging, which is a big bonus to most patients. A lot of patients get very high anxiety every time they have to go and get imaging. It adds a lot of stress and I call it almost PTSD. It is stressful. So I don't just regard this at all. And I do think you probably get more biopsies than the average bear because you've already had cancer before.
So there is that, pros and cons. So I say the benefit here is a quality-of-life benefit for you. Potentially it depends on is this more important or is the other side more important. Is it better to keep everything you have, keep those other things or is it more important for these other reasons. And I think they're all valid. And I tell patients what makes you the most happy makes the most difference.
Dr. Denise Millstine
Sarah also mentioned, and I hope you'll comment a bit more. And that's nipple sparing mastectomy. And Sarah, I'm going to ask you to talk about what you learned about nipples in the course of writing this book, because it's very different than how we talk about breasts. But Barb, a nipple sparing mastectomy is a more technically difficult surgery and something that I wonder if you would just tell our listeners who might be a candidate for that. Why might a woman choose that?
Dr. Barbara Pockaj
Sure. So nipple sparing means usually, so if we think about it and I know you're listening. So visualization we're usually making an incision at the bottom of the breast. So where the breast kind of ends at the bottom it's called the inframammary fold. So we make an incision down there. Then we just take out the inside of the breast, leaving the skin and the nipple ahead.
Now what are the reasons we can't do that or it makes it more difficult or challenging. What's the challenge of that is when we have to leave the blood supply to the nipple so the nipple does not die, unlike the other parts of the skin, the skin of the breast has a layer of skin, which I call the dermis is what you look down and see. And then there's a layer of fat underneath your skin. And then what's ever underneath there, be that muscle, be the breast tissue, be whatever it is, so you have a little thickness. Underneath the nipple, there is no fat. It's just breast tissue and then that dermis.
So you have to really be very careful when you're doing that, that you make sure the blood supply right up to that nipple is perfect and you have not impacted that. So that is the risk when you do that, that the nipples will die because their blood supply is not there anymore. So you got to keep that blood supply right there.
The other person who we can't is if the cancer goes right up into the nipple. So if you're cancer again, these are technical issues. It's just what the cancer started with. Did the cancer go right into the nipple area? If it did then we can't save the nipple. We could do a skin sparing, leaving all the skin but removing that nipple. But we cannot save the nipple-areolar complex.
And the other one where it is more challenging. Luckily, I do work with some very inventive and they're willing to try, kind of like me, plastic surgeons. If you are very big breasted and very droopy. The fancy name for that is ptotic. I like to tell the patients, well, your breasts are kind of ptotic. They look at me. What's that? And I try to whisper to them, I go, well, droopy, you don't want to say that to someone. It sounds bad, but if they're very long, then expecting the blood supply will make it from the periphery or the edges of the breast all the way to that nipple is not very good. And so then you could do a variety of things, but then we need to kind of take some of that extra skin out to make the breast look better at the end.
Dr. Denise Millstine
So important and so challenging. And I like the melon scooping analogy and how you've said it's not at all that simple, because if you think of like the nipple as the bottom of the melon, it's not like you just keep scoop until you get to the bottom of that. You've got to protect that nipple tissue, too.
So Sarah, many people from dancers and sex workers to those who design bras or intimates, to surgeons, to women wearing a bathing suit or even a t shirt, think about nipple visibility pretty frequently. And yet we don't have as much language around that. You in the book, talk about many realizations that you came up with about the nipple as you were researching and writing. Would you just share a couple of those with our listeners?
Sarah Thornton
Yes. It's really interesting that we don't have a lot of slang around nipples, and one word that is used in the bra design business is apex. So God forbid you should mention the word nipple in an email to the manufacturer or to any of your colleagues within the apparel corporation. You always refer to apex, that pointy summit of the mountain.
Apex has been around for probably 100 years as a euphemism, I guess, for nipple in the bra design world. So I mostly explore the issue of nipples in that context. There are two main functions of bras. One is to lift and probably the dominant one because honestly, bras don't necessarily lift that much, masking the nipple. There's a whole history, let's say, of associating breathlessness with feminism, given the bra burning that went on and there was no bra burning. Actually it was, they threw some symbolic items in a trash can outside the Miss America pageant in 1968, but it's kind of considered the official birth of the women's movement. And along with pornography magazines and curlers, and they threw in bras.
There's really what I learned from the bra designers at Old Navy, who have a huge business in sports bras, constructed bras, and swimwear. And they're not necessarily known for that, but they're the biggest big box retailer that does clothing only in America, and they're designing for a big range of sizes as well. It’s not like this kind of elite French lingerie that never does more than a double D cup. They're doing the big range. What their research will show is that bra lessness really only correlates with small breasts.
Women with very large breasts, as a rule, are not comfortable going braless. And they have these two different kinds of women, let's say, have totally different definitions of what's comfortable. So women with an A cup or a B cup will say, oh, I feel comfortable, a bra is comfortable if I just feel like I'm not wearing anything at all. That is not the case for women with a D through G cup. They would like the comfort of feeling snug, hugged, kept in place.
So one of my questions to myself when I started the book was there's this Free the Nipple movement that is European and American, and there's some celebrity proponents of it who might be topless in Central Park and I was kind of skeptical.
I was like, was this really a significant political issue? Like, does it matter, really? It doesn't seem to be the same as some other key issues around women's bodily autonomy or women's rights. That's what I thought at first. But then when I started digging into it, I really came round to the idea that for as long as men's chests are okay to be seen, they're not profane, they're not rude, they're not lewd, and women's chests are considered unsightly in most contexts, then it's really hard to imagine we're going to be treated equally under the law or that our, we'll have the same freedom of movement around our cities and our beaches and our parks.
And the thing that really brought it home to me is when I realized after a trip to the National Gallery in Washington, D.C. I walked out and I thought, oh my God, I just realized who the most famous topless man in the world is.
It is Jesus Christ. You see his beautiful chest, which is like so much part of our culture, even if you're not Christian. And then women's breasts are profane, dirty, and given their life serving function, that strikes me as a terrible shame.
And I think that's one of the things that clutters up our minds when we go through breast cancer or breast feed. It's one of the things that makes it really hard for a lot of women when they start breastfeeding because, like they were in this zone where their breasts were beautiful and sexy and just for their husband or their boyfriend. And then all of a sudden they got like, I got to put my infant child on this appendage of mine. And that, again, is like a really big switch in perspective. And some women don't really get over it. They're never comfortable doing something that I think should be seen as incredibly beautiful, like a source of of human love.
We have wonderfully images of the lactating Madonna from the Middle Ages, mostly, but in general, Mary, the Virgin Mary is not generally seen breastfeeding Jesus, although there are some lovely images and in sculptures, but it's not typical. So what I would say about nipples in the end is that I would love men's and women's nipples to be treated equally.
In many states, the law determines that they should be treated equally, but culturally, we're nowhere near that. It's a deep-seated, embodied problem, you could say. And I really had to bite my tongue when our middle child was like 22 and going braless.
Because as a mother, I'm very protective and I'm like, I want to say cover up or put on a padded bra or whatever. And I think because I was doing this research, I just would bite my tongue because I was like, that is not obscene. I was mostly worried about her safety. In San Francisco, there's not that much public transport, but these are the places where women feel most vulnerable.
And the bra designers, too. It’s really interesting. The Old Navy bra designers quite a few of them there were like, I actually believe that women's nipples are they're a beautiful thing. You see them through a silhouette, through clothes, so be it. But they themselves would not feel comfortable in most environments. They said, I feel comfortable at work. Design groups were largely women, but they would not feel comfortable going out for a drink afterwards or taking the BART, our subway.
Dr. Barbara Pockaj
Do you mind if I ask you, because it's kind of interesting because nothing to do with cancer, just a perceptions. Because I really enjoyed the chapter on the nipple, because you don't think about it brought up the whole Janet Jackson incident again, how that was horrible. And it's kind of interesting thinking about that, how unfair that is and what we do with the nipples.
But you said that your daughter goes braless. So I have a 24-year-old myself and what she wears, I have the same sort of deal that they have no problem. Her and her friends have no problem. No bra, nipple show. Nobody cares. So do you think there are some generational changes that are happening that we as old people, because I could say I'm old.
Sarah Thornton
I think there are a lot of changes, cultural changes going on around women's breasts. And I think college students in particular are probably the ones most comfortable going braless because they've had a little injection of feminism, let's say, and they're kind of in a safe environment where they can feel comfortable. There's definitely major changes around breast ideals.
So I would say a more athletic body has become the ideal, and that the kind of larger-than-life Pamela Anderson-style figure from the 90s has become, is kind of almost considered a matronly look. It's so old fashioned, I guess, or it's associated with professionals in the business, sex workers. It's not as widespread an ideal as it was in the past. I think there are definitely generational changes. I think geography is a key thing; what state you live in, what city you live in can make quite a difference. New York and San Francisco are pretty liberal cities. I'm not sure if it's you'd be as comfortable in other parts of the country.
But I do feel like young women today have a stronger sense of their own empowerment and are a little more ambitious for their freedoms than women of our generation. I'm assuming we're about the same age.
Dr. Denise Millstine
And like we said in the beginning, how curious it is that so many people think about breasts often, but don't really stop and consider them as deeply as you have in your book, “Tits Up” and as you have in your career. Dr. Pockaj.
I want to thank you both for being guests on the episode of “Read. Talk. Grow.,” where we talked about “Tits Up.”
Sarah Thornton
Thank you, Denise
Dr. Denise Millstine
“Read. Talk. Grow.”is a product of the Women's Health Center at Mayo Clinic. This episode was made possible by the generous support of Ken Stevens. Our producer is Lisa Speckhard Pasque and our recording engineer is Rick Andresen.
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