It’s three weeks after Chantel James’ breast reduction surgery, and this afternoon, she’s getting a pedicure. The toe treatment is her first in a year — and the first she’ll be able to appreciate.

“My breasts were so big I actually didn’t see my feet,” says James, a 26-year-old living in Boston who is pursuing a graduate degree in social work this fall. “I looked down [after the surgery], and I was like, “My feet are horrible!”

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James’ obstructued vision was the least of her worries before the surgery, when her bra cup size was a HH. (The biggest bra sold at Victoria’s Secret, by contrast, is a DDD.) Standing only 5 feet 3 inches tall, her back hurt constantly from the weight of her breasts, and she slouched to compensate. Her skin had lasting indents from her bra straps, she had trouble finding clothes that fit, and her breasts had begun to sag. “How am I going to feel within a few years?” James worried.

And, despite losing 40 pounds by eating healthy and doing exercises like spinning, her chest remained stubbornly large. She had trouble practicing yoga and avoided exercises like chest presses and push ups that might make her breasts appear larger. And when she tried to run, she was winded within minutes. “It’s like … being hit with dodgeballs over and over,” she says.

So when James took a job at Boston University in December — and for the first time had access to non-student health insurance that would cover the approximately $6,000 breast reduction surgery — she committed to the procedure, which she had researched and contemplated for years.

“I really did come to a point where I was like, ‘It doesn’t really matter how I look right now,'” James says, “‘I just don’t want to feel like this anymore.'”

Is Breast Reduction Surgery Right For You?

Breast reduction surgery is one of the most common plastic surgery procedures, says Dr. Michelle Coriddi, who is in her fifth year of plastic surgery residency at The Ohio State University Wexner Medical Center. In 2014, plastic surgeons reported performing more than 62,000 reconstructive breast reduction surgeries and more than 41,000 cosmetic breast reduction surgeries, according to the American Society of Plastic Surgeons. Women of all ages undergo the procedure, although it’s rare in women under 18 since surgeons want to be sure the breasts are no longer growing, Coriddi says. Women who may still have children should also consider that one risk of surgery is an inability to breastfeed.

While there’s no particular guideline on how big is “too big” for breasts to warrant surgery, Coriddi says insurance companies usually require women to display symptoms of macromastia (the medical term for large breasts), such as neck, back and shoulder pain, trouble sleeping and exercising and a lack of confidence in intimate and social situations.

“Women have a joke, ‘Look at my eyes — they’re up here!'” says Ann Rosen Spector, a clinical psychologist in Philadelphia who’s worked with women before and after breast reduction surgery. But for some women, it’s not a joke. “When you have really large breasts, it really changes people’s focus of you and your wish to be taken seriously for what you’re saying.”

Plastic surgeons seldom require prospective breast reduction patients to consult with a mental health professional before the surgery, but some are referred to a psychologist if the problems they attribute to their breasts — such as the inability to get a job or a date — may have more to do with depression, anxiety or another mental health issue than the size of their chest, says David Sarwer, a psychology professor in the University of Pennsylvania Perelman School of Medicine’s departments of psychiatry and surgery. As with many elective procedures, “when you have patients who think their lot in life is being influenced by how they look now, or that it will change dramatically based on having the procedure done,” it may be a red flag that they’re not psychologically ready for the surgery — and should see a mental health professional for help.

What It’s Like Under the Knife

After meeting with her primary care physician and consulting with a plastic surgeon earlier this summer, James showed up at her surgery appointment in August. “I was terrified,” she says, though mostly because she worried about not waking up from surgery, not about how her breasts would turn out.

The surgery, which usually takes two to five hours, involves incisions that create skin flaps but leaves the nipple and areola attached to a small amount of breast tissue. The surgeon then removes excess breast tissue, reshapes the remaining tissue and sutures the incisions back together.

While patients should discuss with their surgeons their desired breast size before undergoing the procedure, there’s no guarantee the final product will measure up. Much of it comes down to the surgeon’s judgment during surgery, says Coriddi, who recommends visiting the American Society of Plastic Surgeon’s website to find a qualified match in your area.

The right surgeon can also help minimize risks of the procedure, which include asymmetrical breasts, infection, scarring and potentially permanent changes in nipple and breast sensation. But overall, “when performed by a board-certified plastic surgeon, breast reduction is safe and patients have excellent outcomes,” says Coriddi, whose research has shown that patients report significant improvements in satisfaction with how their breasts look, as well as their psychosocial and sexual well-being. According to RealSelf.com, an online forum for elective cosmetic surgery, 98 percent of over 3,000 respondents deemed breast reduction surgery “worth it.”