Though advertisements and editorials are plastered with models with big breasts, for teenagers, an overly large cup size may come with a host of physical and mental problems.

Lead author of the study Brian Maslaw is an assistant professor at Harvard Medical Center and a pediatric plastic surgeon at Children’s Hospital Boston. Maslaw has performed over 100 breast reductions annually on adolescent girls. In 2011, there were 63,000 procedures of that very nature performed. But despite the large number, Maslaw felt that the physical and psychosocial aspects of macromastia – large breasts – had been understudied.

Maslaw said that the majority of girls seeking the surgery do so because of various issues – shoulder and neck pain, low self-esteem, difficulty finding clothes, and undesired attention. He added that a diagnosis of macromastia can be troublesome, as there are undoubtedly women and girls of all ages who are unbothered by their large breasts.

Complicating the issue is that two-thirds of girls with macromastia are overweight. But Dr. Maslaw is certain that weight loss will not necessarily mitigate the issue – and many girls with the condition find it difficult and painful to exercise.

Maslaw and his team studied 96 girls who had been diagnosed with macromastia, and compared them with a control group of 103 girls who had no such condition and no history of eating disorders or mental health issues. Participants in the study also answered questions about whether they had ever sought breast reduction surgery and other breast-specific issues, as well as questions about their general health, mental health, social functioning, self-esteem, vitality, body image, and eating.

They found that the group with macromastia had higher body mass indexes (BMIs) than the control group, and were more likely to suffer from disordered eating at three times the rate of the control group. They also found that macromastia was more likely to negatively impact their self-esteem, quality of life, and physical symptoms.

Maslaw says that their data contradicts the idea of delaying breast reduction surgery until teens are older. If the surgery is classified as reconstructive surgery, it can often be covered by insurance, sparing teens and their parents the $15,000 price tag for 2.5-hour surgery. However, the surgery, like all surgeries, comes with risks – like wound healing, scarring, short changes in nipple sensitivity, and an inability to breast feed.

The study was published in the latest issue of Pediatrics.