Humans tend to compare themselves to their surrounding culture's idea of beauty. As a result of the influence exerted by the mass media, the American woman's breast is closely linked to womanhood; the fuller the woman's bosom, the sexier and more womanly she feels, or is perceived to be by individuals of both sexes. Because of these cultural expectations, small-breasted women often experience feelings of inadequacy compared with their larger-breasted counterparts, and may seek methods of increasing their breast size, such as breast augmentation. An estimated 5 million to 7 million women have opted to have this elective surgery since its development in 1963. In 2009, nearly 300,000 women chose to undergo breast augmentation--an increase of 36% from 2000, and an impressive 787% since 1992, when the American Society of Plastic Surgeons began formulating yearly national cosmetic surgical statistics. These statistical findings reveal that a significant number of women are interested in this topic, and health care providers need an operational understanding of what is influencing these women's health care decisions. As a result of this need, the motives for breast augmentation have been researched and classified as either internal or external. Internal motives include low levels of self-esteem, body image dissatisfaction, and body dysmorphic disorder, whereas external motives are the desire to attract and retain a romantic partner, pressures from others, and occupational requirements. Understanding these motives allows primary care nurse practitioners to focus their assessments on these areas and to provide the appropriate counseling or referrals as needed.