Breast concerns are a common reason for visiting the doctor. Many women encounter problems like breast pain or lumps. These can be worrying, but are not serious most of the time. Breast symptoms may also be clues to other disorders of hormone glands or internal organs.
Breast cancer is the most diagnosed type of cancer in Canadian and American women today. The topic of male stroke receives little attention. However, on rare occasions, men’s breasts are also at risk for similar ailments, including cancer and infection. Children too can have breast symptoms, which should be evaluated by a doctor.
Breasts are composed of mammary glands capable of producing milk, and fat tissue and connective tissue which further shape and fill the breast. The overlying skin has a central darker colored circle, called the areola, and a nipple. In both males and females, the basic parts of the breast develop before birth. The beginnings of mammary glands grow very slowly until the hormone changes of puberty start maturing these glands in girls. Hormone signals from the brain and ovaries stimulate breast development along with the other changes of puberty. Estrogen is the most important hormone that brings about these changes. Breast buds are small disk-like areas of tissue under the nipples. Their appearance signals the onset of puberty. Boys stop developing further breast structures before puberty starts.
Breasts achieve full development during pregnancy and lactation. At this time, the mammary glands and duct structures grow to their full extent and are capable of making breast milk. A combination of hormones, including the pregnancy hormone HCG, allows breasts to reach their greatest size. Rapid breast growth may create stretch marks on breast skin. Nipples also become more prominent and may be darker in colour. After delivery of the baby, once breast milk production is no longer needed and milk is not expressed, mammary glands diminish and breasts become smaller again.
When a woman reaches menopause and stops menstruating, her ovaries make much less of the estrogen and progesterone hormones. As a result, the breast glands and ducts begin to shrink and disappear. Connective tissue supporting the glands becomes dehydrated and less elastic. These changes mean that breasts become smaller and less firm. Women may notice that their breasts flatten or droop.
The nipples no longer point straight outward but down and to the sides. Such changes are all part of a natural aging process.
Throughout history and cultures, style has dictated the most desirable breast appearance. Some women who feel their breasts are too small want to enlarge them. Others find their breasts too large and consider procedures to reduce their size. Women who need their breasts surgically changed for medical reasons may consider similar procedures. Such reasons can include a previous mastectomy (surgical breast removal), or chronic back and spine problems related to larger breasts.
For many women, both breasts appear to match in size. However, they are never created equal. Women who have pronounced differences in the size or shape of the breasts may choose to match them through surgery. Others use it to counteract the effects of aging on the breasts. Thousands of women have breast surgery in Canada and the U.S. every year, for many different reasons.
As with any surgery, good overall health reduces the risk of complications. Women who are having breast plastic surgery should maintain a stable weight and not plan on significant weight changes after surgery. The appearance of the breasts will change with the amount of body fat. Pregnancy and breastfeeding also affect the appearance of breasts, as well as the way that surgery makes them look. If a woman is having reconstructive surgery, its timing may be affected by other procedures such as radiation treatment. Women must be well informed and have realistic expectations. Before making a decision about surgery, fully discuss your expectations with your family doctor and plastic surgeon.
A breast reconstruction procedure is usually done after breast tissue has been removed due to breast cancer. Breasts can be surgically reconstructed in several ways, including the use of implants and tissue flaps. Various flap procedures involve moving muscle and fatty tissue from other parts of the body, usually from the belly to the chest, to create a breast. The nipple may also be reconstructed from skin taken from other areas. This procedure is usually funded by the provincial health care system.
Some women suffer significant discomfort due to larger breast weight. This may include chronic back, shoulder, neck and breast pain. Lifestyle adjustments, such as a well-fitted bra and weight loss, may improve these concerns. If not, breast reduction surgery may be an option. Several approaches to this surgery are possible. Most involve removing some of the breast tissue and skin, and repositioning the nipples if necessary. This procedure is usually funded by the provincial health care system.
Breast implant procedure has been done for several decades now. Techniques and materials used continue to improve. The idea is to make the breast implant look and feel similar to the natural breast. Implants are usually round sacks filled with fluid, either silicone or saline. These sacks are surgically inserted either behind existing breast tissue or deeper under a layer of chest muscle. One of four types of incisions is used to insert the implant: under the breast, in the armpit, around the nipple or near the belly button. Implants come in many sizes to achieve the desired look. The patient covers the cost of this procedure.
With age, pregnancy and large weight loss, breasts may lose their fullness and volume. These changes are natural and do not need any medical intervention. Still, some women choose to have surgery to change the appearance of their breasts. Hormone replacement therapy for troublesome symptoms associated with menopause may only slightly slow breast gland shrinkage. Various creams on the market may improve the hydration and appearance of breast skin. However, they will not affect the internal mammary gland changes. Some plastic surgeons may offer a breast lift procedure (mastoplexy) that aims to remove extra skin and reposition the nipples. The woman is responsible for the cost of this procedure.
Most women who choose to have breast surgery are satisfied and remain in good health. As with any surgery, excessive blood loss, infection, and reaction to anesthesia are the most frequent concerns right after surgery.
Breastfeeding may not be possible after breast reduction or augmentation. This depends on how much tissue has been removed, as well as scarring. Still, on average about 60 per cent of women are able to nurse successfully. So far, research shows that breast implants do not appear to affect the health of the baby or quality of breast milk. However, it is not known for sure whether silicone from the implant passes into the milk. Sensation around the surgical incision scars can also change, leaving little or no feeling in the breast area.
Breast implants are not guaranteed for life. It is possible that the implant may break or leak in the future, or change shape or position. Also, a woman’s own tissue may grow a hard capsule around the implant, which may need to be surgically removed. A rare possible complication of breast implants is lymphoma, a type of cancer, around the implant.
Breast implants make the process of screening for breast cancer more difficult. Growing masses can be masked by the implant during a physical exam and mammography (breast x-ray). Breast implant material blocks radiation and may hide small cancer lesions. For this reason, women with breast implants have more views of their breasts taken during mammography. This is an attempt to ensure no concerning growths are missed. Some doctors advise these women to have breast MRIs to better see all breast regions.
If you have a breast concern, doing your own Internet research may lead to unnecessary worry, or to underestimating the significance of symptoms. Visiting your family doctor is the most important step in addressing breast concerns in children, women and men.
Breast lumps: Most breasts are not perfectly smooth. Some small irregularities are normal if they have been around unchanged for years. However, any new lump needs to be assessed by a doctor, who will decide if further tests are needed. Usually ultrasound and mammography are used to see if there is a reason for concern. A breast biopsy may be done at the radiology or breast clinic to make a diagnosis with more certainty. (A biopsy involves removing and examining a small sample of tissue.) On rare occasions, breast surgery may also be advised to get the final answer. Most lumps found by patients and doctors are not serious. They are caused by cysts, fibroadenomas (lumps of fibrous and gland tissue), other non-cancer breast tissue growths, and lipomas (fatty lumps). The minority of breast lumps are cancerous. In this case, appropriate treatment needs to be started swiftly. For this reason, all lumps need to be thoroughly checked.
Breast pain: Breast pain is common in women and some men also experience it. Pain may or may not be associated with a breast lump. Most breast pain occurs in response to natural hormone changes in the body. It also may be caused by hormone medications like birth control pills or hormone replacement therapy. Most women with breast pain feel discomfort in both breasts a week or so prior to their period. Many women have sensitive breasts due to fibrocystic breast changes. These breast lumps are not cancerous. In breastfeeding women, breast pain can happen due to engorgement or infection of a gland. Persistent breast pain can also be a sign of breast cancer.
Nipple inversion and retraction: When the nipple looks like it is pulled inward, it is considered to be inverted. If it seems like part of it is drawn in, or appears to have a slit, it is considered retracted. These nipple appearances may exist since birth and so are not a concern. Nipples can also retract with age as the ducts contract, or after inflammation due to infection. However, any new nipple change should be promptly checked by a doctor because it may also signal cancer.
Nipple discharge: Breasts are glands and will produce milky discharge during pregnancy and after delivery. They can also produce discharge after repetitive physical stimulation or as a side effect of some medications. Less commonly, it may be a symptom of internal disease affecting the body’s hormones. Bloody discharge and discharge limited to only one breast may be signs of breast cancer. See a doctor as soon as possible.
Some male and female newborns have breast gland enlargement during the first few weeks after birth. This is due to the mother’s hormones, and will go away. As breasts develop at the time of puberty, a breast bud may appear on only one side, before the other catches up. This is usually not a cause for concern, but should be evaluated by a doctor. Boys may also develop breast buds (gynecomastia) in puberty. This can last up to 18 months before disappearing. Breast enlargement in children before puberty, and more specifically, before age eight in girls, may be a sign of a health problem. This should be assessed by a doctor. Children can also develop a breast infection, especially after an injury.
The male breast area is composed of a small areola and nipple without any mammary gland prominence. When a man looks like he has breasts, fat deposits are usually the reason. Gynecomastia is a condition where the primitive mammary glands in the male breast are stimulated to grow. This may be a side effect of some medications, or another internal disorder. It should be checked by a doctor. Breast cancer in men is rare - only about one per cent of all breast cancer that is diagnosed. Breast cancer screening is not done routinely in men at any age, so it is important that men discuss any breast concerns with their doctors.
The female breasts, being part of the skin, can be maintained by daily moisturizing and avoiding harsh cleansers. Both genders should avoid breast injury and nipple and areolar irritation that may lead to infections. Although no longer routinely advised, (see Breast is Best on page 21), both men and women should occasionally feel and inspect their breasts for new changes. All women with increased risk of developing breast cancer should have routine screening based on the latest guidelines and discussion with their doctor.
Medical research suggests that regular physical activity may reduce breast cancer risk, especially in women after menopause. As well, after three drinks a week, the more alcohol a woman drinks the greater her risk of breast cancer becomes. This is especially true if she is taking hormone replacement therapy. Smoking speeds the aging process of the entire body, and should be avoided for many reasons as well as to maintain breast health. Quitting smoking may reduce breast cancer risk as well. It has been shown to be paramount in cancer risk reduction of other organs and systems.
Dietary changes, including low fat diets, avoiding red and processed meat, or eating a soy-rich diet, may also reduce breast cancer risk. However, more research is needed. To date, caffeine consumption has not been linked with higher or lower breast cancer risk. Especially after menopause, women should keep their body mass index (BMI) below 30, as research shows strong evidence that obesity does increase the risk of breast cancer. Some research shows that breastfeeding for at least six months may give some protection from cancer as well.
Breast health research is wide and ongoing, and will surely provide us with more certainty in the future.