Every human, no matter their sex, possesses breasts. In fact, male and female breasts are nearly identical in build, with one key exception: during puberty, women develop the milk-producing lobules necessary for lactation. With that biological distinction in mind, Roper St. Francis Healthcare puts forth specific guidelines for female breast care. Here, we review the most up-to-date advice given to women for supporting these glandular organs, from anatomical awareness to chest checkups.
WRITTEN BY Holly Fisher
PHOTOGRAPHS BY Scott Henderson
Humans are the only animal with permanent breasts. In every other female mammal, mammary glands emerge to feed babies and then disappear. But in women, breasts appear during puberty and remain for life (unless surgically removed). Girls as young as 10 are developing breast buds, and moms are shopping for training bras. Beyond that, breast development varies for every woman. “Breasts are like people—they come in all different shapes and sizes,” says Dr. Megan Baker, a Roper St. Francis Healthcare affiliated breast surgeon.
Ages & Stages
A woman’s breasts will change over the course of her life, maturing from those breast buds into a variety of shapes and sizes. They change during and after pregnancy and breastfeeding. They change as she ages and goes through menopause. They may even change with weight gain or loss.
Breasts often go through their most significant shifts during and after pregnancy, as they gear up for milk production. An organ comprised of connective, fat and breast tissues, the female breast contains between 15 and 20 glands called lobes that house sacs to produce milk and ducts to transport milk to the nipples.
“The breast is ultimately a hormonal response gland. When a woman is pregnant, hormones cause increased blood flow and glandular development as the body gets ready to potentially breastfeed,” says Dr. Philip Albaneze, a Roper St. Francis Healthcare affiliated breast surgeon and medical director of the breast care program. “Breast soreness is a normal side effect of the hormonal changes happening inside the body.” (That’s why women often notice breast tenderness as a first sign of pregnancy.)
As these hormonal changes continue, breasts typically grow in size to prepare for postpartum milk production. The breast morphs again when a woman stops breastfeeding, as hormones make another shift and the glandular tissue atrophies, returning the breast to its pre-pregnancy size (though the skin may stay stretched or sag).
Aging has a similar effect on breasts. When women enter menopause, breast tissue responds to changing hormone levels much as it did after pregnancy and breastfeeding. The glands that were focused on milk production in years past begin to shrink, explains Dr. Albaneze, and the breasts may sag.
Drooping breasts may just seem like nature’s way, but women do have control over their breast health. While experts are split over whether or not wearing a bra can prevent sagging, they agree that regular attention is perhaps the best support a woman can give her breasts. Noticing abnormal changes or lumps and being aware of any family history of breast cancer are fundamental to overall breast health.
“The best thing you can do for your breasts is live a healthy lifestyle,” Dr. Albaneze tells his patients. “Most people know instantly what that means: eat a well-balanced diet high in fruits and vegetables. Avoid alcohol. Don’t smoke. Get 30 minutes of exercise three times a week.”
Unfortunately, all women are at risk for breast cancer. But there are ways to mitigate the risk, point out breast health specialists. For years, women were urged to conduct monthly self-exams in an effort to catch any lumps or bumps in their breasts that might develop between visits to their doctor or a mammogram. However, the American Cancer Society no longer recommends physical breast exams, either by yourself or a health professional. The rationale? There’s very little evidence that these tests help detect breast cancer early.
While doctors may not be handing out shower cards with instructions on how to conduct a step-by-step breast self-exam, they certainly don’t want women to ignore their breasts altogether. These days, doctors focus on what’s called “breast awareness,” Dr. Albaneze explains. He urges patients to check for any obvious breast lumps and note any new moles or skin discolorations about once a month. By simply paying attention to their bodies on a regular basis, women can catch issues more quickly.
Memos about Mammos
In addition to breast awareness, doctors stand behind mammograms as the gold standard for early detection of breast cancer. There’s no other screening tool that has been proven to increase cancer survival like the mammogram, Dr. Albaneze says. Mammography uses low-energy X-rays to examine the breast from multiple angles to check for abnormal areas in the breast. Designed to look at only a woman’s breast tissue, the machine compresses the breast between two plates to spread the tissue apart and give a better picture with lower levels of radiation.
For those concerned about added radiation exposure during a mammogram, Dr. Baker says not to fret. The radiation levels in a mammogram aren’t as high as people commonly think. “You would need to take 100 breast pictures to equal the radiation of just one chest X-ray,” she says. That bit of radiation exposure is a minuscule sacrifice for the benefit of early breast cancer detection, which translates into a much greater chance for surviving a diagnosis. The American Cancer Society reports that, when a woman’s breast cancer is caught early, she has a 99 percent chance of surviving at least five years following her diagnosis. Eighty-four percent of patients live for 10 years or longer.
While there has been debate over when women should start mammograms, research shows no benefit to delaying the test. Major health organizations like the American Cancer Society, the National Consortium of Breast Centers and the American College of Radiology all support women starting annual mammograms at age 40, unless their family history dictates otherwise. According to the Society of Breast Imaging, “more than 40 percent of the years of life lost to breast cancer are among women diagnosed in their 40s.” The society also points to scientific studies that have shown a decline in deaths from screening women beginning at the age of 40.
However, that time line changes for women with a family history of breast cancer, who should start these exams 10 years younger than the youngest age at which a family member was diagnosed. (For example, if your mother was diagnosed with breast cancer at 42, you may benefit from screening starting at age 32.) Dr. Baker encourages women with a family history of breast cancer on either their mother or father’s side to have a risk assessment. Additional genetic testing can better calculate a woman’s risk for developing breast cancer and determine when to start routine breast imaging. A risk assessment will also benefit any woman who has had radiation therapy to her chest from leukemia or lymphoma or who has had a biopsy with atypical findings.
“In the United States, we only identify 20 percent of women who technically qualify as high risk,” laments Dr. Baker. “Nationally, the medical community does a poor job of promoting this service. If done properly, it truly saves lives. Roper St. Francis Healthcare conducts high-risk breast assessment throughout the Tri-County.”
Dr. Albaneze recommends the National Cancer Institute’s Breast Cancer Risk Assessment Tool at bcrisktool.cancer.gov. It’s a free and simple series of questions to calculate your five-year and lifetime risk of a breast cancer diagnosis. “The test offers really good information to help you and your doctor make personalized decisions,” he says.
Thick & Thin
Until a woman has a mammogram, she probably never even thinks about the density of her breasts. The subject doesn’t exactly come up at a bra fitting, and it’s not related to the size, shape or firmness of your breasts. Breast density refers to the amount of fat in the breast relative to glandular tissue—the fattier the breast, the less dense it is, explains Dr. Albaneze. For the most part, breast density correlates to age, with breasts becoming less dense as you get older.
Density becomes an important element of a mammography, because dense breasts are less transparent on an X-ray, making it more difficult to spot tumors. This shouldn’t deter you from getting screened, though, especially because women with dense breast tissue are also at a higher risk for developing breast cancer. Women with dense breasts may benefit from additional screening techniques such as ultrasound.
Tending to your breasts is as important as taking care of any other part of your body. Be mindful of your overall physical health, take note of any issues or abnormalities related to your breasts and get a mammogram when you hit the big 4-0. You’ll also want to learn about your family history, so you can be aware of any heightened risk for breast cancer.
Mammograms & the COVID-19 Vaccine
Any time you get a vaccine, the immune system becomes temporarily inflamed, which can cause enlarged lymph nodes. Since mammograms look at the lymph nodes in the armpit area, if you’ve recently received the COVID-19 vaccine, the mammogram won’t know if your lymph nodes are enlarged due to the vaccine or a tumor.
Dr. Baker recommends spacing your vaccine and your mammogram out by eight to 12 weeks, if possible. Should you need to do both at the same time, it’s fine, she assures. Just know that it may result in a false positive and an ultrasound. “In the era of Delta, don’t let anything get in the way of getting your vaccine,” Dr. Baker says.
As soon as a woman gets pregnant, her breasts go to work preparing for breastfeeding. Breasts have milk ducts that grow in number and size thanks to those pregnancy hormones. Throughout pregnancy, the breasts grow larger, with the milk duct system fully developing in the second trimester. Immediately after the baby is born, the mother’s body makes a nutrient-rich colostrum for her infant; over the next few days, the colostrum transitions into mature milk.
Breastfeeding may be natural, but the process isn’t always straightforward and not every mom breastfeeds with ease. Sometimes the breasts don’t make enough milk, or the baby doesn’t latch onto the nipple properly. For any mother wishing to breastfeed her newborn, a lactation consultant can help guide the journey. Roper St. Francis Healthcare has board certified lactation consultants trained to support breastfeeding mothers and create a personalized care plan that fits both mother and baby’s needs.
Learn more at www.rsfh.com/pregnancy-newborn/lactation-breastfeeding.