Breasts

Breasts

To men they''''re mainly erotic--the subject of locker-room jokes and goofy nicknames that range from the ridiculous to the more ridiculous--hooters, knockers, jugs, bazooms, boobs, kasabas, ta-tas, coconuts and melons.

Even women can get caught up in the sexualization of mammary glands. In her book The Female Eunuch, feminist activist Germain Greer lamented the plight of the busty female as she''''s viewed by men:

She is never allowed to think that their popping eyes actually see her. Her breasts . . . are not parts of a person but lures slung around her neck, to be kneaded and twisted like magic putty, or mumbled and mouthed like lolly ices.

Jugs? Lures? Putty? It''''s obvious that breasts represent much more in this society than mere mammary organs. Like it or not, these two mounds of glandular, fatty and fibrous tissue located over the pectoralis muscles of the chest have a lot to do with our identity as women. For many women they''''re also a source of pleasure. Because their stimulation often causes sensual arousal during sex, the breasts are also secondary sexual organs.

Breast Basics

Breasts begin to emerge during puberty responding to the hormonal changes in the body.

Usually, adult breasts are tear-shaped, with breast tissue running from the collarbone all the way down to the last few ribs, and from the breastbone in the middle of the chest to the back of the armpit. Most of the breast tissue is toward the armpit and upper breast, with fat located in the middle and lower part. Like the rest of the body, breasts also have arteries, veins and nerves.

The areola--or darker area of skin surrounding the nipple--varies in shape, size and color. In blonds it''''s often pink; in brunettes it''''s browner and in Blacks, it is black. It also changes colors during sexual arousal or orgasm.

What''''s in a Lump?

Breast and lump--the two words clash as badly as drinking and driving. With one out of every eight women in the United States getting breast cancer, it''''s no wonder that new lumps cause consternation. But despite the ominous implications, lumpy breasts are simply a fact of life--like freckles or body hair.

Because most normal breast tissue is lumpy glandular tissue, about 75 percent of women get what could be called fibrocystic changes in their breasts, notes Kerry McGinn, R.N., author of The Informed Woman''''s Guide to Breast Health and certified oncology nurse at the University of California, San Francisco, Mount Zion Home Care.

"Every month, the body has a dress rehearsal for what would happen if a woman has a baby," according to C. H. Baick, M.D., founding director of and breast surgical oncologist at the Breast Health Center in Santa Ana, California. "The body brings in extra fluids the woman might need. As we get older, things get tired on the job, and the cleanup isn''''t as effective. Fluids are left in the breast."

It''''s not uncommon for women to have lumpy breasts, says Lydia Komarnicky, M.D., radiation oncologist at Thomas Jefferson Hospital in Philadelphia and co-author of What to Do If You Get Breast Cancer. Normal breast tissue often has a lumpy consistency.

Signs of Trouble

Aside from everyday lumpy breast tissue, there are two types of nonmalignant lumps to be aware of. The first are cysts, which are most common in women nearing menopause. These fluid-filled sacs are smooth on the outside and often tender when touched. When you''''re treated for cysts, the doctor first anesthetizes the skin over the lump and then draws out the fluid with a needle--causing the cyst to collapse.

The other common lump is a fibroadenoma, which is a round lump that feels smooth and rubbery. It can be as small as a pencil eraser or as large as a lemon. To make sure the lump is harmless, a biopsy is often done, during which a piece of tissue is removed and then analyzed. After diagnosis is made, the doctor removes the lump while you''''re under local anesthesia.

Despite the fact that only 1 in 12 lumps in premenopausal women is malignant, it''''s still important to have any suspicious lumps checked out by a doctor before you write them off as harmless, notes Dr. Komarnicky.

Smooth Strategies

Although most lumpiness can be blamed on hormonal changes in your body, you can try some strategies to help smooth things out. Here are some doctors'''' recommendations.

Dry your whistle. It''''s important to cut back your alcohol intake or stop imbibing altogether, says Susan Lark, M.D., a physician in private practice in Los Altos, California, and author of The Woman''''s Health Companion. "Alcohol elevates levels of estrogen in your system, which makes breast lumpiness worse."

Defat your diet. A low-fat diet that''''s high in fiber, fruits and veggies is a great way to get excess estrogen out of your system, notes Dr. Lark. A high-fat diet impairs estrogen excretion and raises estrogen levels by promoting growth of bacteria. That growth increases the absorption of estrogen back into your body instead of allowing it to be excreted through your intestinal track. "Vegetable-eaters excrete estrogen more effectively." Significant sources of fat are foods such as salad dressing, cheese, margarine, lunchmeats and other fatty meats.

Drink an un-cola. Avoiding caffeine could help cut back on lumpiness, notes Dr. Komarnicky. "Some people do seem to be very sensitive to caffeine. When they stop drinking cola or eating chocolate, their lumps decrease in size or go away, and breast tenderness decreases also." So if you are particularly sensitive, you might consider decreasing your intake of caffeinated products.

Check with your doc for E loading. A good way to smooth out your breasts is with vitamin E, notes Dr. Lark. "You need 400 to 1,600 international units (IU) of vitamin E a day to help combat cystic breast changes." Since this is a high level of vitamin E--which can be toxic in large doses--you should check with your doctor before taking this much. (The Daily Value for vitamin E is 30 IU.)

What a Drag

Gravity is an inexorable force. For the woman with breasts like overpumped volleyballs, the sheer weight makes them hard to support. Unfortunately, even the breasts that fit in A and B cups may succumb to sag. Doctors call it ptosis--which simply means droop. Women call it a pain in the butt.

Like it or not, the droop factor is a fact of life, notes Sharon Webb, M.D., Ph.D., assistant clinical professor of surgery at Tufts University School of Medicine in Boston.

"All soft tissues on the human body respond to gravity--from the ear lobe to the nose to the chest to the rear end," Dr. Webb says. "Since there is no intrinsic support to the breast, the forces of gravity take their toll."

The tissues responsible for holding up breasts are the suspensory ligaments that run underneath them. But they''''re not very strong, and they lose elasticity when the breasts are large and heavy, notes Dr. Webb.

Lots of other factors add to the drooping dilemma: weight gains and losses, pregnancy and breastfeeding all cause breasts to enlarge. These changes stretch the skin. Later, after childbearing or a period of weight gain, the tissues go back to normal, but the skin doesn''''t, according to Dr. Webb.

Although some of these changes are unavoidable, you don''''t have to completely succumb to the sag. Here are some tips to keep your breasts saluting the sun as long as possible.

Push it up. Exercise can''''t correct a sagging breast, but it can give the illusion of a firmer bust, notes Dr. Lark. Anything that builds up the pectoralis muscles of the chest, such as bench presses or resistance exercises for the arms will help to firm and tone the muscle underneath the breasts.

Get some support. Contrary to the popular thinking of the 1960s, going braless does not foster perky breasts. "It does help to wear a bra," notes Petra Schneider, M.D., a plastic surgeon in private practice in Melbourne, Florida. "It puts less stress on the ligaments. The more you wear one during the day, the more it helps."

Save your skin. Too much sun exposure and smoking both take their toll on the skin''''s collagen--the fibrous protein that holds skin together, notes Dr. Schneider. "Some people have very elastic skin that holds up well, and others have thin, very fragile skin that doesn''''t." Whichever kind of skin you have, a lot of sun exposure and smoking damages the skin and its elastic fibers.

If you''''ve tried every trick in the book and still have breasts like deflated balloons, you might even consider a breast lift, called a mastopexy. The surgery involves a doctor moving the nipple by elevating it and trimming off excess skin. You''''ll have a scar around the nipple and undersurface of the breast, notes Dr. Webb. "You haven''''t altered the force of gravity; you''''re just tightening up the skin envelope." To see if you qualify for this surgery, look at the position of your nipples in relation to your breast fold. If your nipples are at or above it, you''''re probably not droopy enough to have a breast lift done.

Your Risks of Breast Cancer

If breasts make us uniquely female, then to lose one is almost like being defeminized--to some it''''s a loss of sexual identity. But breast cancer means much more than possible disfigurement. It''''s the second most common cause of cancer death among women in the United States.

Breast cancer can be slow- or fast-growing. The actual cancer cells are microscopic and may take one to five years before the cancerous area grows large enough to be felt as a mass or tumor.

From 70 to 80 percent of all breast cancer develops in the ducts of the mammary glands. It''''s best to discover cancer while it''''s still growing in the ducts before the cells have spread outside the duct lining and potentially throughout the body.

Get in Touch with Your Breasts If you know the shape and texture of your breasts by sight and touch you''''re more likely to detect changes. "Some women say their breasts are so lumpy that they just don''''t know what they''''re feeling," notes C. H. Baick, M.D., founding director of and breast surgical oncologist at the Breast Health Center in Santa Ana, California. "You have to get to know your breasts. It''''s the only way you can detect unusual changes." Because the texture of your breasts changes according to your cycle, Dr. Baick recommends doing the exam at the same time each period--seven to ten days after your period begins. Begin with a visual inspection. Stand before a mirror with your hands at your sides. Raise your hands and clasp them as shown in the illustration below. Then press your hands firmly on your hips with your shoulders and elbows pulled forward as shown in the illustration, above left. Look for any changes in size or shape of your breasts, as well as for nipple discharge, redness, puckering or dimpling. Following the visual exam, check your breasts by touch. It''''s important to follow a definite pattern--vertical, wedge or circular--to make sure you examine yourself thoroughly for any unusual lumps. You can use one of these methods or all three. You may want to do it in the shower with soapy water so your hands slide smoothly. For a visual self-exam, clasp your hands as shown and press forward against the back of your scalp. Complete the visual exam in this position. Vertical pattern. Slide the hand up and down to methodically examine the entire breast. Wedge pattern. From the nipple, examine outward toward the edge of the breast as shown. Circular pattern. As the last step, check the entire breast and underarm, including the armpit. Circular pattern. Then move your fingers in small circles, working toward the nipple. Circular pattern. First place your fingers at the outer edge of your breast and slowly compress the tissue.

Although breast cancer will strike over 180,000 women in the United States each year, that doesn''''t mean a death sentence--and many times, not even loss of a breast.

These days more and more women are opting for lumpectomies and radiation (called breast conservation therapy) rather than mastectomy--which means only the tissue around the lump is removed rather than the whole breast. Dr. Komarnicky says that more and more physicians are starting to recognize breast conservation as an equal option to mastectomy in early localized breast cancer, so the mastectomy trend is changing.

In addition, mammography and monthly self-exams give women the chance to catch cancer early, says Dr. Komarnicky. "There can be a 95 percent survival rate if it''''s found in the earliest stage. We can excise the area and then treat the breast with radiation."

Open That Family Album

Another vital step in beating breast cancer is knowing your risk factors. Many factors are linked to conditions that affect hormonal patterns and increase estrogen metabolism in the body, notes Larry Kushi, Sc.D., associate professor of epidemiology at the University of Minnesota School of Public Health in Minneapolis.

You''''re at higher risk for breast cancer if you''''ve never had children or if your first child was born after you reached the age of 30. Other women with a higher risk factor are those who had their first period early or started menopause late in life. Being on estrogen replacement or supplements may also raise your risk of breast cancer.

"It''''s often linked with a high constant exposure to estrogen," notes Dr. Kushi. "Before family planning, when women were often pregnant or breastfeeding, the breast cancer rates were low. Now women have fewer children later in life and don''''t breastfeed as long."

Also, having first-degree maternal relatives like a mother or sisters who got breast cancer raises your risk 1½ to 2 times. If a relative had cancer in both breasts or before menopause, you''''re 50 percent more likely to get breast cancer than the woman who has no family history of the disease.

Go Looking for Trouble

To spot breast cancer early, doctors recommend both self-examination and mammography. But a number of experts debate the effectiveness of self-exams and question how often the exam should be done.

While many physicians advocate doing self-examination at the same time every month, a growing number, including Susan Love, M.D., author of the best-selling Dr. Susan Love''''s Breast Book, disagree.

In her book Dr. Love says that self-exam "alienates women from their breasts . . . it puts you in a position of examining yourself once a month to see if your breast has betrayed you." Instead, she advocates simply touching and getting to know your entire body without making a monthly "search and destroy" mission out of it.

But Dr. Baick says that''''s a defeatist attitude. Instead, he''''s for monthly self-checkups.

"Self-exam should be once a month and no more, because you cannot detect a change in your breast if you''''re doing it every day," he notes. "The important thing is to get to know your breasts."

Farsighted Screening

The other method of detecting early signs of breast cancer is baseline mammography. Once your breasts are x-rayed, the doctor has a record of normal breast tissue appearance, and later x-rays can be compared for changes. With annual or semiannual screenings, the doctor can detect possible abnormalities.

You should have your first mammogram when you''''re between ages 35 and 40--the earlier the better if you have a family history of breast cancer, previous biopsies or a record of breast problems. Between 40 and 50, you should have a mammogram every one to two years. After 50, doctors say, you should have a mammogram done annually, according to Dr. Baick. In his practice, which is predominantly a population of women ages 65 and younger, Dr. Baick estimates that 50 percent of those diagnosed are women between the ages of 45 and 50. "That''''s a very, very vulnerable age." Among those women, about 50 percent of their cancers were diagnosed by mammography. He has found mammography a very valuable tool in diagnosing breast cancer, even in these younger women.

The Breast Defense

Even if you''''re a childless, postmenopausal woman over 50 whose mother and sister had breast cancer, it''''s not at all certain that you''''ll get the disease.

Studies show that a healthy lifestyle--meaning a low-fat diet that''''s high in fiber and fruits and vegetables, as well as regular exercise--can help make a difference.

"Prevention has to apply to everyone," observes Kim Westerlind, Ph.D., research scientist at the AMC Cancer Research Center in Denver. "Right now, early detection is what we have, along with healthy diet and physical activity."

Though there is a gene that predisposes some women to early onset breast and ovarian cancer, the majority of us can take steps to reduce our risk. Here are some tactics that doctors recommend to improve your chances of staying cancer-free.

Stop chewing the fat. Cutting down on dietary fat has a powerful protective effect on hormones, which are linked with breast cancer, notes Jon Michnovicz, M.D., Ph.D., president of the Foundation for Preventive Oncology in New York City and author of How to Reduce Your Risk of Breast Cancer.

"I recommend getting 20 percent of calories or less from fat a day, plus adding more fruits and vegetables," he says. With those simple changes in diet, hundreds of thousands of women could avoid getting cancer. In China and Japan, where the diets are based on low-fat staples such as rice and fish, women get breast cancer at only 10 to 15 percent the rate of women in the United States, he notes.

A 1994 study by researchers at the Stanley S. Scott Cancer Center at Louisiana State University Medical Center in New Orleans supports the view that a low-fat diet is one way to reduce your cancer risk. In that study doctors compared 40 women who had breast cancer with 40 women without breast cancer of the same age, weight and waist size. In the group that had cancer, researchers found, 45 percent had a higher level of deep abdominal fat.

Although some doctors argue that obesity rather than dietary fat affects breast cancer risk, Dr. Michnovicz disagrees. "Diet is an independent protective factor against breast cancer. Dietary fat and body fat are two sides of the same coin. It''''s the people who eat relatively low-fat and low calories and are thin who have a low cancer rate."

Can those beers. Staying away from alcohol seems to have some benefit, notes Dr. Kushi. "Among all the diet-related things you can do, the evidence is strongest for cutting out alcohol," he says. "If you look at all the studies, even a little bit of alcohol--a few times a week or more--increases the risk."

A 1995 study in a four-state area compared the drinking habits of 6,662 women who had breast cancer with the habits of 9,163 healthy women. Results showed that compared with women who had no alcoholic drinks, those who had one alcoholic drink a day were 1.3 times more likely to get breast cancer. Those who consumed two drinks a day were 1.7 times more likely to get breast cancer. The women who downed three drinks a day were over twice as likely to get the disease.

Load up on wheat bran. Making wheat-bran fiber part of your diet is another way to eat yourself healthy, notes Dr. Michnovicz. When you eat insoluble fiber--the kind that''''s in wheat bran--estrogen gets bound up in your stool and therefore leaves your body, he notes. Whole-wheat bread or pitas and tabbouleh made of cracked wheat are other good sources of wheat bran.

Top up your total fiber, too. "You need 25 to 35 grams of fiber a day," says Dr. Michnovicz. Some especially good choices for boosting your total fiber are foods like carrots, squash and cantaloupe, notes George Liepa, Ph.D., professor of nutrition and food sciences at Texas Woman''''s University in Denton. "Carrots have lignin, a food compound that binds to some troublesome hormones and carries them out of the body with the feces." Like some compounds found in wheat bran, complex carbohydrates in carrots have been shown to help reduce some estrogen metabolites in your body.

Get an A. Some studies have shown that vitamin A may be a good tool in the prevention of cancer, notes Dr. Liepa. In food, this vitamin comes in the form of beta-carotene, which is in many orange- and yellow-colored fruits and vegetables and in dark leafy greens. Dr. Liepa recommends eating foods that are rich in the vitamin rather than taking supplements, because you get a lot more than just beta-carotene. "There are many other compounds in that carrot that a vitamin pill doesn''''t contain." Many of these other carotenoids are also reported to have some cancer-fighting effects. Dried apricots, beet greens, broccoli, kale and spinach are just a few foods that rate an A in the carotenoid department.

Take a hike. Aerobic exercise just might put breast cancer on the run, notes Dr. Westerlind. "The bottom line in all diseases is that physical activity is a good thing." Try to incorporate walking, biking, swimming, aerobics or some other form of activity into your daily life. "Thirty minutes of moderate-intensity physical activity seven days a week is the ideal."

Pass the olive oil. Using olive oil instead of your standard golden cooking liquid could cut your breast cancer risk, says Dimitrios Trichopoulos, M.D., professor of cancer prevention and epidemiology at the Harvard School of Public Health. There is about 40 percent less breast cancer in Mediterranean countries, where olive oil is a dietary staple, than in the West, he says. "Olive oil also contains plenty of vitamin E, an important antioxidant."

Making Mountains out of Molehills When you wish for more than you have, the world seems full of cruel reminders. Bikinis display assets you can only dream about. Strapless evening gowns dare your nonexistent chest to hold them up. And most of the actresses who make it big remind you of the true meaning of big. It''''s just not fair. But thanks to breast implants, medical science can tip the scales--and cup size--in your favor. In an average year some 40,000 women are likely to get this operation. A plastic surgeon makes an incision around the areola, under