Your Breasts: An Owner's Manual

From bizarre breast problems and implant questions to what to do after a diagnosis, we've got breast health covered.

doctor holding pink ribbon for breast cancer awareness

Photo by Getty Images

Photo by Getty Images

Age and Your Breasts

“Most changes are caused by fluctuating hormone levels,” says Sandhya Pruthi, MD, a breast health specialist at the Mayo Clinic Breast Diagnostic Clinic. Peek at what you can expect over the decades.

20s and 30s

  • Perkiness: High Rock that bikini top! With lots of firm tissue and little fat, your girls have it going on! Still, most women get breast augmentation in their 30s.
  • Tenderness: High Elevated hormone levels make breasts tender before your period.
  • Lumpiness: High Breathe a little easier. Most breast lumps aren’t cancerous, and less than 5% of breast cancers occur in women younger than 40. You can blame shifting hormones for most lumps and bumps.

40s

  • Perkiness: Medium You’ve still got it—so flaunt it!—but the twins are starting to soften as fat replaces dense tissue.
  • Tenderness: Medium Proceed with caution! Shifting hormone levels due to periods and the onset of menopause cause tenderness.
  • Lumpiness: Still pretty high Don’t panic! See your doctor if you feel something odd, but know that most lumps are due to hormone changes or benign cysts. Still, breast cancer risk increases after age 40.

RELATED: Next Steps After a Breast Cancer Diagnosis

50s and beyond

  • Perkiness: Low Your girls lose shape because they are now mostly fat.
  • Tenderness: Medium to low Tenderness should be a thing of the past unless you use hormone replacement therapy for menopause symptoms.
  • Lumpiness: Low After menopause breasts soften, so a bump now is more concerning. Breast cancer risk goes up as you age, with most women diagnosed in their 60s.

Source: Alyssa Dweck, MD, CareMount Medical

4 Bizarre Breast Problems (That Aren’t Usually Cause for Concern)

Your nipples point in, not out
About 10% of women have inverted nipples, and most are simply born that way. “It’s normal, doesn’t require correction and doesn’t usually interfere with breastfeeding or sexual pleasure,” says Pruthi. But see your doctor if an outward-facing nipple suddenly turns inward. 

One breast is larger than the other
Approximately half of all women have asymmetrical breasts, meaning your breasts differ in size, shape or position. While usually not noticeable, uneven breasts are one of the top reasons women want augmentation surgery. 

Funky-colored gunk comes out of your nipples
Medications, contraceptives, infections and blocked milk ducts can sometimes cause your nipples to produce yellow, green, brown, milky or clear fluid. It should be checked out, but nipple discharge is rarely a sign of something as serious as cancer. 

Your breasts feel like they’re full of marbles
Half of all women ages 20 to 50 have fibrocystic breast changes, which cause noncancerous fluid-filled cysts to form. The masses may be painful, move around or come and go. “A woman with fibrocystic breasts should get to know these lumps well and notify her doctor immediately if something feels different,” says Pruthi.

Questions About Boob Jobs You’re Too Afraid to Ask

Nearly half a million women had some type of cosmetic breast surgery in 2017, according to the American Society of Plastic Surgeons. The organization’s president-elect, Alan Matarasso, MD, answers the top queries he hears.

“How can breast surgery improve my appearance?”
Implants make breasts larger and more symmetrical in size and shape. Lifts reshape the breast and nipple areola by tightening skin and tissue. Reductions reshape and make breasts smaller through the removal of excess skin, fat and tissue. 

Why do some women’s breasts look fake?
If your surgeon places implants too high on the chest (armpit level or above), your breasts won’t look natural. Some women choose implants that are simply too large or the wrong shape for their body size. And about 5% of women who get implants develop an unusually thick band of scar tissue inside the breast that presses against the implant. This complication, called capsular contracture, gives the breast the appearance of a grapefruit stuck to the chest. Should this happen, you’ll need another surgery to fix it. 

How painful is breast implant surgery?
Most breast implant surgeries take place on an outpatient basis. You receive a calming sedative and local anesthesia to numb the breast area. After surgery, you should only need over-the-counter pain medicine to manage the swelling and discomfort. Some women have the procedure on Friday, go out to dinner on Sunday and return to a job (that doesn’t require lots of movement and lifting) on Monday.

How much does breast surgery cost?
Costs vary depending on the procedure type, the surgeon’s credentials and even where you live. On average, lifts and implants range from $5,000 to $10,000. You can expect to get at least 10 years out of your implants, assuming they ever need to be replaced. If you need a breast reduction due to verifiable back and shoulder issues, for example, your insurer may cover some or all of the approximately $6,000 to $12,000 bill. 

Do implants increase my cancer risk?
There’s no proven link between implants and breast cancer. However, women who have textured implants may be at risk for a rare form of cancer called breast implant-associated anaplastic large cell lymphoma (BIA-ALCL). The good news is that once your doctor removes the implant and surrounding scar tissue, the cancer tends to go away without the need for any type of cancer treatments.

When You’ve Been Diagnosed

gyno and patient at mammogram

Photo by Getty Images

Photo by Getty Images

Critical questions to ask your doctor:

What subtype of cancer do I have?
“Knowing this helps guide management,” explains Kristi Funk, MD, breast cancer surgeon and author of Breasts: The Owner’s Manual. There are more than 20 subtypes and they’re fueled by different elements—like progesterone, estrogen or human epidermal growth factor receptor 2 (HER2)—so they respond to different treatment therapies.

Do you advise having a lumpectomy, a lumpectomy with radiation or a mastectomy?
The answer depends on the subtype and size of your tumor, genetic mutations, family history and your personal preferences. “If radiation is recommended, ask what kind,” says Funk. “The standard for many decades has been 6.5 weeks of about 33 treatments of external beam radiation to your whole breast. But now it can often be accelerated to just 3.5 weeks, or brachytherapy delivers it straight to the cavity in just 5 days. There’s also intraoperative radiation with one dose during your surgery.”

How do I know if I need chemotherapy?
“This used to be figured out by your doctor putting the facts together with an intuitive feeling,” says Funk. “But now there are genomic tests to analyze your unique cancer cells and provide data showing whether chemo will improve the prognosis.”

Should I have genetic testing for mutations? “Women will benefit one way or the other,” says Funk. “Positive results can help you and affected family members make better choices. Negative results can give you relief.” Some of the women genetic testing is recommended for include those with a breast cancer diagnosis before age 50, cancer in both breasts, ovarian cancer or a family history of it, Ashkenazi Jewish heritage or two or more primary types of BRCA1- or BRCA2-related cancers in one family member. 

What can I do to help my body heal? There’s no magical treatment for everyone. “Use this diagnosis to embrace new diet and lifestyle behaviors,” says Funk. “Eat a whole-food, plant-based diet with tons of vegetables, fruit, whole grains and legumes.” She also suggests five hours of moderate exercise or two and a half hours of intense exercise each week and decreasing stress.

3 Terms You Should Know

Precision medicine
This targeted treatment approach picks the most effective medication based on your genetic makeup, personal characteristics (such as lifestyle) and analysis of your tumor.

Genomic tests
Not to be confused with genetic tests, genomic tests analyze the activity of a tumor’s genes to predict how a cancer will respond to treatments, as well as the likelihood of the cancer spreading or returning.

Breast-conserving surgery
Lumpectomy, a procedure that removes just the cancerous tumor and some surrounding tissue, spares most of the breast. Combined with radiation, it’s as effective at preventing recurrence as mastectomy.

Protect Your Breasts from Cancer

Learn about the latest advances that could change everything.

Earlier this year, the American College of Radiology and the Society of Breast Imaging began recommending that all women have a breast cancer risk assessment at age 30. “This assessment is particularly critical for women who are African American or of Ashkenazi Jewish descent because they’re more likely to have aggressive cancers at a younger age and be diagnosed after cancer has spread,” says Marc Hurlbert, PhD, chief mission officer of the Breast Cancer Research Foundation. The Q&A with your ob-gyn or PCP goes beyond family history to cover factors like when you started your period and pregnancy history. Depending on the results, your doctor might recommend testing for breast cancer gene mutations (BRCA) or starting cancer screenings earlier. 

In other news, better screening tools for dense breasts are being used. Tumors and dense glandular tissue have a similar whitish appearance on mammograms, making cancer harder to spot. So 34 states have laws requiring mammography centers to inform you about breast density (find out what is required in your state at densebreast-info.org/legislation). If your breasts are dense, talk to your doctor about supplementing 3D mammography (which detects cancer better than 2D digital mammography) with breast ultrasounds or more-advanced tests. Contrast-enhanced breast MRI uses an injectable dye and radio waves to create images, while molecular breast imaging (MBI) relies on an injectable radioactive tracer that is drawn to cancer cells.

Finally, testing for multiple gene mutations (not just BRCA1 and 2) in women diagnosed with breast cancer has been shown to provide information that can help family members who may unknowingly carry the mutations and benefit from genetically targeted preventive measures.

Comfortably Safe
Wearing a seatbelt can be unpleasant for women undergoing treatment for and survivors of breast cancer, so Ford Warriors in Pink designed a cover that reduces pressure in the chest area. Apply for the free, limited-release seatbelt cover at fordcares.com.