Mikio A. Nihira, MD
Breasts: Some women worry that theirs are too big or too small or not as firm and youthful as they once were, but here's one thing that every woman wants -- healthy breasts for a lifetime.
As you enter your 30s, 40s, and 50s, your breasts change along with the rest of your body. In your childbearing years, you may wonder whether breastfeeding will affect your shape. After menopause, you might be more concerned about breast cancer risk. WebMD asked breast specialists to guide women through each important decade.
During this decade, hormones like estrogen help to keep breasts firm. Breasts contain no muscles. Rather, they consist of fibrous tissue, fatty tissue, plus dense glandular tissue that includes milk-producing glands called lobules and ducts to carry milk.
Fortunately, in the 30s, breast problems tend to be benign (noncancerous). Younger women commonly experience fibrocystic breast disease, a broad term that is characterized by breast pain, cysts, and noncancerous lumpiness. "Breast pain can be cyclic, coming with menstrual periods, or it can be more persistent," says Leona Downey, MD, assistant professor of clinical medicine at the University of Arizona Health Sciences Center.
What helps ease breast pain? Avoiding caffeine, says Elizabeth Steiner, MD, associate professor at Oregon Health and Science University and director of the Oregon Cancer Institute Breast Health Education Program.
Fibroadenomas can also affect women in their 30s. These rubbery lumps made of fibrous and glandular tissue aren't cancerous, but they can hurt. If they're bothersome, they can be surgically removed, Downey says.
During this decade, which has become more popular for childbearing, breastfeeding offers mothers some long-term protection against breast cancer. "One of the best gifts they can give themselves and their babies is to breastfeed for as long as possible," Steiner says.
But some women worry that breastfeeding will cause breast sagging. Experts tell WebMD, however, that nursing doesn't actually cause breast tissue to droop. Instead, breast swelling during lactation can stretch the skin over the breast. "Then when your breasts shrink again, you have this loose skin that appears to sag more than it did before," Downey says.
In fact, one 2007 study presented at an American Society of Plastic Surgeons conference exonerated breastfeeding. But it named other culprits that contribute to sagging: larger pre-pregnancy bra cup size, greater number of pregnancies, cigarette smoking (which can weaken skin elasticity), and older age.
As the years go by, breasts become less glandular and fattier, which makes them less firm. Another factor is the stretching of fibrous bands in the breast called Cooper's ligaments. "They're fibrous tissue that holds the breast up a bit, and those can stretch over time, and that leads to some of the sagging, too," Downey says. Hence the term "Cooper's droopers."
Experts tell WebMD you can't do much to slow or prevent sagging. Because the breasts contain no muscles, you can't really exercise your way to a perkier chest.
However, some doctors advise women to wear sports bras during jogging to prevent bouncing that can stretch the ligaments. "Wearing a tight-fitting bra on a regular basis probably doesn't make a big difference," Downey says, "but wearing a bra that prevents a lot of bouncing, like with jogging, probably does minimize stretching of those fibrous bands."
Breast cancer is uncommon; women aged 30-39 have a risk of only one in 229 of being diagnosed with breast cancer, according to the National Cancer Institute.
Unless there's a strong family history of breast cancer, women in their 30s don't need mammogram screening. In fact, younger women's denser breast tissue makes it harder to detect breast cancers on mammograms.
However, regular manual breast exams by your doctor are crucial to check for lumps, skin dimpling, and other signs of breast cancer, according to experts.
Furthermore, Downey urges women in their 30s to report lasting breast changes or pain to their doctors. "Many of these things that cause breast pain in young women are going to turn out to be benign, but there are breast cancers that happen in young women," Downey says. "My advice is, just because you're young and you're less likely to have a cancer doesn't mean that you shouldn't get it looked at."
What about doing monthly breast self-exams at home? The American Cancer Society has declared them optional, citing a lack of evidence that they reduce breast cancer deaths. But each doctor who spoke to WebMD emphasized that women should still perform breast self-exams monthly -- at the very least -- to familiarize themselves with their breasts so that they can report changes to their doctors.
"It's easy enough ... and there are certainly women out there who find their breast cancers that way," Downey says. "I encourage all women to do breast self-exams and get comfortable with what their breasts feel like."
If you are premenopausal, the ideal time to check your breasts is 5 to10 days after the beginning of your period, Steiner says, before premenstrual lumpiness appears. "That's when you have the least hormonal effect and you're going to have the most accurate exam," she says.
During the 40s, breast shape continues to change for most women. "As we get older, sort of in a progressive way -- but certainly after menopause -- the breast has less glandular tissue but more fat," Downey says, leading to more sagging.
The Revlon/UCLA Breast Center reports that cysts are the most common type of breast lump seen in women during their 40s, although cysts can develop at other ages as well. These fluid-filled sacs aren't cancerous, but they can be painful. Doctors can drain or surgically remove them.
Cellular hanges like atypical ductal hyperplasia may also begin during this decade, Downey says. These abnormal cells in the milk ducts increase a woman's chances of breast cancer.
The numbers show that breast cancer risk rises during this decade; a woman between the ages of 40 and 49 now has a one in 68 chance of being diagnosed. Therefore, mammogram screening enters the picture.
The medical community has debated the benefits of mammography for women in their 40s, in part because false positives can lead to unnecessary anxiety and procedures.
The National Cancer Institute recommends getting a first mammogram at age 40 and then one subsequently every one to two years afterward. However, women with a strong family history of breast or ovarian cancer should ask their doctors about starting mammogram screening before 40.
The National Cancer Institute also urges all women to report the following breast changes to their doctors:
But don't worry about underwire bras, antiperspirants, or trauma to the breast increasing your risk, Steiner says. None of these has been proven to promote breast cancer.
After menopause, the breasts not only become fattier but will shrink because women no longer need the milk-producing glands for breastfeeding.
"We lose the hormonal effect on our glandular tissue in our breasts, and over time that tissue atrophies," Steiner says. "That's a time when women notice their breasts are less firm, certainly less tender if they've had problems with tenderness, and they're less lumpy."
While harmless lumps may come and go with the menstrual cycle in younger women, any new lump that appears after menopause requires a doctor's prompt attention, Steiner says.
Most breast cancers occur in women over age 50, according to the National Cancer Institute. From ages 50 to 59, a woman's chance of being diagnosed with breast cancer stands at 1 in 37.
In the 50s decade, experts advise women to get mammograms every year.
The good news? Doctors have an easier time detecting breast cancers in older women because breast density is less likely to obscure tumors. Dawn Hershman, MD, assistant professor of medicine at the Columbia University College of Physicians and Surgeons, says, "As the fat content increases, the sensitivity of the mammogram often increases."
It's also smart to keep your weight under control. Research has shown that the chances of developing breast cancer after menopause are higher in overweight or obese women.
SOURCES:Leona Downey, MD, assistant professor of clinical medicine, University of Arizona Health Sciences Center.Elizabeth Steiner, MD, associate professor, Oregon Health and Science University; director, Oregon Cancer Institute Breast Health Education Program.Dawn Hershman, MD, MS, assistant professor of medicine, Columbia University College of Physicians and Surgeons.Raquel Prati, MD, visiting assistant professor, department of surgery, Revlon/UCLA Breast Center.News release, American Society of Plastic Surgeons.American Cancer Society: "Role of Breast Self-Examination Changes in Guidelines."National Cancer Institute: "Understanding Breast Changes: A Health Guide for Women."National Cancer Institute: "Screening Mammograms: Questions and Answers."Revlon/UCLA Breast Center: "Breast Cancer Screening."Revlon/UCLA Breast Center: "Benign Breast Problems."
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