Breast A-Z Knowledge




Anatomy of Breast

The breast is a glandular, containing fatty and fibrous tissue located over the pectoralis muscles of the chest wall and attached to these muscles by fibrous strands. The breast itself actually has none of muscle tissue that is why exercises cannot help build up breasts. A layer of fat surrounds the breast glands and spreads throughout the breasts. This fatty tissue provides the breast soft consistency and gentle, flowing contour. The actual breast contains fat, glands with the capacity for milk production when stimulated by special hormones, blood vessels as well as milk ducts to transfer the milk from the glands to the nipples and sensory nerves that give feeling to the breast. These nerves extend from the muscle layer to the breast and are greatly sensitive, especially in the areas of the nipple and areola that accounts for the sexual responsiveness of some women’s breasts.

As the breast is made of tissues with different textures, it might not have a smooth surface and is often feel lumpy. This abnormality is normally noticeable when a woman is thin and has small breast fat to soften the contours; it turns to be less obvious after menopause at the time that the cyclic changes and endocrine incentive of the breast have ceased and the glandular tissue softens. Estrogen supplements after the menopause can produce continued lumpiness. The breast glands drain into collecting system of ducts that go to the base of nipples. The ducts then extend through the nipples and open on its external surface to serve as a channel for milk. These ducts are often sources of breast problems.

The ducts terminate in the nipple, and are a conduit for the milk evolved by glands and suckled by a baby during the breast-feeding time. There is essential variation in women’s nipples. In some, the nipple constantly erects; in others, it only becomes erect when impacted by cold, physical contact or sexual activity. Other women have inverted nipples. The surrounding of nipple is slightly raised circle of pigmented skin which is called the areola. The nipple and areola contain muscle fibers that make nipple erect and give the areola its firm texture. The areola contains Montgomery’s glands that may appear as tiny, raised lumps on the areola. These glands lubricate the areola. They are not symptoms of unusual condition. Under the breast is a large muscle, the pectoralis major, that supports arm movement and the breast rests on this muscle. On the chest wall, the pectoralis major extends from under the breast to the upper arm. It also helps shape the axillary fold, created where arm and chest wall meet. The axilla is the depression behind this fold. Each woman’s breasts are different. Individual breast appearance is influenced by the volume of a woman’s breast tissue and fat as well as her age, a history of previous pregnancies and lactation. Her heredity, the quality and elasticity of her breast skin and the influence of hormones are also the important factors.

Breast Compositions

Cooper’s Ligament: Strong ligamentous band spreading upward and backward from the Gimbernat’s ligament along the iliopectineal line to which it is attached (called also ligament of Cooper). 

Pectoralis major: A bigger chest muscle that arises from the clavicle, the sternum, the cartilages of most of the ribs, and the aponeurosis of the external oblique muscle. It is inserted by a strong flat tendon into the posterior bicipital ridge of the humerus.

Pectoralis minor: A smaller muscle beneath the larger, arises from the third, fourth, and fifth ribs, and is inserted by flat tendon into the coracoid process of scapula.

Connective tissue: A tissue of mesodermal origin which is rich in intercellular substance or interlacing processes with little tendency for the cells to meet in sheets or masses, especially the connective tissue of stellate or spindle-shaped cells with interlacing processes that pervades, supports, and binds together other tissues and forms ligaments and tendons.

Blood vessels: Any of vessels through blood circulates in the body.

Ribs: The paired curved bony or partly cartilaginous rods that strengthen the lateral walls of the body and protect the viscera which occur in mammals or almost exclusively in the thoracic region, and that in humans normally include 12 pairs of which all are articulated with the spinal column at the dorsal end and the first 10 are connected also at the ventral end with the sternum.

Subcutaneous fat: fat cells living, used, or made under skin.

Infra-mammary crease: The fold or crease under the breast where breast lobe meets torso.

Breast fat:  Fatty tissue above the glandular of breast.

Ducts: A bodily tube or vessel for carrying the secretion of a gland, especially breast milk.

Glandular tissue: Of involving glands, gland cells, or their products such as breast milk production

Nipples: The protuberance of a mammary gland. In female, the lactiferous ducts open while the milk is drawn.

Lobules: The glandular of the breast where milk is formed.

Breast envelope: The skin surrounds the structure of breasts.




Asymmetrical Breasts

There is a third situation that often occurs in puberty: the breasts grow unevenly. In some cases this is simply a question of the rate of the breasts’ growth, and in a year or two the breasts are fairly symmetrical for example, one breasts will be an A cup size, while the other is a B cup size. (Keep in mind that most people’s breasts are slightly uneven, as are their feet and hands.) But sometimes the breasts remain extremely asymmetrical. Again, asymmetrical breasts are perfectly “normal” form a medical viewpoint: they can both produce milk. But they can create extreme psychological distress, causing the adolescent girl and the grown women to feel like sexual freak. Some girls refuse to date in their teens because they fear their condition will be discovered and ridiculed. A falsie or a pile of several falsies can be worn on one side, of course, but that can still leave a feeling of something ugly and somehow shameful that must be hidden from the world.

For a woman who is bothered by extreme asymmetry, cosmetic surgery can help achieve a reasonable match. Either the larger breast can be reduce or smaller one augmented or combination of both can be done. It’s important for the surgeon to discuss these options often we assume a women will want her small breast made larger and neglect to suggest the possibility of reducing the larger breast. What a woman decides will depend on the size of both breasts, the degree of asymmetry, and, above all, her own aesthetic judgment.

It’s fortunate that plastic surgery techniques exist for women who want them. But don’t assume that because you have atypical-looking breast you have to get them altered. Many women are quite pleased with how their breasts look. Some women with large breasts feel that their breasts are “feminine and sexy.” Small breasts, too, have their advantages. Some women like their small breasts because “they’re unobtrusive, and they work well during nursing. Occasionally some male person will intimate that they’re less than optimal. That’s his problem, not mine.” Another likes her tiny breasts because they don’t get her way when she engages in spots. A woman with very asymmetrical breasts says she used to feel self-conscious about them, but has “come to terms with them” since she nursed her child.

There is a woman telling a wonderful story about a friend of hers who had inverted nipples’ “When I was 12 and my cousin was 14, we stood before the bathroom mirror and compared breasts. I notice how different her nipples were; they didn’t protrude, the way mine did. We had this big discussion about whose were ‘normal.’ I was convinced mine were, but she insisted hers were and since she was older and I thought, more knowledgeable, I decide she must be right. After she graduated From College and was studying in Paris, she became ill and had to be hospitalized. The doctor who was examining her asked if her nipples ‘had always been like that.’ That’s how she learned that she had inverted nipples and that mine were the normal ones!”

Obviously, the women inverted the nipples hadn’t caused her any distress. If you don’t object to the way your breasts look, don’t think about plastic surgery. You’re fine as you are.




Breast Compositions

The breast is glandular, fatty, and fibrous tissues over the pectoral muscles of the chest wall and connected by fibrous strands called Cooper’s ligaments. A layer of fatty tissue encloses breast glands as well as spreads over the breast. The fatty tissue offers the breast soft consistency.

The glandular tissues of the breast are like a house for lobules and ducts (milk passages). At the nipple, each duct extends to form a sac. While performing the lactation, the bulbs on the ends of lobules create milk. When milk is produced, it will be transferred through the ducts and the nipple later on.

The breast compounds of:

  • Milk glands (lobules) that produce milk.
  • Ducts that transport milk from the milk glands (lobules) to the nipple.
  • Nipple
  • Connective tissue that surrounds lobules and ducts.
  • Fat



Breast Sensitivity

Breasts are usually very sensitive as you’ll notice if you get hit in the breasts. It’s very painful, but if you’ve been told being injured in the breast leads to cancer, ignore it. All a bruised breast causes is temporary pain. Similarly, scar tissue that results from an injury to the breast won’t cause cancer. The supposed fragility of women’s breasts has been used as an excuse to keep girls from playing contract sports. Interestingly, however, the extreme sensitivity of testicles is rarely used to keep men form such sports. You own pain threshold, plus your enthusiasm for the particular game, should determine whether or not you want to avoid risking pain by playing. A bruised breast will hurt, but so will a bruised shin.

The sensitivity of the breast changes within the menstrual cycle. During the first two weeks of the cycle it’s less sensitive; it’s very sensitive around ovulation and after, and it’s less sensitive again during menstruation. There are also changes during the larger development process. There’s little sensitivity before puberty, much sensitive after pube11rty, and extreme sensitivity during pregnancy and perimenopause. After menopause, the sensitivity decreases slightly, but never fully vanishes. As in most aspects of the normal breast, sensitivity varies greatly among women. There’s no “right” or “healthy” degree of responsiveness.

Breasts are also very greatly in their sensitivity to sexual stimuli. Physiologic changes in the breasts are an integral part of female sexual response. In the excitement phase the nipples harden and become more erect, the breasts plump up, and the areola swells. In the plateau just before orgasm breasts, nipples, and areola get larger still, peaking with the orgasm and then gradually subsiding. For most women’ Breast stimulation contributes to sexual pleasure. Many enjoy having their breast stroked or sucked by their lovers, but have been told that this can lead to cancer. It can’t. Breasts, after all, are made to be suckled and your body won’t punish you because it’s a lover rather than a baby doing it. Some women’s breasts are so erogenous that breast stimulation alone can bring them to orgasm; others find breast stimulation alone can bring them to orgasm; others find breasts stimulation uninteresting or even unpleasant. Neither extreme is more “normal”: as we know, different people have different sexual needs and respond to different sexual stimuli. Couples may wonder whether their lack of sexual excitement around their breasts means something is wrong with them or not. It’s doesn’t. There is an unfortunate tradition in our culture to label as “frigid” women whose sexual needs don’t correspond to those of their (usually) male partners. Ironically, the converse of this still persist in our supposedly liberated era: a women who is easily sexually stimulated is seen as a “tramp.” All such stereotypes are unfortunate and destructive. If your breasts contribute to your sexual pleasure, enjoy it. If not, enjoy what you do like, and don’t worry about it.




Cup Size and Appearance Changes

Women breast size and shape varies considerably. Some women have large amount of breast tissues, so they have large breasts. Other women who have smaller amount of the tissues gain smaller breast size.

Factors of woman’s breast size:

  • Amount of breast tissue
  • Family history
  • Age
  • Weight
  • Pregnancies and lactation
  • Thickness and elasticity of breasts
  • Hormonal influences on breasts
  • Menopausal conditions

Normally, breasts are rarely balanced or symmetrical. One breast might be larger or smaller, higher or lower, or shaped differently than the other. The size of the nipples is also different in each woman. Some women’s nipples are constantly erect, while others’ only become erect when stimulated by cold or touch. Also, some women might also have inverted nipples. This is not a a serious condition unless it is a new change. Hair follicles around nipples are actually common as long as it is not occur on the breast.

Nipples can be flat, round, or cylindrical in shape. Its color is determined by the thinness and pigmentation of the skin. Nipple and areola contain particular muscle fibers that stimulate the nipple to erect. The areola also contains Montgomery’s gland that may occur as tiny, raised bumps. The Montgomery’s gland provides lubricate for the areola. Whenever nipples are stimulated, the fibers will contract areola so the nipples become hard.

Breast appearance undergoes various changes as a woman gets older. For young women, breast skin expands as the breasts grow, which promotes a rounded breast appearance. However, they tend to have denser breasts more than older women.

At menstrual period, breast tissues swell from changes due to levels of estrogen and progesterone. The milk glands and ducts enhance and the breasts retain water. During this time, women might feel swollen, painful, tender, or lumpy on their breasts.




Cancer of both breasts

Once in a great while a woman will be diagnosed as having a cancer in each breast at the same time. Typically, this will be discovered when finding a lump in one breast, she gets a mammogram to find out what’s going on there, and learns there’s also a lump in the other breast. A biopsy shows them both to be cancer.

They’re probably both primary cancers; one isn’t a metastasis of the other. So they’re both treated the same way: we do a lumpectomy, or mastectomy and lymph node dissection on one and then the other side. Usually the surgeon will first dissect the lymph nodes on the side that appears worst, so that, if the nodes are positive and will require chemotherapy, the other nodes won’t necessarily have to be dissected if the second cancer has a low likelihood of spreading to the nodes. Unfortunately, the surgeon’s guess isn’t always right. There was a woman who had three cancers: she had a lump in the top of her right breast, and the mammogram showed to densities in the bottom of the left breast. They’d all been biopsied with needles. She really wanted to keep her breasts, so a surgeon did a wide excision of the right breast and sampled the lymph nodes, and they were fine. Then he did a wide excision of two cancers in the left breast, and on the left side she had positive lymph nodes. You can have radiation treatment on both breasts at the same time but the radiation therapist has to be very careful that the treatment doesn’t overlap and cause a burn in the middle area.

It’s isn’t necessary to do the same treatment on both breasts. You might decide on a mastectomy on one side and wide excision plus radiation o the other, for example. It is important to note that your prognosis is only as bad as the worst of the two tumors, not doubly as bad as either one.


Development of the Breast

Human breast tissues start to develop at sixth week of fetal life. Breast tissues initially improve along the lines of the armpits and stretches to the groin. At the ninth week, it returns back to chest area, leaving two breast buds on upper half of chest. For women, a large amount of cells grow inward from each breast bud. They become separated sweat glands with ducts leading to nipples. Both male and female infants actually have small breasts and face some nipple discharge during the first few days.

Women breasts do not develop until the puberty which is the period in life when body undergoes a various changes to prepare for reproduction. Puberty usually starts when women age around 10 or 11. As the pubic hairs grow, breasts begin to respond the hormonal changes. The production of two hormones including estrogen and progesterone signals improvement of glandular breast tissues. At this period, fat and fibrous breast tissue becomes more elastic. Breast ducts start to grow and will grow until menstruation begins. Menstruation supports breasts and ovaries for potential pregnancy.

Before puberty

Early puberty

Late puberty

The breast is flat except for nipples that stick out from the chest

Areolas become prominent buds; breasts begin to fill out

Glandular tissues and fats increase in breasts, and areolas become flat


Women Breast Developmental Stages

Stage 1

The tip of the nipple is raised.

Stage 2

Buds appear, breasts and nipples raise, and areolas enlarge.

Stage 3

Breasts are slightly bigger with glandular breast tissue present.

Stage 4

Areolas and nipples raise as well as the rest of breasts

Stage 5

Mature breasts; breasts become rounded and only nipples are raised.


Five Stages of Breast Development


Breasts during childhood. Breasts are flat and show no signs of development.


Breast bud stage. Milk ducts and fat tissue form a tiny mound.


Breast continues to grow. Breast becomes rounder and fuller.


Nipple and areola form separated small mounds. But not every girl goes through this stage. Some girls skip stage 4 and go directly to stage 5.


Breast growth reaches finial stage.
Adult breasts are completely full and round shaped.





The nipple is an especially sensitive area and subject to a number of problems, such as the subareolar abscess discussed earlier. The most common nipple problem or rather concern, since it’s not always a problem is discharge. Most women do have some amount of discharge or fluid when their breasts are squeezed, and it’s perfectly normal. In a study at Boston’s Lying-in hospital breast clinic women had little suction cups, like breast pumps, put on their nipples and gentle suction applied. Eighty three percent of these women (young, mothers, non-mothers previously pregnant, never pregnant) had some amount of fluid. This fluid can be analyzed for precancerous cells.

The ducts of the nipple are pipelines; they’re made to carry milk to the nipple, so a little fluid in the pipes shouldn’t be surprising. (It can come in a number of colors like gray, green, and brown, as well as white.)

Sometimes people confuse nipple discharge with other problems like weepy sores, infections and abscesses. Inverted nipples can sometimes get dirt and dried-up sweat trapped in them, and this can be confused with discharge.

Some women are more prone to lots of discharge than others: women on birth control pills, antihypertensive such as Aldomet, or major tranquilizer such as thorazine tend to notice more discharge, because these medications increase prolactin levels. It may seem aesthetically displeasing, but beyond that there’s nothing to worry about.

There are also different lift periods when you’re more likely to get discharge than others: there’s more discharge at puberty and at menopause than in the years between. And there’s the “witch’s milk” that newborn babies get. This makes sense, since the discharge is a result of hormonal processes.

When should you worry?
The time to worry about nipple discharge is when it’s spontaneous, persistent, and unilateral (only on one side). It comes out by itself without squeezing; it keeps on happening; and it’s only from one nipple and usually one duct. It’s either clear and sticky, like an egg white, or bloody. You should go to the doctor right away. There are several possible causes:

  1. Intraductal papilloma: This is a little wart-like growth on the lining of the duct. It gets eroded and bleeds, creating a bloody discharge. It’d benign; the surgeon removes it to make sure that’s what it is.
  2. Intraductal papillomatosis: Instead of one wart, you’ve got a lot of little warts.
  3. Intraductal carcinoma in situ: This is a precancer that clogs up the duct like rust.
  4. Cancer: Cancers are rarely the cause of discharge. Only about 4 percent of all spontaneous unilateral bloody discharges are cancerous.

You clinician should first test for blood by taking a sample, putting it on a card, and adding a chemical (hemacult test). If it turns blue, there’s blood (which may not be visible to the eye alone, because of the color of the discharge itself). The doctor may do a Pap smear, very like the Pap smear you get to test for cervical cancer. Discharge is put on a glass slide and sent to the lab for the cells to be examined. This is not as accurate as testing for blood in the discharge, but occasionally it can demonstrate the presence of abnormal cells.

Next the doctor will try and figure out the “trigger zone” by going around the breast to find out which duct the discharge is coming from, though often the woman herself can give the doctor this information. If you’re over 30 you'll be sent for a mammogram to see if there’s a tumor underneath the duct.

You can then have your duct lavaged. If the cells are abnormal you can then be given a ductogram. The radiologist takes a very fine plastic catheter and, with a magnifying glass, threads it into the duct, squirts dye into it, and takes a picture. The procedure sounds uncomfortable, but it really isn’t that bad—the duct is an open tube already, and the discharge has dilated it. The ductogram provides a “map” for the surgeon who may do a biopsy and may also show the source of the discharge. Not every surgeon will order a ductogram or lavage, they are extremely worthwhile.

A biopsy itself is fairly simple; it’s a specialized form of the regular breast biopsy. It can be done under local anesthetic, and on an outpatient basis. A tiny incision is made at the edge of the areola; the areola is flipped up, and the blood-filled duct located and removed. Sometimes the radiologist will cut a fine suture and pass it into the duct to the point to be removed, or blue dye can be injected into the duct to help identify it. Both of these techniques will help to pinpoint the right area. Sometimes if the ductogram has shown the lesion to be far from the nipple, the surgeon will localize the area with a wire. That’s way the duct won’t get blocked, which interferes with breast feeding, or numbed, which interferes with sexual pleasure.

Because the lesion can be far from the nipple itself, the old standard surgical practice of removing all of the ductal system to make sure that the discharge has stopped and largely been abandoned. Though this procedure stops the discharge (by disconnecting the ducts from the nipple), it may or may not remove the pathology causing the discharge.
Some centers are using duct endoscopy to figure out what’s causing the discharge. An endoscope is a thin tube put directly into the nipple duct, by which the surgeon can view the inside of the ducts on a video screen. They have reported success in seeing Intraductal papillomas and other pathology.

Another form of problematic discharge is one that is spontaneous, bilateral (on both sides), and milky. If you’re not breast-feeding, and haven’t been in the past year, this is probably a condition called galactorrhea which is excessive or spontaneous milk flow. It occurs because something is increasing the prolactin levels, sometimes a small tumor in the brain. This may not be as alarming as it sounds: often it’s a tiny tumor which may not require surgery. A neurosurgeon and an endocrinologist together need to check this out. You may be given bromocriptine to block the prolactin. Galactorrhea is often associated with amenorrhea; failure to get your period. It can also be caused by major tranquilizers, marijuana consumption, or high estrogen doses.

Galactorrhea is diagnosed only when the discharge is bilateral. Many doctors don’t understand this, and send patients with any discharge for prolactin level tests. They shouldn’t; the unilateral discharges are not associated with hormonal problems. Unilateral spontaneous discharge is anatomical, not hormonal, and the money spent on prolactin tests is wasted.

Other Nipple Problems
There are a few other problems women can have with their nipples. Some women complain of itchy nipples. Usually, this doesn’t indicate anything dangerous, especially if both nipples itch.




Effects on Breasts

Even though breasts of non-pregnant women are considered inactive, they undergo cyclic changes associated with normal ovulation. Some women face premenstrual enhance in breast size and density. Many women also feel the tenderness on breasts. This is probably because of the tissue edema. For older women who have fibrotic lumps might feel painful along the perimeter of breast mass. The changing levels of estrogens and progesterone during the menstrual cycle can also cause density changes.

Other factors like hormone therapies such as birth contraceptives can also affect on the breast density. Estrogens and progestins supplements simulate premenstrual breast changes and make breasts tender. At the menopause period, there many changes occur with gonadotropins, estrogens and progesterone levels as well as in both glandular and ductal components. Without the therapy, a large amount of the glandular elements reduces and volume of the breast begins to be smaller. Also, there is a loss of contour in structure because of the decreasing.

When women get pregnant, various changes occur with breasts including gradual increases in weight and size as it produces milk. Breastfeeding also continually changes the density, and nipples are extremely vulnerable to chaffing by fabric rubbing. So, pregnant and lactating women should wear appropriate bras while attending physical activities.

Lack of internal anatomical support of breast structures needs some external supports. Too much movement of breasts during exercise might also raise this need for some women due to structural changes during pregnancy and menstruation.




Early Development

Human breast tissue begins to develop remarkably early—in the sixth week of fetal life. It develops across a line known as the milk ridge, which runs from the armpit all the way down to the groin. In most cases, the milk ridge soon regresses, and by the ninth week it’s just in the chest area. (Other mammals retain the milk ridge, which is why they have multiple nipples.) So you already have breast tissue at birth, and it’s sensitive to hormones even then (your mother’s sex hormones have been circulating through her placenta). Infants may even have nipple discharge. This “witch’s milk,” as it’s called, goes away in a couple of weeks, because the infant is no longer getting the mother’s hormones. Between 80 and 90 percent of all infants of both genders, have this discharge on the second or third day after birth.

Dr. Nicholas Petrakis, a researcher in San Francisco, has been studying infants’ breast tissue. He is looking at the possibility that it’s a sign of how much estrogen the fetus is exposed to in utero. With a group of women in mainland China and a group in San Francisco, he is comparing the amount of breast tissue in babies in the neonatal nurseries, to see if the exposure that leads to cancer actually begins in the mother’s uterus. There is a very low incidence of breast cancer in mainland China, a very high incidence among white women in San Francisco, and a moderate incidence among Chinese women who have migrated to San Francisco. If indeed it proves that the babies of the women in China have less breast tissue, it could be an early tip-off about those infants who might be at higher risk as they grow older.

If your baby has a lot of breast tissue, however, don’t panic. Dr.Petrakis himself isn’t even sure his theory is correct: it’s simply an area worth studying. Even if he finds a big difference in the amount of breast tissue that has witch’s milk, it wouldn’t prove a correlation with cancer. It would simply mean this warrants further study. In any case, many other factors are involved.




Facts of Breasts

  • Breasts start growing at age 10 and never stop until your early 20’s.
  • Breasts are overly sexualized in Western culture which make them bigger than a part of a girls physical identity.
  • A biological purpose of breasts is for feeding babies.
  • Having a baby changes breast appearance forever, and many women get bigger breasts after pregnancy.
  • During puberty, breasts can grow rapidly causing discomfort, sensitivity and stretch mark.
  • Bigger breasts do not make a girl more feminine or sexier.
  • Very huge breasts cause back pain and bad posture.
  • Bra are necessary to keep your breasts supported and help stop injury to the breast tissue.
  • Breast cancer is rare in teenagers, but it is important to check your breasts for lumps and irregularities regularly, especially when you have a family history of breast cancer.
  • All breasts are beautiful and amazing to the opposite sex.


Facts of Very Large Breasts

Very large breasts can occur early in puberty, a condition known as “virginal hypertrophy.” After the breasts begin to grow, the shut-off mechanism, whatever it is, forgets to do its job and the breasts keep on growing. The breasts become huge and greatly out of proportion to the rest of the body. Sometimes the condition runs in families. In very rare instances, virginal hypertrophy occurs in one breast and not the other. It’s worth noting here that "large" is both a subjective and a variable term. A five-foot tall woman with a C cup is very large-breasted; a five foot-eight woman with a C cup may not feel especially uncomfortable with her size. A five foot-eight woman with a DD cup is likely to be very uncomfortable.

Large breasts have been a problem for a number of many women. One woman revealed that because people keep staring at her breasts. Another, at 71, still "hunches over” when she walks to avoid having her breasts stared at.

Huge breasts can be very distressful to a teenage girl. She faces ridicule from her schoolmates, and—unlike the small-breasted girl—extreme physical discomfort as well. She may be unable to participate in sports, and she may have severe backache all the time. She usually needs a bra to hold the breasts in, but the bra, pulled down by the weight of the breasts, can dig painful ridges into her shoulders. 
If the breasts cause this much discomfort, the girl might want to have reduction surgery done while she’s still in her teens. There are a number of procedures. Though they’re all major surgery, because they're done on the body’s surface they’re less dangerous than other equally complex operations, and the recovery period is speedier. 
The procedures vary according to the size of the girl's breasts. If they’re really huge, the nipple will have to be moved further up on the newly reduced breast. In this case, the ducts may be cut and so breast feeding will be compromised.

For this reason, some mothers refuse to let their daughters have reduction surgery, urging them to wait until they’ve had their children. This concern must be weighed against the physical and emotional damage the girl will go through first. If she decides to have children, pregnancy itself may worsen her problem. When the breasts become engorged with milk, they become even larger, and thus, in a woman with huge breasts, more uncomfortable. Though it’s unfortunate that someone so young is faced with a decision that affects her whole life, it’s important to realize that not having the surgery will also affect her life. Many girls of 15 or 16 are mature enough to make their own decisions if all the facts are carefully explained to them, including the possibility of bottle feeding. In any case, the losses and gains of either choice are the girl’s, and she should be given the right to decide for herself what to do. She should be encouraged to talk to doctors, mothers of young children, and very large-breasted women; to read all the material she can find about the pros and cons of the procedure and of breast feeding; and to make her decision only when she feels she is fully informed.

Not all problems with huge breasts appear right after puberty. Some comfortably large-breasted women find that their breasts have expanded considerably after pregnancy; others become uncomfortable after their breast size has increased with an overall weight gain. Many surgeons are reluctant to operate in this latter case, preferring to wait till the woman has lost weight. Sometimes, however, this can backfire psychologically: There were women who were so depressed by their huge breasts that they compensated by overeating, thus intensifying both problems. In such cases, the pleasing appearance of their breasts created by reduction surgery can be a spur to continue self-improvement.

In any case, the decision must be made by the individual woman; she’s the one who lives with the problem and she’s the one who can best judge its impact on her life. Some women with very large breasts don’t mind them. One woman, who admits they cause her discomfort, says that she nonetheless enjoys their size. "They feel feminine and sexy,” she says.




Genetic Risk Factors

Hereditary breast cancer first made its appearance in medical history in 1757. A French surgeon named LeGrand told of a nun with breast cancer who was treated by a surgeon in Avignon. The surgeon wanted to perform a mastectomy, but the nun, "fearing extirpation more than death,” refused the operation. She was convinced, furthermore, that itwould do no good, as her grandmother and maternal great grand uncle had died of the disease, and thus, she said, "her blood was corrupted by a cancerous vermin natural to her family.” As the pain of her disease worsened, she gave in, had the mastectomy, and was restored to "perfect health.” It would be nice to know how soon after the nun’s surgery LeGrand wrote this, and how long her "perfect health" lasted. 
Some things never change: the nun, just like many women today, tended to exaggerate her risk of breast cancer. While it’s true that breast cancer in the family increases a woman’s chance of getting breast cancer, the additional risk for most women may not be that great.

Genetically, we divide breast cancer occurrences into three groupings. The first, and most common, is sporadic that’s the 70 percent of women with breast cancer who have no known family history of the disease. The second is genetic, there’s one dominant cancer gene, and it’s passed on to every generation. Most people assume that these are the only two kinds of breast cancer: the kind that is inherited and the kind that isn’t. In fact, there is a third group that is much more common than the genetic group. It’s what we call "polygenic," and it occurs when there is a family history of breast cancer that isn’t directly passed on through each generation in one dominant gene some members of the family will get it and others won’t. Women in this category are at greater risk for cancer than the general public, though less so than women with hereditary cancer.

Dr. Henry Lynch of Creighton Medical School’s oncology clinic did a study estimating the percentages of these genetic groupings of breast cancer within a particular population. He looked at 225 patients with breast cancer, and found that 82 percent had sporadic breast cancer (or no family history), while 13 percent had polygenic and only 5 percent had true genetic breast cancer. Other studies have put polygenic cancers at about 20 percent of breast cancers.

Most estimates are that pure hereditary breast cancer is rare, but it does occur between 5 and 10 percent of all breast cancers fall into this category. In this case, the mother (or father) has a breast cancer gene, and there’s a 50-50 chance it will be passed on to the daughters. If a daughter, or son, has inherited the gene, that gene again has a 50—50 chance of passing on to the next generation. There was one family with a dramatic instance of genetic cancer. The grandmother had it, and the mother had it. The mother was fine after the surgery, but two of her five daughters died of breast cancer, and two others have had the disease. (This is a very different situation from the more common one, when the family members with breast cancer are aunts or cousins rather than mother and sisters, and the risk is not so high.)

There was no test to pick out which women were at risk, and so doctors developed an elaborate system of guesswork based on what knowledge existed. It was sort of like searching for a criminal before the discovery of fingerprints or DNA, but with a fairly good description. If the suspect was a tall blond man with glasses, many tall blond bespectacled men might get rounded up, but only one would be the criminal.

So it was with determining cancer risk. If a woman’s mother or sister had had bilateral breast cancer, or had gotten breast cancer at an early age, or if the woman had more than two relatives with breast cancer, she was at risk. But, as we were to learn later, such a woman, though she had the risk factors, didn’t necessarily have the one element that actually made her at genetic risk—the BRCA 1 or 2 gene. Now that we have a way to test for the genes, the old rules are much less relevant.

Some women have a family history of breast cancer without having an inherited gene. About 20 percent of breast cancers fall into this category. This doesn’t mean the cancer is pure coincidence. These people may have inherited something that makes them more prone to breast cancer. What could make you more prone to breast cancer? Well, you may inherit a gene that causes you to begin menstruating at an early age, or a gene that makes you particularly susceptible to estrogen which means other family members will be likely to get breast cancer.

Another possibility is exposure to similar external risk factors. There was one who is one of five sisters who got breast cancer. The sisters were all tested for BRCA1 and 2, and were shocked to discover they didn’t have it. When all the cancer is in one generation, it’s possible that they were all exposed to an environmental factor that caused the cancer. When this is the case, the gene won’t be passed on to their children: it’s not hereditary.




Hormones and Breast Changes

Breasts are responsive for the complex interplay of hormones that cause breast tissues to improve, enhance and provide milk. Three main hormones that can affect on breasts breast are estrogen, progesterone and prolactin, which make the glandular tissue to change during a woman’s menstrual cycle. Due to the hormonal level reduction, breasts are less full for 1 to 2 weeks after the menstrual flow. It might be easier to search for the breast lumps at this time. Hormonal level reduction is also responsible for returning the breast shape after the breastfeeding.

Breast appearance changes when women age. For young woman, the breast skin stretches by the developing breasts. Adult breasts are usually rounded and equally full in all areas. As a woman gets older, the peak of breast tissue settles to lower position. The skin stretches and then, the breast shape changes. After the menopause, the composition of the breast changes due to the decreasing of hormones and the amount of glandular tissues.  Fat and ductal tissues become predominant components of the breast. Also, glandular volume reduction can affect on further looseness of breasts.




Hormonal Risk Factors

Aside from genetic risk factors, the other most obvious group of risk factors is hormonal. We know that hormones play a large part in breast cancer because it’s a form of cancer common in women and rare in men, and women’s breasts undergo a complex hormonal evolution that men’s don't. We don't yet understand what the hormonal risk factors are, but we have some interesting clues. We know that it has something to do with age and menstrual cycle: the younger a woman is at her first period, and the older she is when she goes into menopause, the more likely she is to get breast cancer, It seems that the longer a woman has reproductive levels of hormones, the more prone she is to breast cancer. If she menstruates for more than 40 years, she seems to have a particularly high risk. If your ovaries are removed early, and no hormone replacement is given, your risk of breast cancer is greatly reduced. It’s not exactly a cure-all, however, since it would also greatly increase your danger of osteoporosis. If you’ve had a hysterectomy, it may or may not influence your vulnerability to breast cancer, depending upon whether your ovaries, as well as your uterus, are removed. If you still have ovaries, your body is still going through hormonal cycles, even though you have no periods.

Pregnancy also appears to affect breast cancer risk. Women who have never been pregnant seem to be more at risk than women who have had a child before 30. And women who have their first pregnancies after 30 have a greater risk than women who have never been pregnant at all. The hormones of a pregnancy carried to term will mature the breast tissue in a young woman. The same hormones after 30 may actually stimulate breast tissue that has already been mutated. Some studies indicate that a pregnancy that ends in a miscarriage or abortion slightly increases your risk, while other studies have not been able to confirm this.

The key seems to be the amount of time between the first period and the first pregnancy. There are a lot of theories about why this is so. One possible explanation is that between menarche and the first pregnancy the breast tissue is especially sensitive to carcinogens. This seems to be true such factors as diet, alcohol consumption, and radiation exposure all seem to have a greater effect on a woman’s breasts between her first period and her first pregnancy than they do later. So it may indeed be that the "developing breast” is more susceptible to carcinogens than the breast that has gone through its complete hormonal development. This increased sensitivity may relate to the breast cells’ capability of mutating up until the first pregnancy. There may be something about the first pregnancy of a young woman that stops the cells from being able to sustain a mutation; thus, the more time cells have to sustain a mutation, the greater the chance that they’ll mutate in response to a carcinogen and in a way that develops into cancer.

Dr. Malcolm Pike thinks the total number of ovulatory cycles a woman has gone through is a factor in her vulnerability to breast cancer, since it’s the length of time between menarche and menopause that seems to count. In fact, a Swedish study found that the total number of regular menstrual cycles prior to the first full pregnancy was a better predictor of risk than age at first period or age at first pregnancy. This may be because early menarche is associated with rapid onset of ovulatory menstrual cycles. Within two years of early menarche (ages 8—11) all cycles become ovulatory; however, late menarche is associated with delayed onset of regular ovulatory cycles that is, for young women who are 13 or older at menarche, no more than 50 percent of their cycles are ovulatory four years after their first period. Estrogen doesn’t always become elevated if ovulation does not occur. Also, it is usually accompanied by a shortened luteal phase, which means less cumulative exposure to high levels of hormones. This has been shown by Leslie Bernstein at the University of Southern California. She suggests that this is another explanation for the difference in breast cancer rates in white and Japanese women in the United States. Asian women have a later age at menarche and menstrual cycles that are on average two days longer than those of white women in the US. (30 vs. 28 days). This increase in days is almost completely in the follicular phase, where estrogen levels are lower.

Another factor relating to the number of menstrual cycles is breast feeding. Recent studies have shown that women who breast-feed for a long period of time (more than six consecutive years) have a decreased risk of breast cancer. In addition, women who have had early pregnancies and have breast-fed have a decreased risk of subsequent breast cancer. This is probably related to fewer ovulatory cycles at a crucial time in reproductive life.

As you see, we’re still very much in the theorizing stage: as yet, we don’t know why there is this vulnerable time in a woman’s life and why or how internal hormones affect breast cancer. Theories are interesting, but more useful to scientists than to individual women, who can’t control heredity, ethnicity, or menarche.