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with Jane Harrison-Hohner, RN, RNP and Laura Corio, MD

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Thursday, June 4, 2009

All About Breasts

My Breasts Don’t Look Normal. Is Something Wrong?

Given the breast centered focus of western civilization it’s no surprise that many women are critical of the size and shape of their breasts. But what if something is truly abnormal about a young woman’s breasts – would she know it? The purpose of this post is to try and address what is within the range of normal for breast appearance – and what may not be.

Age Matters
What is too early for the beginnings of breast development? Many mothers would be surprised to hear that breast development is not considered premature if it appears in African American girls by age of seven, or in other girls by age eight! Mothers then worry about the development of premature/precocious puberty (full breast development, menstrual periods, etc). Fortunately 80% of early-developing girls will not come fully into puberty. In fact, breast development may halt, only to reappear at the more usual time.

So what is the usual time to be “developed”? Lack of any breast development by age thirteen merits some monitoring. The small, firm breast buds usually appear about age eleven. By age thirteen a majority of girls have the beginnings of a mound-shape of breast tissue. Unless there is an overt reason for lack of development such as illness, radiation exposure, or hormonal problems there is evidence that breast development can continue until one’s early 20′s.

Size Might Matter
While most all of us have at least some difference in size between our two breasts, there are situations where the size difference is very apparent. Size differences which onset in teen years will likely equalize for about 75% of women.

Very large breasts can develop in teen women. This can occur on just one side or be bilateral. In this instance normalization of size is unlikely to happen. While a tumor can prompt a very large breast, most enlargement is related to a robust tissue response to normal hormonal influences. According to DeSilva (2006) there is no increased risk for breast cancer among young women with an extremely enlarged breast. Cosmetic surgery, if indicated, can be done. Reduction of a very large breast(s) is called reduction mammoplasty. Unlike breast augmentation (i.e. breast implants) there is usually more apparent scarring.

Conversely, there can be insufficient breast development on one or both breasts. One type that seems to cause particular distress creates a tall tube shaped breast. There is tissue growth under the nipple, but no rounded breast mound. Again, plastic surgery is the usual treatment.

Extra Nipples?
Having extra nipples has been reported in 1-2% of women. The line along which extra nipples are usually found extends from the armpit to the groin. Extra nipples do not usually have associated breast tissue so they may go unnoticed. A woman may think that the “accessory nipple” is a mole or other skin lesion. These do not have to be surgically removed unless, like a mole, they become inflamed by restrictive underwear or clothes.

Hormonal Medications
It has been noted that women using birth control pills may experience bilateral breast enlargement. This has been attributed to the hormone estrogen. A similar effect can occur in older women using post-menopausal hormonal therapy. Usually this is not a lasting effect, and size goes back down when the medication is stopped.

Previously, medications which block estrogen effects were tried as a treatment for too early or excessive breast development (Bloom 2008). This is not a standard treatment, however.

Breast Enlargement Options?
There are breast enlarging creams and herbal products advertised on the internet. As new products are touted, our Women’s Health Board gets a spate of questions about the effectiveness of such products. The array of products includes pills, creams, devices, and even a chewing gum! I would concur with the review article written by Dr. A. Fugh-Berman (2003) published in the journal Obstetrics/Gynecology. She investigated many of the herbal ingredients touted to increase breast size. A few ingredients have the possibility of producing weak estrogen-like hormones. Yet most have no data to support their use for breast enlargement. Perhaps most concerning is there are no long term safety studies. In the real world, women may not use such products for very long when the promised 3-5 cup size increase does not appear.

Honestly, the most reliable way to get a larger breast size (short of weight gain or pregnancy) is breast augmentation done by surgically inserting a saline or silicone implant. The American Society of Plastic Surgeons reports an increase for cosmetic surgery from 14,000 in 1996 to 333,000 in 2005 for patients under age eighteen. At least 90% of those were females. Breast augmentation is one of the two most frequent plastic surgery procedures performed on teens (Zuckerman, 2008).

Since most health insurance will not cover breast augmentation, the costs have to be borne by the young woman, or her family. While the decision to do augmentation is a very personal decision it is worth understanding some of the risks. The FDA has not approved the use of saline implants in women under age 18, nor the use of silicone implants in women age 21 and younger. Surgeons can still do the procedure, but the benefits have not been demonstrated to out weigh the risks to the satisfaction of the FDA. Currently breast implants have a limited life expectancy. According to Zuckerman breast implants typically last about 10 years, and there is an increased of scar tissue formation the longer the implant is in place.

Interestingly, a study of women planning to get breast implants because of dissatisfaction with being too small, found that there was no difference in bra sizes compared to a group of women who were satisfied with their breast sizes (Didie, 2003).

Jane’s Economy Breast Lift
Thus far we have moved from discussing medically focused breast issues through more self-concept, or cosmetic, concerns. Most women can think of a change in breast size, or firmness which they would prefer if the Fairy Godmother of Breast Structure was to grant them a wish. Would you be willing to develop a firmer breast profile without drugs, surgery, or any cost? OK, I was skeptical, too. But here it is-free to my readers:

If you do a few simple exercises, especially if combined with a balanced body work out, you will get better contours. As a bonus, saggy underarms (triceps flop) can improve. It will not increase or decrease your cup size by three to five sizes, but it will make what you have look better. And after all, isn’t enhancing what we have been given what it’s all about?

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Posted by: Jane Harrison-Hohner, RN, RNP at 4:35 pm

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