You and your breasts

Prof Carol-Ann Benn takes you on a magic carpet ride to show you the world and open your eyes to a new fantastic point of view and unbelievable sight for you and your breasts.


Breasts are beautiful. We all have them (boys and girls). They provide fascination; fear; food and form (for some too much and others not enough).

Like those tacky tropical-island-T-shirts that show different breasts shapes resembling different fruits, breasts come in different sizes and shapes. 

It’s important to understand that only in Photoshop (Hollywood style or magazines) are both breasts perfectly symmetrical without ptosis (droop) and stretchmarks.

Let’s talk size

What generates our breast size and shape is a combination of genetics; and adipose (fat) as well as how we look after our girls. 

Just like with Goldilocks and The Three Bears, sometimes breasts could be too big, or too small (not exactly what you may want) or just right. The important thing to remember is that all options are okay. No matter what you think, your breasts are probably just right for you exactly the way they are. FYI – you can’t diet your breasts smaller or exercise them bigger. 

How do we dress them?

Current societal norms dictate that we do dress them. Brassieres, bras or breast coverage has a two-fold purpose: cover and support. Understand that underwire bras don’t impede lymph drainage and prevent toxins from existing or increase cancer risk. There is no one bra type for all. Like the T-shirt, dressing melons is different from dressing lemons. What is a standard is our ability to determine the size around our chest? 32;34;38. 

It’s slightly harder to work out if we are an A or D cup, and not all cups should be the same. The distance between our breast varies, as does the shape. So, look at the cup and hold it over your breast and see if it’s a good fit. Take time trying on many to see what gives your girls the best support and coverage.

Breast facts

We are all born with breasts. In other words we have them from when we are inside the uterus (boys and girls); and then due to nature (hormonal changes) and nurture (how we eat and live) we all develop some form of breasts. Usually just two, but accessary breasts and nipples can occur along the mammary line which extends from our armpits to our groin. The breast as we understand occurs anywhere between the 2nd and 6th anterior rib line. The base of the breast is called the inframammary fold. This can be higher or lower on the one side.

Breast concerns

Different breast concerns happen at different phases of our lives. Witches Milk is the term for when babies produce milk (both boy and girl babies can have breast development and milk production due to mom’s hormones).

When should you be alarmed? Almost never but see a specialist. Ensure no one operates or puts a needle into a young breast bud even if it gets red or inflamed (which happens rarely) as this impedes the ability of the breast to subsequently develop. Sometimes topical antibiotics are needed but mostly just calming mom down is sufficient.

Breast development in young girls before they start menstruation. What should we do and when should we be concerned? Well like in Little Red Riding Hood, if it doesn’t look like Granny get some help. Most times early breast development isn’t a concern but checking why there is precocious (this is a medical term) development is important.

How do you check your breasts? 

There is a misconception about how to check your breasts. The number of women who check their breasts too firmly or with their hand above their head, or who squeeze their nipples. That’s all a big no! 

Pick a day on the calendar or a few days after your menstrual cycle. Watch as you take your bra off. Let your breasts jiggle and lift your arms from your sides to right above your head. This gives you an opportunity to see if there are any changes in the skin or if anything is attached to the underlying skin. Know your norm, and if the examination is the same every month, this is good. 

The secret is gentle palpation; you aren’t kneading bread and neither squeezing fruit. Flat of the hand; middle three fingers and gentle. If you feel lumps, bumps or see changes in the skin from one month to the next, a simple ultrasound at a specialist unit is advised. 

Remember screening is about health economics. What your medical insurance allows is bare minimum (bear necessity of life) of what you should do. Go to a reputable unit and don’t rush into biopsies and surgery. There are excellent units for non-insured patients, if you have a breast health concern. 

Breast cancer risks

Are there signs as to who can get a cancer? The 65% of all women who get breast cancer have no risks whatsoever. What does this mean? For most women, getting a breast cancer is ‘in the stars’. 

Can you change your risk profile? Risk factors are divided into modifiable and non-modifiable. Or better yet, risk factors that you can change and risk factors that you can’t change. So, this is the card hand that we are all dealt with: genetics, environmental, physiological, hormonal and age. Sorry neh!

Age 

I was just looking at pics of 25 years ago, the body looks a bit like a shatsu now and lockdown has made me realise, I’m grey. I’m grateful though for every year I age. And as we age on the outside, no matter how much Botox and fillers try to hide the obvious, our cells age inside and aging cells are more likely to undergo horrible cell changes. This is a risk factor you can’t change. About the only conclusive anti-aging data is on hyperbaric. Not only does it give you a buzz but helps with inflammation and aging cells. So, screen your aging cells so that if they’re misbehaving the changes can be dealt with early and affectively.

Physiology

This is when you start your period and when your period stops; and when you have children. I’m often asked why girls start their periods earlier. This is to do with mom’s health and fitness. Menstruation can occur anytime from eight to 16; and breast development usually starts just before this. 

Development is often asymmetrical so let’s make sure our young ladies know how to examine their breasts and not be scared to ask if concerned. Breast problems are uncommon in young girls; but they do happen. 

When a woman goes into menopause is also variable; from 45 to 55. Early menopause may be a result of medical conditions, and discussing menopause and management is important.

Early menarche and late menopause are listed as contributing factors to developing breast cancer. But aren’t significant risk factors.

When one has kids and if one can have kids is often out of our control (the contraception chat is important).Physiologically you can’t change if your breast tissue is dense, or if you have had exposure to breast radiation for a previous diagnosed childhood cancer. 

The hormonal chat

This is modifiable (you can change). Using contraception shouldn’t be avoided as a method to prevent breast cancer. Obviously, any medication taken should be preceded by a consultation with a healthcare professional. 

Taking contraception not for contraceptive purposes is also a discussion that should be had with a medical team. 

Hormone replacement therapy (HRT) doesn’t cause breast cancer, but will fertilise cells. So, fertilising the roses makes them grow; but remember that weeds grow faster. The weed seed was dropped by a bird (modifiable) or already in the soil (genetics (non-modifiable)).

Modifiable is considered breast-feeding, contraceptives and HRT. 

Let me just clarify, you can’t screen for breast cancer with a blood test. The blood test (CA 15-3) is a tumour marker that is used only in women with cancer elsewhere in their bodies (spread breast cancer) to determine response to cancer treatment.

Genetics

You can’t choose your family, only your friends. The 25-30% of women who get breast cancer have a family history, on either mom or dad’s side, of breast and/or other cancers. It’s critical to know your family history – who got what cancer at what age. If great Uncle Bertie got prostate cancer at 83, this isn’t significant. If Uncle Bertie got prostate cancer at 40, this is. 

Which cancers cluster together? Breast and ovarian (not cervical); prostate; melanoma; stomach and colon. So, a detailed family history can help. Document this and screen for the cancer clusters.

Unlocking the genetic lock 

I’m often asked by family members of cancer patients whether they should have a BRCA test to see if they’re carrying a gene for cancer, or whether they are going to get breast cancer. Genetic testing is very important but not straight forward. We usually like to test a family member who has a cancer and if they are positive for BRCA then we can test family members who don’t have cancer. Remember that both men and woman can be BRCA positive.

Only 10% of breast cancers have single gene mutations. What does this mean? Firstly, we all have a BRCA gene. The problem is when we don’t. Only 6-8% of breast cancers are BRCA 1 or 2 positive. Only 2% are other weird genetic mishaps, like Li Fraumeni, Cowden disease and Pten mutations. 

BRCA 1 deletion implies that one has a significantly higher risk of breast and ovarian cancer. This doesn’t mean that there is a 100% chance of getting breast or ovarian cancer. The first concept to understand when being faced with a positive test is that you have had this mutation since you were born. So, don’t rush into any decisions as to what you should do.

BRCA 2 gene deletion is more complex because not only does it mean you have a 60-80% risk of developing breast cancer. It also means you have a risk of a variety of gynae malignancies (ovarian, fallopian tube and uterine). You also have an increased risk of melanoma, stomach and colon cancer, pancreatic cancer, and prostate cancer if you are male. Male breast cancer is associated with a higher BRCA 2 gene mutation. 

Three-digit code

But what if you have a crazy family history of breast cancer and the person with the cancer tests negative for BRCA. How do we explain this? Well think of your family as having its own personal security bag lock. Let’s just say a three-digit code.

How does this work? We all know I’m an anxious traveller. All the locks in my house have the same combination; my birthday. Therefore, all locks are 221. Now this may sound like a daft and simple combination. But if you come to my house and try and open a combination, the options are endless, actually 999. This explains why trying to uncover the genetic mutation causing a breast cancer can be so difficult and daunting for a geneticist as there are so many combinations. Combination mutations are like family histories on your father and mother’s side of breast cancer (particularly) and other cancers too. 

Environmental

Luckily, the genie can give you three important environmental wishes. Find your genie to help you fulfil your dreams and desires.

Our first wish: Help me exercise

And not “I’m very busy”, I mean 45min to 1 hour at least five times a week. You can walk on a treadmill at an incline of 6-8 at a pace of 6km plus. You can sit on a bike and burn.

Our second wish: Food

It’s not so much about what, but about how much. Keeping your BMI in the normal range and watching your daily calorie count is critical. Fat is where it is at. Abdominal fat is not good.

Our third wish: Help me control my bad habits

Alcohol and smoking. Alcohol is a significant risk factor, so less is more.

Let’s walk the red carpet of a whole new world, a new exciting place to be this year, where our breast health is prioritised and we wish for health and happiness.

Prof Carol-Ann Benn heads up internationally accredited, multi-disciplinary breast cancer centres at Helen Joseph Hospital and Netcare Milpark Hospital. She lectures at Wits University and, in 2002, established The Breast Health Foundation.

MEET THE EXPERT – Prof Carol-Ann Benn

Prof Carol-Ann Benn heads up internationally accredited, mutli-disciplinary breast cancer centres at Helen Joseph Hospital and Netcare Milpark Hospital. She lectures at Wits University and, in 2002, established the Breast Health Foundation.


One Reply to “You and your breasts”

  1. I love Prof Benn’s articles. I love her simple way of explaining things to a patient using cartoon characters. It really makes it easy to follow and understand. She has a way of making one feel better even before you start treatment. God bless her and keep her for many years to come.

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