Monday Medical: Is this normal?
October 14, 2018
Editor's note: This is Part 2 of a two-part Q & A on breast health.
Ever wonder why breasts feel tender at certain times or if a good bra is important for breast health?
In honor of Breast Cancer Awareness Month, Dr. Christine Bliven, a breast radiologist at UCHealth Gloria Gossard Breast Care Center in Steamboat Springs, answers a variety of questions about breast health.
Q: Why are breasts tender at certain times?
A: Breast tenderness is a side effect of hormones that fluctuate with menstruation. "Tenderness and swelling are most common right before your period or mid-cycle," Bliven said.
Q: Why does size fluctuate?
A: Swelling from monthly hormones and weight change can affect breast size. "Many people tend to gain or lose fat in their breasts with weight change," Bliven said. "For someone who's thin, five pounds can make a difference."
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Q: What if one side is larger?
A: "It's very common that one side is larger," Bliven said. "We don't necessarily develop symmetrically. So when we see an asymmetry, we can often say it's been there since puberty. But a big, new change on one side, such as one breast getting bigger or smaller or harder, needs to be investigated."
Q: Is breast pain bad?
A: "The most common symptom women come to see us with is pain," Bliven said. "We confirm it's in their breast, not the chest wall or chest. But typically, breast pain is not a sign of anything bad."
Hormones are the most common culprit when it comes to pain. Some women notice that caffeine and chocolate can also impact pain.
Q: Is discharge normal?
A: Some types of discharge are fine: discharge that is white, blue or green in color and that comes out of both nipples and multiple ducts as a result of squeezing is okay, though Bliven doesn't recommend squeezing the nipples as part of a self-exam. "Abnormal discharge comes spontaneously on its own, from one duct and one nipple," Bliven said. "It may be bloody or clear. That's more worrisome and should be checked by your health provider."
Q: What if a nipple inverts?
A: It's common for a nipple to invert now and then, but if a nipple pulls in and won't squeeze back out, or if it turns scaly or gets red spots, see your health provider.
Q: Why are some women more endowed than others?
A: It all comes down to genetics. "Your baseline size is genetically determined," Bliven said.
Regardless of what you may have believed as a teenager, no exercises or herbal supplements will increase breast size. However, weight gain or loss can affect size, as well as breast augmentation or reduction surgeries.
Q: How do pregnancy and breastfeeding affect breasts?
A: In pregnancy, hormones prepare the breasts for making breast milk: ducts and lobules are added, and breasts get bigger. After pregnancy and breast-feeding, breasts again become smaller.
Q: Is proper breast support (a good bra) important to breast health?
A: Wearing a good supportive bra can help women dealing with breast pain or back pain, but does not make a difference in breast health.
"Sometimes there are stories that you shouldn't wear a bra because it increases breast cancer, but that's not true," Bliven said. "Wearing a bra does not make a difference in breast cancer risk."
Q: Speaking of bras, will they help prevent sagging?
A: A bra does not help breasts maintain their shape. "It's not going to prevent sagging, because we just normally lose that elasticity in our tissues," Bliven said. "That loss of elasticity is also what causes wrinkles."
Q: What can I do to take care of my breasts?
A: Get a regular mammogram, do self-checks and practice healthy habits by maintaining a healthy body weight, not smoking and not having more than one alcoholic beverage each day. And remember that, even if you face a diagnosis, breast cancer can often be successfully treated.
Susan Cunningham writes for UCHealth Yampa Valley Medical Center. She can be reached at firstname.lastname@example.org.