Breast Health: All Guides

Breast Health: General Information

braWomen’s breasts come in many shapes and sizes. There is no perfect shape or size for breasts. Normal breasts can be large or small, smooth or lumpy, and light or dark.

Your breasts start growing when you begin puberty. During puberty the hormone levels in your body change, which causes your breasts to develop and your periods to start. Many factors affect when you are going to begin puberty and develop breasts, including heredity (the way certain characteristics are passed down from generation to generation), weight, exercise, nutrition, stress, and chronic illnesses.

How do breasts develop?

The inside of your breasts is made up of fatty tissue and milk-producing glands, called mammary glands. The dark area of your breast around your nipple is called the areola. As your body starts to develop, a small lump grows under the areola and nipple. This lump is called the breast bud. As the buds get larger and rounder, the breasts grow.

As your breasts develop, the areolae get bigger and darker. Areolae and nipples can range in color from light pink to purplish to light gray depending on your skin color.

When will I get breasts?

Your breasts start growing when you begin puberty and the hormone levels in your body change, causing your breasts to develop and your menstrual periods to start. Heredity (the way certain features are passed down from generation to generation), nutrition, weight, exercise, and chronic illness determine when you are going to begin puberty and develop breasts. Most girls’ breasts begin growing when they are about 9 or 10 years old, but some girls may start developing breasts earlier or later than this age.

How long will it take to get breasts?

It takes different people different amounts of time to develop breasts, usually between 3 and 5 years. The age when you start to develop does not have an effect on the final size of your breasts. For example, if you develop earlier than most girls, this doesn’t mean that you will have bigger breasts than most girls.

Does everyone develop breasts at the same time?

No. It’s normal for some girls to start to develop breasts when they’re 8 or 9 years old, while others don’t start until they’re 11 or 12. Every girl has her own “clock” that her body follows. For example, girls who do gymnastics, dance, track, or another very active sport may go through puberty at a later age. Even if your development is normal, it can be hard if you seem to be either the first or the last one among your classmates or friends to develop breasts. Talk to a parent or an adult that you trust and tell him/her how you are feeling. If you develop early, remember that other girls will soon catch up.

It’s important to talk with your health care provider if you haven’t started any breast development by the time you’re 13 years old.

Is there anything I can do to increase the size of my breasts?

Heredity is the most important factor in determining breast shape and size. No creams, special exercises, or clothing will permanently change your breast size. Your breasts may change with weight loss or gain or after a pregnancy, but for the most part, the size of your breasts stays the same once you’ve finished puberty. Also, breast size has no effect on whether a woman will be able to breastfeed her baby.

When and how will my breasts make milk?

Inside a woman’s breasts are tiny pockets called alveoli. After a woman gives birth, her brain’s hormones tell the alveoli to produce milk. When her baby sucks on her nipple, the sucking draws milk from the alveoli through the milk ducts and out small holes in the nipple. When the mother stops breast-feeding her baby, her alveoli slowly stop making milk.

Normal Breast Development

My breasts are uneven. Is this normal?

It’s very common for your breasts to grow at different rates while they’re developing. Usually, they’ll look about the same size by the time they’re done growing. If you have a size difference and it bothers you, try a foam or gel insert that fits into your bra or bathing suit. These inserts are sold at specialty bra and lingerie shops and in department stores.

Most women have breasts that are not exactly the same size. However, sometimes breasts can be noticeably uneven (different by more than a cup size) after you have started your periods and your breast development has finished (3-5 years from when they started developing). If you are unhappy about the difference in your breasts’ sizes, you can talk with your primary care provider about using gel inserts and about the benefits and risks of corrective surgery.

My breasts are very large, and they make my back hurt because they’re so heavy. It’s also hard to exercise, because I get sore breasts. What can I do?

Some girls feel that their breasts are too large. Often, they’re not worried about how they look, but they’re bothered by breast pain, back pain, shoulder pain, dents in the shoulders from bra straps, rashes, skin problems under the breasts, or difficulties with exercising. Girls can also feel badly or self-conscious if they are teased about their large breasts.

If your breasts are very large, there are some options that can help.

  • First, find a well-fitting bra to minimize and support your breasts. Look for a bra that has wide shoulder straps and supportive cups. If you need help with measuring for a bra, see a trained salesperson working at a department store or a lingerie store for help.
  • If you are overweight, working to reach a healthy weight may also help.
  • The last option is to have breast reduction surgery. This type of surgery, which is done by a plastic surgeon, removes some of the extra breast tissue to decrease pain. It’s a serious decision and operation. Talk to your primary care provider to get more information.

Is it normal to have hair around my nipples?

Some girls have hair around their nipples. This is completely normal. If the hair bothers you, it’s best to cut it with small scissors. Plucking or shaving the hair can cause infection.

My nipples point inward instead of out. Is this normal?

If your nipples point inward instead of out, you have “inverted nipples.” Between 10%-20% of all girls have an inverted nipple on at least one breast. This is normal and will not affect your health in any way. If you have inverted nipples, it’s important to keep them clean to avoid getting an infection in the folds of skin around your nipple.

If your nipples used to point out but have suddenly turned in, you should make an appointment with your primary care provider.

What are stretch marks? Are they normal?

Stretch marks are red or purplish spoke-like lines that appear on the skin during times of rapid physical growth (such as puberty or pregnancy). During puberty, stretch marks on the breasts are very common and completely normal. Other common places for stretch marks are on the hips and thighs. Over time, the stretch marks will fade to match your normal skin color.

If I have a rash around the nipple area on my breasts, does that mean that my breasts are infected?

Usually, yes. A rash can be a sign of an infection, especially if one breast is swollen and tender, if there’s discharge, or if you have a fever. You can also get a rash on the skin under your breasts, which is usually either a heat rash or a yeast infection. If any of these signs of infection are present, call your primary care provider. Sometimes a hair root around your nipple area can become infected. When this happens, one or more tiny red bumps appear. The tiny red bumps are called folliculitis.

Is breast pain or tenderness normal?

You may feel a tingling or aching in your chest when your breast buds start developing. After you start to get your periods you may notice that your breasts become tender or sore a few days before you get your period each month. Not everyone has soreness. If your breasts are tender, check with your primary care provider. Your HCP may suggest taking over-the-counter pain medicine (such as ibuprofen) to help with the symptoms. Older teens who are bothered by breast pain before periods may benefit from taking low dose oral contraceptive pills. Some, but not all, individuals have found relief after quitting caffeine.

What if I have a discharge coming from my breasts?

Discharge from your breast(s) could mean that your breast(s) are infected, that a breast duct is dilated (widened), or that you have a hormone imbalance. The discharge may be on just one side or from both breasts. When a milky discharge comes from a young woman’s breast when she is not breast feeding, it’s called galactorrhea. This condition can result from taking certain medications such as birth control pills or medicine for mood disorders, from being pregnant or recently being pregnant, from low thyroid hormone levels, or rarely from a benign (not cancerous) pituitary tumor. Your body may be making extra amounts of prolactin, which can cause galactorrhea. A brown or bloody discharge may come from dilated breast ducts or small polyps in the breast ducts or glands beneath the areola (Montgomery glands). There may also be a blue area under the nipple. A small amount of yellow discharge sometimes occurs around the time a girl starts her period. You should call your primary care provider if you have breast discharge and/or local breast tenderness, pain, redness, or fever.

I have small bumps around my nipple. Is this normal?

These bumps are normal. The medical term for them is “periareolar glands of Montgomery.” They play a role during lactation (during the time when a woman’s body makes breast milk). If these glands become inflamed, red, and/or you notice drainage of clear to brownish fluid, you should make an appointment with your health care provider.

Breast Self-Exam and Cancer Risks

How do I take care of my breasts?

Like so many topics in health care, there’s controversy on how helpful breast self-exams are in finding cancers. Regardless, it’s great to know how your breasts normally look and feel so you’ll be able to tell if something changes. Once you’re in your twenties, you may want to begin doing a self-breast exam every month at about the same time, 3-5 days after your menstrual period ends. This routine will help you get to know how your breasts feel normally. You will then be able to notice if there are any changes, including any new or different lumps. Remember, some lumps are normal, but if you’re worried at any time, talk to your health care provider.

Another great time to do an exam is the day you see your HCP for a check-up, and he or she has said that your breasts are healthy. Then you’ll know that what you feel on that day is normal and what you should expect to feel each time you do a self-exam. Here’s how to do a 3-part breast self-exam that takes only a few minutes.

Lying down:

  • First, place a pillow under your right shoulder.
  • Next, put your right hand under your head.
  • Check your entire right breast area with the pads of the fingers of your left hand.
  • Use small circles to feel all around your breast, and then feel up-and-down.
  • You should feel the area from your collarbone down and in to your chest bone and around the side to underneath your armpit.
  • Use light, medium, and firm pressure over each area of your breast.
  • You should be able to feel deep down close to your ribs, and closer to the surface of your breast.
  • Gently squeeze the nipple to check for any discharge.
  • Switch arms and repeat these steps on your left breast.

In front of a mirror:

  • Look in the mirror (without wearing your bra) then check for any changes in the shape or the appearance of your breasts.
  • Note any skin or nipple changes such as dimpling, rashes, bruising, bumps, redness or nipple discharge.
  • Look at your breasts in four steps: arms at sides, arms overhead, hands on hips pressing firmly to flex chest muscles, and bending forward.

In the shower:

  • With soapy hands and fingers flat, raise your right arm.
  • Check your right breast.
  • Use the same small circles and up-and-down pattern described above in the “Lying Down” position.
  • Switch arms and repeat on your left breast.

Your health care provider will likely do a breast exam once a year. While you may find this a little embarrassing, a breast exam is an important way for your HCP to learn what’s normal for your breasts and to look for anything that isn’t normal.

Is it normal to have lumpy breasts?

Normal breasts can be smooth or lumpy. Most lumps are due to normal changes in breast tissue that occur during development. Your breasts may also feel different or lumpy around the time of your period. If you do notice that a new lump appears in your breast and does not disappear after your period, you should make an appointment with your health care provider.

What if I notice a new lump or something different about my breasts?

Most lumps or changes in your breasts that occur when you are a teen or young woman are due to normal changes in the breast tissue. If you find a lump, it could be from hormonal changes, an injury, a breast cyst filled with fluid from a blocked mammary gland (milk-producing gland), an infection, or a benign (not cancerous) tumor called a fibroadenoma. If the lump is sore or the skin over it is red, you may have an infection and you should contact your health care provider. If your breast just feels lumpy, check it again after your next period, since your breasts may feel different or lumpy to the touch around or before the time of your period. If the lump doesn’t disappear after you finish your period, see your health care provider (HCP). Your HCP may order an ultrasound of your breast to figure out what kind of lump you have. If you have a fibroadenoma, your HCP will discuss whether it can be regularly examined and watched without any special treatment (most common), or if you need surgery to remove it.

What if I notice a hard lump and redness on my breast?

A hard lump in the breast with redness over it could mean you have an infection of the breast (cellulitis or a breast abscess), especially if you also have breast pain and a fever. Although a breast infection is usually a complication of breastfeeding, other things can cause breast infections, such as shaving, tweezing, or plucking hairs around the nipple area; sexual play that causes trauma; or getting a cut on the breast. Abscesses can also occur if a duct becomes blocked during breast development, or from bacteria getting into the nipple. It’s best to try to prevent a breast infection by avoiding things that could cause trauma or cuts to your breast(s). If you’re breastfeeding, keep your nipples clean and dry.

If you think you might have a breast abscess, don’t wait! Call your HCP and start antibiotics right away.

What if I have a lump on my breast(s) from a sports injury or fall?

Treat your breast injury as you would treat an injury on any other part of your body. If the lump is sore and black and blue, it’s probably from the injury. If you feel a lump but you don’t remember injuring yourself, or if the lump is still present after a week, see your health care provider. Don’t worry – there’s no link between breast injury and breast cancer.

Breast Cancer Risks

Who is at risk for breast cancer?

Anyone can get breast cancer, but some women with certain medical conditions, lifestyle habits, genes (information passed from one generation to the next), or traits (referred to as “risk factors”) are more likely than other women to get cancer. However, having risk factors does not mean you will definitely get breast cancer. Most women who develop breast cancer have no risk factors at all.

Overall, you are at a higher risk for developing breast cancer if you:

  • Have close relatives (mother, sister, grandmother, or aunt) who have had breast cancer and/or ovarian cancer
  • Have one of a few specific genetic mutations (altered genetic code) that are passed on from one generation to the next that increase your chances of getting breast cancer and ovarian cancer
  • Have previously received radiation therapy to the chest/breast area in order to treat another cancer
  • Drink alcohol excessively
  • Are obese, which is primarily linked with menopausal status
Breast cancer is very rare in children and adolescents. Adolescents who have a medical history of another type of cancer or who have had exposure to ionizing radiation are at risk, and should be followed closely by their medical team.

How can I lower my risk for breast cancer?

You can lower your risk for breast cancer by keeping your lifestyle healthy. Don’t smoke, limit alcohol intake, exercise regularly, eat a healthy diet including lots of fruits and veggies, and have regular checkups with your health care provider.

Do I need to have a mammogram?

A mammogram is a special type of x-ray of the breasts, usually done to try to find early signs of breast cancer. Teens do not need to get mammograms. In fact, mammograms don’t work in teenagers and young adults because the breast tissue is too thick and too dense to get a clear picture. Most women start having mammograms when they are about 40. Some women younger than 40 years old may have a mammogram and/or MRI if they have a family history of breast cancer, if they have had radiation treatment for other cancers in the past, or if their health care provider recommends it for another reason. Talk to your HCP to decide if you need to start your screenings early. As a general rule of thumb, if a first-degree relative (your mom or your sister) has been diagnosed with breast cancer, you should begin to get breast cancer screening 10 years before the age at which they were first diagnosed. So if they were diagnosed with breast cancer at age 45, you would start your screenings at age 35. Otherwise, typical routine screenings begin at about 40.

Learning to care for your breasts when you’re a teenager is an important way to make sure that your whole body stays healthy when you’re older. Although breast cancer is uncommon in women under the age of 35, it’s good to become familiar with the normal look and feel of your breasts now. This will help you recognize any changes should they occur in the future.

Breast Health: Buying a Bra

bra

If you’re ready to buy your first bra or if your breast size has changed, you may be wondering what size bra to buy. Figuring out the correct size can be tricky unless you do your homework first. This guide will help you measure yourself correctly to determine the size you will need (chest size and cup size). This will be important when buying a bra as well as other clothing that uses bra or cup measurements, such as bathing suits. Of course, trying on bras is always important, since different brands and styles fit differently.

If you are about to buy your first bra, it’s best to go to a department store that has a special section that sells bras and underwear, usually called the “lingerie department”. Ask to be fitted by a “lingerie specialist” (a professional who has special training in fitting bras). This service is free, and having the measurements done by a professional will make sure that your bra fits correctly. By doing this, you’ll find the bra that feels the best and also looks the best under your clothes.

If you decide you would feel more comfortable figuring out your bra size at home, the following information will guide you through the steps of measuring yourself.

Chest size:

Place a cloth measuring tape under your breasts, on your ribs. Wrap the tape around your chest so the tape measure meets the beginning part of the tape. When you have the measurement number, add 5 inches.

For example: if the measurement around your chest is: 27″.

27″ + 5″ = 32″

This means that your chest size is 32.

If your measurement ends up to be an ODD number, you will need to go up to the next EVEN number to figure out your size.

For example: your measurement around your chest is: 28″.

28″ + 5″ = 33″

This means that your chest size is 34.

Cup size: Next, you will measure around your chest at the largest or fullest part of your breasts, called your “bust line.” You need to measure with your arms straight down, so ask someone you feel comfortable with to help you (like your mom, sister, or friend).

Your bust line measurement will be higher than your chest (“under the breast”) measurement. Your cup size is the difference between your chest size and your bust line measurement.

For example: Your bust line measurement at the fullest part of your bust is 34″ and your chest size is 32″. 34″ – 32″ = 2″. The difference is 2″, which means your cup size is a B cup.

Bra cup size:

Cup Size:Difference:
AA Cup½ inch
A Cup1 inch
B Cup2 inch
C Cup3 inch
D Cup4 inch

What should I know before I buy a bra?

A bra supports your breasts. While some girls don’t wear one, others like to wear them, especially when they play sports. All bras are shaped to fit around both your chest and your breasts.

Some bras are sized small, medium, or large. Bras sized this way, such as sports bras, fit snugly but comfortably. A well-fitting sports bra can prevent breast pain during sports or running.

Fitted bras have both a breast cup size and chest size. The cup sizes range from AA (smallest) to H (largest), and the chest sizes range from about 30 inches to 40 inches (this is the number of inches around your chest at the fullest part of your bust). Not all stores will carry very small or very large sizes, so you may have to check out a few stores or shop online to find the size that fits you the best.

You or a clerk at the store can measure you for the right size bra. You should try on many bras to find the most comfortable size and style. Finding a well-fitting bra is important to prevent breast discomfort, back pain, and shoulder pain.