There are three important
aspects of women's breasts: they often give erotic pleasure, they have a
large part to play in shaping a woman's self-image, and a woman can feed
a baby with them. Men's breasts can give erotic pleasure, but they have
little influence on self-image.
It is a normal reaction to
stimulation for a woman's nipples to erect. Until menopause, if she has
not breastfed a child, her breasts will increase in size under sexual
On the outside there are
nipples, each surrounded by areola. Inside there are milk glands, which
produce milk after delivery of a child, and milk ducts, which convey milk
from the milk glands to the nipples.
of the breasts is composed of fatty tissue and fibrous connective tissue
that binds the breasts together and gives them shape.
Nipples may point out
prominently, they may have a flattened appearance, they may be set a bit
deeper in the breast or they can be inverted.
normal range of variety
in appearance is large. The milk ducts leading from the mammary glands
in each breast converge and empty into the nipple, allowing a baby to
suckle. Each nipple is supplied with nerve endings, which make it very
sensitive to touch.
The thin muscle fibers present
in each nipple enable it to become erect during sexual excitement, and in
response to other stimuli such as cold.
The areola (plural: areolae) is the darker pigmented area
around each nipple; its color varies from woman to woman. It is quite
normal to have small bumps in the areola - they are oil-producing glands
that secrete a lubricant to make breastfeeding easier.
the areolae become darker and remain that way to a degree after pregnancy. The
size of the areolae varies from person to person.
Inside each breast are 15 to 25 small milk-producing sacs.
The milk they produce passes through ducts to the nipple, ready for the
baby to suckle. Regardless of breast size, the milk glands are about the same size in each woman and they produce about the same amount of milk.
These ducts connect the milk
glands in each breast to the nipple. The milk is produced in the glands,
passes through the ducts and collects around the middle. Milk is produced
in response to the action of two hormones, prolactin and oxytocin.
Prolactin stimulates the milk glands to make milk, and as a baby suckles,
more prolactin is released into the bloodstream to cause more milk to be
Oxytocin causes the milk to move from the glands to the nipples
in the process called 'let down." Sometimes a newborn baby does not suckle
vigorously enough during the first day or two, so insufficient amounts of
oxytocin are released into the bloodstream and "let down" is inadequate.
Once the mother and baby learn
the breastfeeding routine, everything works out properly.
The breasts produce a further substance, colostrum.
Colostrum is not milk, but it is extremely nutritious. It is thick and
yellowish and Is liable to drip from the nipples occasionally during the
final weeks of pregnancy.
VIDEO - CARING FOR YOUR
Babies rely on colostrum for
the first few days, until the proper milk flow arrives. Not only is
colostrum rich in proteins but it also contains important protection
against certain diseases to which newborn children are particularly
Q: "I have hair round my breasts. Do
I have a hormone problem?"
A: "No. Many women have hair around their nipples. It is a perfectly
normal part of being a woman. Many women accept the appearance
of hair on the nipples as they accept pubic hair or leg hair, though some
women remove it for cosmetic reasons. If you decide to remove yours, do it
carefully as it is easy to irritate sensitive breast tissue."
Q. "Do women produce milk all the time?"
A: "No. Milk starts to be produced only when a woman is pregnant. The
milk-producing glands in her breasts respond to the particular hormone
changes that occur during pregnancy, and by the time the baby is born the
woman will be ready to give milk. She will continue producing milk as long
as the baby is breastfeeding. "
Q. "I don't get any thrills from having my breasts fondled or kissed.
Am I normal?"
A: "Yes, you are. A lot of women find that they get very little erotic
pleasure from their breasts, despite popular belief that all women do. It
is often the case that a woman's breasts do more to turn her partner on
than they do for her."
Q. "My breasts really get sore and swell up just before my period.
Is that normal?"
A: "Yes, it happens to a lot of women. The shift In hormone levels and
fluid build up and retention are the chief causes. If you avoid excessive
salt, alcohol and refined carbohydrates, you may feel some relief."
Because of the enormous
importance we attach to breasts, their size and shape, many women worry
that their breasts are too small, too large, or just the "wrong" shape.
a culture, we often think of breasts as sex objects, not as living parts
of someone's body, and that gives rise to all sorts of anxieties. The fact
is that breasts vary just as much as faces - and for the same reason: that
we are all unique.
Occasionally - and only
occasionally surgery is desirable to reduce the size of uncomfortably
large breasts. Only very rarely is there justification for surgery to
increase the size of a woman's breasts.
A: "There is no normal size. Breast size and shape are determined
by heredity, but remember that regardless of size and shape
It is impossible to tell anything from the size and shape of a woman's
breasts. Almost every woman can breastfeed, and many can be aroused by touch as
Q. "Can exercise increase the size of my breasts?"
A: "No and yes. No amount of exercise can increase the amount of breast
tissue you naturally possess, but exercise can tone up the chest muscles
(pectoral muscles) and firm up the breasts, making some change in their measurement."
Q. "A friend of mine is taking
the pill to make her breasts larger. Does that work?"
A: "It may. There is a slight
increase in some women who take the pill, but there are risks in taking
the pills indefinitely. She should have regular checkups."
Q: "My lover just started to
take the pill to regulate her period, and I've noticed her breasts have
enlarged, and she complains of tenderness. Is this common, or is there a
A: "It is quite common. A lot
of women find that in the first few months of using oral contraceptives
their breasts become tender. If the discomfort is severe, she should
consult a doctor. Perhaps a different pill will overcome the problem.
Slight breast enlargement is also common among women who use the pills.
She should consult a doctor though if her breasts enlarge so much she
needs to change bra size."
Q "I'm 15, overweight and very
busty. One of my friends in the same situation lost weight and has these
terrible stretch marks around her breasts. What can I do to avoid this?"
A: "Stretch marks around the
breasts occur when the fibers of the skin lose their elasticity and
ability to contract. So when weight is lost rapidly these marks show up
and they remain. If you lose weight slowly over a long period of time,
there is less likelihood of obvious stretch-marking. Also stretch marks
that do appear tend to become less noticeable over time."
A: "Yes. Masters and Johnson
found that a very small percentage of women can do this, but it is not
sufficiently arousing for most women. It seems that in general it is
partners who get more turned on by breasts."
Because breasts have achieved such enormous importance as sex symbols,
there are numerous common myths about them. Each of these is totally
larger breasts mean a woman is
breastfeeding causes breasts
breast cancer is caused by a bruise or blow to the breast
a real woman's breasts stand out and her nipples protrude
smaller breasts are not good for breastfeeding
women aren't really concerned about their breast size - it's only
men that care
hair around her breasts means a woman is manly
breastfeeding changes the shape of breasts permanently
women with smaller breasts are less interested in sex
men are always attracted to women with larger breasts
women do not get any feeling from touching their own breasts
all women enjoy having their breasts stimulated
Women's breasts begin to
develop at puberty; estrogen, a hormone
produced by the ovaries, causes the nipples to bud and the milk glands and
fatty tissue to grow. Breast development is often uneven, in that one may
start to develop before the other, and no-one can say precisely when it
will happen as there is no set order in which the events of puberty occur.
Under stimulation, a woman's nipples will normally erect, though the
extent of the erection varies widely from person to person. A woman who
has not breastfed and who has not yet reached menopause will probably
experience some increase in breast size as she becomes sexually excited.
The veins will become more obvious and the areolae will enlarge too and
This is due to vasocongestion, an increased blood flow -
just the same thing as happens to her vagina. After menopause women still
have nipple erection, but there is no increase in the size of the breasts,
whether they have had children or not.
During pregnancy the areolae and nipples darken. Breast size increases
rapidly during the first three months, so much so that most women have to
change to a larger bra. At this time, a number of women report that their
breasts feel tender when they are sexually excited.
A little over 50 percent of men report nipple erection when they are
excited (but no increase in breast size), though they tend to lose this
characteristic after the age of 55 or so.
Q. "My daughter's breasts started to develop a bit when she was
three years old. Is anything wrong?"
A: "Probably not. Have your doctor check your daughter to see if her
hormone level is proper for her age. It probably is, so don't alarm your
daughter or make her feel self-conscious or abnormal. Puberty will occur
as usual and development will be normal. If your daughter's hormone level
is higher than it should be for her age, a hormone specialist (an
endocrinologist) should be consulted. As a special case, it has happened that small children have eaten
someone's birth control pills. Check that this is not the case with your
daughter, but check with your doctor anyway."
Q: "My 11-year-old daughter's
left nipple is developed and the breast enlarged."
A: "Sometimes the left breast will
begin to develop sooner than the right. We don't know why this happens but
we do know that it is not unusual. The other breast will probably catch up
in size by age 15 or so. Reassure your daughter if she is concerned and
try to prevent her from feeling too self-conscious about it."
Q: "I'm 13 and my breasts haven't begun to grow yet. I'm ashamed to go to a
doctor and I'm worried."
A: "It is natural to worry when your breasts haven't developed when you
want them to. You need to be patient for a bit because your body has its
own timetable that triggers breast growth, and your time will come soon.
If you go to a doctor, she or he will tell you to try to relax and allow
your biological clock to respond in its own way. Incidentally, many adult
women will remember the time when they were younger and felt the way you
do now, and soon afterward they felt the relief you will when their
Q. "I'm 14 and flat-chested. One of my friends told me to wear a
padded bra. I just don't know what to do."
A: "Wearing a padded bra
("falsies" as they are sometimes known)
may give you some temporary comfort. Padded bras have been used by many
women who weren't satisfied with their breast size. However, in your case
you still have several years of development ahead of you. It may very well
be that your natural breast development program hasn't been triggered yet.
Remember also it is important for you to accept your own unique shape.
Only you can look the way you do, and becoming content with your
individuality will help your growing self-image and your ability to relate
Q: "My brother is 15 and his breasts look like they have grown a little.
Is that normal?"
A: "Yes. Around puberty the breasts of many boys do develop slightly. This
is called gynecomastia and is probably due to very small amounts of
estrogen in their bodies. As puberty goes on, hormone levels settle down
and other parts of the body grow to balance up any breast increase."
Breasts in Relationships
As women and men said:
"I used my breasts in relationships, they gave me power."
"I felt nobody would want to go out with me because I was flat chested."
"As I got older the importance of my breasts, and especially how other
people felt about them, really diminished." "I felt men liked me only for
my breasts." "I'm a breast man, so it is important for me to be in a
relationship with a woman with big breasts." "Guys really started to go
out with me when my breasts developed."
"For years I didn't want to
expose my breasts because I was afraid to be judged by my lovers." "I
think her breasts were more of an issue to her than to me." "As I learned
to accept myself as a woman I didn't care how others liked my breasts or
any other part of me." "Although her breasts were important to me when we
were first together, our relationship has become much deeper." "Sometimes
I get a sad feeling when I look at my sagging breasts - but life goes on."
One can see from these
comments how the significance of breasts varies from person to person, and
from relationship to relationship. There is also a distinct connection
between the significance people attach to breasts and their stage in the
life cycle. It is not unusual for young women to be seriously concerned
about their breast size and shape as predictors of whether they can
involved in a relationship.
Some young women overcome
feelings of anxiety and inadequacy by using their breasts as lures or as
weapons in relationships. Men sometimes assign such importance to the size
of a woman's breasts that just that one attribute may be the reason for
starting a relationship - even for continuing one.
Although these values linger
in some people, most are able to move beyond the simple physical aspects
of a relationship. The beginning of this wisdom is the ability to accept
yourself completely, recognizing that the kind of a person you are arises
from the deepest parts of your personality and not from a single part of
This is not easy when, as now, society's messages about who is
successful in relationships concentrate on superficial, cosmetic aspects
and not on people's more fundamental qualities. Even if it is difficult,
it is one of the keys to a mature, lasting, fulfilling relationship in
which sexual dysfunction like premature
ejaculation is not a problem.
Ours is a culture in which
"tits sell." The notion has overwhelmed advertising and the media. It has
also made breasts perhaps the most commercialized aspect of sexuality.
Despite the statements of many women who say they really aren't concerned
about their own breast size, and similar protests from men regarding the
relative lack of importance of women's breasts, the evidence is that
breast size and shape matter enormously to a great many people. Breasts
affect self-esteem, relationships - in fact sexuality in general to a
profound degree: "It's what's up front that counts."
Unfortunately, many women (and
men) feel that breasts need to be a certain size and shape in order to fit
our culture's current standards of beauty and desirability. Standards
change from decade to decade, for example from pointed
bras and the sweater look of the 1950s to bra-lessness or natural-look
bras in the 1960s and 70s.
Large breasts are sometimes in
style, then smaller breasts, full looks, and understated looks, and so on.
Women rush to keep in style and many men expect that the women with whom
they relate will do so. Whether the need to change is commercially
inspired or not, a great many people obviously feel that this is what they
should do, however arbitrary it may seem.
Young girls express very
strong feelings about their breast development. Such self-questioning also
reflects the pressures young people feel to fit in and be like the popular
image of sexy women. Of course they would like their breasts to be just
right, but achieving that ideal is not something many young girls believe
will happen to them.
At the same time that girls
are beginning to worry privately about their breasts, family members and
contemporaries start to comment and show a greater interest in their
general development, but especially in their breasts. Imagine the feelings
of humiliation when a parent, a brother or a sister points out the
12-year-old girl's two tiny mosquito bites.
On the other hand, having
well-developed breasts can signal comments from peers about alleged early
sexual activity and this leads some girls to overdo intellectual and
academic interests as a compensation. Not being an early developer can
lead to embarrassment and self-consciousness, and perhaps a withdrawal
from relationships with friends.
Of course, some young girls
develop at their own pace without too much fuss being made about size and
shape and some young girls are very fortunate in being able to see their
friends naked while changing for sporting events. This helps them to
realize how varied breast size, shape and development can be.
During this period boys become
very interested indeed in breasts, and sometimes obsessed with them. This
comes from their own growing sexual interest but is also greatly
influenced by our social and media attitudes; it is the beginning of how
boys become "breast men." Around puberty boys learn words for breasts -
jugs, tits, and so on - and by the time they have done that, they are well on
the road to absorbing the breast lore that Western cultures are saddled
Much breast lore says that
women's breasts are singularly sensitive to erotic touch, but some women
find that this is not so, which may lead them to worry about their
normality. At the same time men seem to be very interested in breasts, and
one must wonder who this interest is for.
Men are truly shocked if they
discover that all the time they may have been spending on their partners'
breasts gave pleasure to themselves alone. Some people by the time they
reach adulthood are imprisoned by conventional ideas about what is normal,
And in some cases women will
have their breasts enlarged, reduced or shaped in a certain way to please
someone else. It is true that this kind of surgery may positively
influence a woman and her self-image but it stands out as a poor
reflection on the character of a culture, when any person must alter her
or his physical appearance to conform to the changeable standard of a
society, in order to gain acceptance from others and personal value.
Problems that can occur with breasts fall into two categories.
The more common, by far, is lumps. The less common is anxieties over
breast size that affect a woman's mental health or prevent her from
leading a fulfilling life.
When a woman discovers a lump in her breast, she isn't much
comforted to know that 75 to 80 percent of lumps are benign and not
cancerous. She is likely to be flooded with anxiety. She may hope that it
will not be there tomorrow, that it will just go away. Ultimately, though,
she will see her doctor, and probably
be examined in one of the following ways:
Mammography: an X-ray of the breast which allows the doctor to
evaluate the size, nature and depth of the lump. This test can detect
breast tissue changes before they form a lump or before it spreads, but
the risks of being exposed to X-rays prevent mammography from being used
for routine screening.
Thermography: a temperature survey of all parts of the breast - it is
quite safe. Cancer causes an increased blood flow to the area affected and
therefore a higher temperature at that place. Thermography avoids the need
for radiation, but it is not an absolutely accurate technique.
Needle Biopsy: usually done in
the doctor's office with a local pain killer. The doctor inserts a needle
into the breast and draws out fluid from the lump. The lump may break down
or collapse immediately, indicating it was a fluid cyst. The fluid will be
sent to a pathologist for examination. Usually this type of cyst is benign
and soon disappears.
Surgical Biopsy: this is a
surgical procedure usually done under general anesthesia, although local
anesthesia can sometimes be used if the patient prefers. An incision is
made in the breast and the lump is removed, leaving a scar on the breast
about an inch or two long. The operation does not change the shape of the
The tissue from the lump is
then analyzed by a pathologist at a cancer center or university hospital.
If the tissue is benign, the major concern is over and a routine treatment
for the lump will be conducted.
If the tissue is
malignant (cancerous) the woman can discuss the type of surgery and/or
other treatment she requires for her situation. The short delay in
scheduling new treatment after a decision has been made does not
complicate future treatment or affect the recovery.
Frozen Section: tissue is
taken from a suspicious area, frozen immediately and examined to determine
if it is benign or cancerous. This can be done in 15 minutes, but it is
not as reliable as the routine pathologist's examination, which takes a
day or two. When possible, the standard, longer tissue examination and
diagnosis should be done.
Many women elect to have only
a biopsy first and then surgery, if required, at a later date. This gives
an opportunity to seek second opinions and allows the woman to prepare
herself and her family for her surgery.
Seventy-five to 80 percent of
breast lumps are not cancerous. These are the two common benign
Fibroadenoma. This is a tumor made up of gland tissue and fibrous cells.
It is firm, round, painless and movable, and is common in women between 15
and 40. Fibroadenomas may indicate a higher risk of cancer later in life,
although this is not certain.
Fibrocystic Disease. These are painful cysts and produce a sense of
fullness in the breast. The cysts contain fluid, which can be drawn off
(aspirated) in the doctor's office if they grow large. The symptoms tend
be more obvious just before menstruation when the body generally retains
fluid; they diminish after the period. As with fibroadenomas, the presence
of fibrocysts may suggest a greater risk of developing cancer later in
Lumps in the breast that are cancer
may feel solid, painless
and immovable. They may appear in any part of the breast.
Mastectomy, the surgical removal of the breast, is the most common form of
treatment for breast cancer. There are several different types of
Radical Mastectomy. This is the oldest treatment for breast cancer and
involves the removal of the entire breast, the chest muscles in that area,
and the surrounding lymph nodes. This method has become very controversial
and doctors and patients are questioning its long-term effectiveness compared with other, less severe types of surgery.
Modified Radical Mastectomy. In this operation the breast, near and
superficial lymph nodes are removed.
Total or Simple Mastectomy. This is the removal of the breast alone.
Lymph nodes and muscle tissue remain untouched.
Lumpectomy. The removal of the lump and the bare minimum of surrounding
tissue - occasionally called a tumorectomy. This is controversial, as many doctors
feel it is not enough to halt the reappearance or spread of the disease.
The same objections are raised to
partial mastectomy. In this procedure more tissue is removed than in a lumpectomy - as much as half the breast may be taken away.
Then there are three nonsurgical methods of treatment:
Chemotherapy, the use of powerful drugs that kill cancer
cells. It may be used right after breast surgery or later, should the
cancer reappear, and should only be given at a special cancer center.
Radiation Therapy. Generally, this treatment is used in addition to
mastectomy. Powerful X-rays are focused on the cancerous areas to kill the
cells and prevent their spreading. In some limited cases doctors may
decide to use radiation first in an effort to avoid mastectomy.
Immunotherapy. A new technique designed to help the woman's body to use
its own immune system to destroy cancer cells. This is done by using drugs
to trigger the patient's immune system to combat the cancer cells.
Each of these methods has its
advocates and detractors. It is clear that not enough is known about
breast cancer and which kind of treatment is best for which person.
However, people must think carefully and discuss fully the treatments
available from local cancer care centers or university medical teaching
centers and the consequences of each. The signs are that the medical
profession is trying to improve and expand non-surgical treatment, so
breast surgery may well begin to be used less.
After surgery, a woman with
breast cancer must learn to live with her surgery. The normal medical
concerns right after a mastectomy are to do with drainage of blood and
tissue fluid, controlling the post-operational pain, and beginning to
exercise the arm and shoulder, which is important in reducing any swelling
of the arm that may have occurred.
These physical aspects are
painful and distressing and must be attended to, but for many women the
principal distress is the emotional impact of losing such a sexually
significant part of the body.
In the broadest sense,
mastectomy challenges a woman's sexuality because her body image, gender
identity and role, and her erotic possibilities and her ability to become
involved intimately with a partner can be profoundly affected: "I always
found an excuse not to have sex - I felt like half a woman." "For a long
time, my lover wouldn't look at me when I was nude." "During lovemaking I
couldn't lean or take any pressure on that of my body." "I wondered what
people were thinking when they looked at me." "I was glad I was alive, but
sometimes I wondered if I could live with how I looked."
This is real pain and real suffering. Not every woman experiences it, but
many do, and in order to overcome the effects of these feelings understanding, continuing support and communication are essential. Women do overcome
the physical and emotional effects of mastectomy, but it isn't easy and
the trauma to their sexual identity can be enduring.
The sooner sexual
relationships can be resumed, with appropriate recognition of the surgery,
the more easily problems will be avoided and overcome. And if sexual
problems do occur, the quicker they are acknowledged and discussed
candidly and sensitively, the more likely they are to be resolved without
The effects of mastectomy on
longevity and on various physical aspects of functioning are being studied
thoroughly, but research into the effects on sexual identity and sexual
expression is far from complete. Getting through the trauma of mastectomy
therefore requires genuinely creative understanding from the patient's
partner; mastectomies can be concealed very effectively with pads and
Although it is quite obvious
when the woman is undressed that she has had a mastectomy, we don't yet
have rules to help, so each situation has to be worked through by the
people concerned on their own terms.
What is clear, though, is that
many relationships are strengthened by the process - the effort of
understanding and sharing the problem often brings two people closer
Q: "I heard that a discharge from a woman's nipples is a sign of
cancer. Is this true?"
A: "If a discharge from a breast is bloody or brown a woman should see her
doctor immediately, as she should if the discharge is heavy and continuous
or if it is milky/clear and she is not pregnant or breastfeeding. A discharge is normal prior to birth, and shortly after birth if the woman is
not nursing. Sometimes a watery discharge can result from manipulating the
breast vigorously. Some discharges are due to hormonal imbalances, so even
if a woman does have an inappropriate discharge it does not mean
automatically that she has cancer."
Q. "What is mastitis?"
A: "Mastitis is an infection
of the breast caused by bacteria that enter through the nipple or a crack
in the nipple. Fever, tenderness of the breasts and generally feeling low
are the common indicators. More than half the cases of mastitis occur
while a woman is breastfeeding, but traumatic mastitis may follow breast
surgery (this very occasionally occurs in men too). A painful swelling of
the breasts may occur at puberty which is sometimes known as puberty
mastitis; it disappears after a few weeks. Mastitis may also occur during
the menopause because of changes in hormone levels.
Q: "I'm 18, and I felt a movable lump in my breast just before
I got my
period one month. My doctor told me to wait a month and
then to see her. Is it wise for me to wait?"
A: "Usually yes. In your case your physician probably felt that since it
was so close to your period, some of the normal fluid that builds up at
that time could have been trapped in the ducts of your breast. The chances
are great that after your period you will notice first a reduction, then a
disappearance of the cyst. But do go back to check with your doctor as she
Q: "Do men get breast cancer too?"
A: "Yes, rarely. The forms of treatment are the same."