Increasingly, people are becoming conscious of the size and shape of their breasts. Often this concern stems from body-image issues and the desire to look good. But, this is not a new phenomenon. Throughout history and across cultures, women have tried to alter the appearance of their breasts. Those with large breasts would often bind them to make them appear smaller while women with smaller breasts stuffed cloth or cotton wool into innerwear to create the illusion of fullness.
Breast development is a gradual, natural process that begins during puberty, typically around ages 10-12. It occurs under the influence of the hormone oestrogen. By the late teenage years, breast development usually reaches full maturity. However, breast size does not remain static throughout life. Mild changes commonly occur during the normal menstrual cycle, with engorgement and tenderness appearing just before menstruation. Significant changes also take place during pregnancy, childbirth and breastfeeding.
Menopause brings its own set of changes due to declining oestrogen levels. The glandular tissue of the breast gradually shrinks and is replaced by fat. This can lead to changes in breast size, loss of firmness, sagging, tenderness and dull aches. These changes are normal and part of the ageing process.
Breast size varies greatly among women and is determined by several factors, including genetics, body weight, height, hormones and age. There is no single “perfect” breast size. From an aesthetic perspective, an often-quoted ideal is that the lower breast accounts for about 55 per cent of the volume and the upper breast 45 per cent. This has no medical significance.
Breasts are not twins; they are sisters. In about 10-15 per cent of women, there is noticeable asymmetry in size or shape. This often results from uneven development during puberty, where one breast grows faster or larger than the other. In many cases, this asymmetry runs in families and is genetically determined. However, if there is a sudden change in the size or shape of one breast, or if there is a painless or painful lump, redness, skin changes or nipple discharge, medical consultation is essential.
For many women, breast cancer is a major fear. The moment a lump is felt, panic often sets in. Fortunately, about 80-90 per cent of breast lumps are non-cancerous. Nevertheless, this is not a reason to delay seeking medical advice. Pain, size or mobility of a lump does not reliably distinguish cancer from benign conditions. Any breast lump, at any age, must be evaluated with a physical examination, ultrasound and mammogram when indicated. Some cases may require an FNAC (fine needle aspiration cytology), a minor biopsy or removal of the lump for confirmation.
If there are no lumps but the breasts differ markedly in size or are considered unacceptably large or small, surgical correction may be considered for physical comfort or psychological well-being.
Men, too, have rudimentary breast tissue lying flat against the chest wall. At any age, they may develop gynaecomastia, commonly known as man boobs. This can be embarrassing. Adolescent boys are affected and may suffer teasing.
Gynaecomastia is usually bilateral and non-cancerous, although breast cancer can, rarely, occur in men. It develops due to an imbalance between oestrogen and testosterone. This imbalance can occur during puberty, in older men or at any age due to obesity. Alcohol consumption, anabolic steroids, marijuana, certain medications and liver, kidney or thyroid disease may also contribute. Sometimes it is pseudo-gynaecomastia, caused by excess fat.
Most cases can be managed with treatment of the underlying cause, weight loss and exercise. Surgery is considered only when conservative measures fail.
The writer has a family practice at Vellore and is the author of Staying Healthy in Modern India. If you have any questions on health issues please write to yourhealthgm@yahoo.co.in