Breast Health Guide for Women with Augmented or Natural Breasts

Posted October 14, 2016 by Dr. Alex Sobel

Whether you’ve had a breast augmentation or not, keeping tabs on your breast health is a key part of staying healthy. In honor of Breast Cancer Awareness month, we’ve created this guide to common breast concerns and tips for keeping your breasts healthy.

Step 1. Learn your breast anatomy

To effectively monitor breast health, you need to be familiar with breast anatomy. From the outside, the anatomy of the breast is fairly straightforward: a breast mound, which projects from the chest, as well as a nipple surrounded by darker skin called the areola. The inner workings of the breast are a little more involved.

Mammary glands. These consist of lobules, which are clusters of cells called alveoli. Most are found in the breast mound, but glandular tissue extends horizontally from the sternum (breastbone) to as far as the armpit—what is called the “axillary tail.” This is important to know, because breast cancer can originate in the armpit area, not just the breast mound.
Milk Ducts. These are thin tubes that connect the lobules to the nipple to transport milk when breastfeeding.
Cooper’s ligaments. Also known as suspensory ligaments, these make up the network of strong, fibrous connective tissue that gives your breasts support and firmness.
Fat. Space not filled by glands, connective tissue, or milk ducts is composed of fat. The fat to glandular tissue ratio increases as you get older, which is one reason that breasts sag with age.
Transaxillary lymph nodes. While technically not part of the breast itself, lymph nodes play an important role in breast health. Located between the breast mound and the armpit, lymph nodes filter fluid away from the breasts and help fight infections. Because of their proximity to the breast, swelling of the transaxillary nodes is common after breast surgery, as they assist with the body’s healing process.

If you’re augmented…

Breast implants are either placed over or beneath the chest muscle, but they are always placed behind your breast tissue. If you’ve also had a breast lift, the nipple and areola may have been relocated, but internal breast tissues are left largely undisturbed.

Step 2. Get to know your own breasts.

Although the American Cancer Society no longer recommends breast self exams (BSEs) as a primary tool to detect breast cancer, they remain the best way to learn what’s normal for your breasts so you can keep tabs on any changes and report them to your physician.

How to self-examine your breasts

It’s best to perform a breast self exam (BSE) at the same time each month, 3 to 5 days after the start of your period, when breasts are least likely to be sore, swollen, or lumpy and it’s easier to notice changes. Using your fingers as a flat surface, apply pressure to feel for changes. Be sure to include the tissue underneath the breast and the axillary tail in your BSE. Note that you’re not just looking for lumps: skin dimpling (like an orange peel), itchiness, heat, or unusual discharge are other things to bring to your doctor’s attention.

To help you out, here’s a fun, educational video demonstrating how to check your breasts:

https://www.youtube.com/watch?v=Ais88Os_CTg

If you’re augmented…

Having breast implants does not significantly affect BSEs. In fact, implants are under the breast tissue and thus push breast tissue closer to the skin, which can make irregularities easier to feel for some women. If anything looks or feels suspicious, don’t panic, but do report it to your doctor. The vast majority of breast changes are benign, but it’s best to rule out disease.

Lumps: What’s likely harmless and what deserves a visit with your doctor

If you’re confused about breast lumps, we don’t blame you. Most women grow up hearing that if you find a lump in your breast, it might be cancer. Yet lumpy, or “fibrous,” breasts are normal for many women. How do you know if there’s a problem?

If you have a lot of thick, lumpy feeling tissue throughout both breasts, this is likely due to fibrocystic breast changes. Extremely common in women in their late 30s and 40s, hormonal changes cause tough, fibrous tissue to develop, typically along with fluid-filled cysts. Fibrocystic breasts are considered normal and although they can cause discomfort, they are not an indication of breast cancer or other disease.

If you feel a single, distinct lump in your breast, it is most likely a cyst. Common throughout the body, these firm-feeling, fluid-filled sacs are harmless and typically come and go on their own. A hard, marble-like lump may be a benign connective tissue growth called a fibroadenoma. However, because there is a chance that a lump may indicate cancer, it’s best to get any lump you feel checked out.

When to see a doctor: If you notice a new lump or area of thickened tissue or if an existing lump seems to be changing (i.e., growing larger or changing texture) during your regular self-exam, call your doctor.

If you’re augmented…

Your implants will make you no more or less prone to issues like fibrocystic breasts or other conditions. You should take the same precautions as unaugmented women, seeing a doctor about any lumps that seem unusual for you.

Breast Pain: What’s a problem and what’s just a pain.

Breast pain is extremely common—only a very few lucky women go a lifetime without experiencing it at some point. Breast pain alone is not a sign of cancer or any other serious breast disease.

The most common type of breast pain is “cyclic mastalgia,” which is a fancy term for breast swelling and tenderness prior to your period. Fibrocystic breasts can also be sore and tender. Although there is no confirmed cause, hormonal changes are thought to be the culprit in both situations. High caffeine consumption may also make pain from fibrocystic breasts worse.

When to see a doctor:

If you have breast implants and have developed new pain, possibly accompanied by hardened or misshapen tissue. This is may be a sign of capsular contracture, so see your cosmetic surgeon first.
If pain interferes with your sleep or normal activities. Although breast pain may not be life-threatening, it can impact your quality of life. Your doctor may recommend medication, dietary changes, or a procedure to remove the cysts.
If one breast feels warm, itchy, or swollen or your pain stems from skin irritation. These are symptoms associated with illness and breast disease.

If you’re augmented…

Breast implants do not exacerbate or lessen cyclical breast pain in the long term. However, some breast augmentation patients report a temporary increase in pre-menstrual breast pain after surgery, while postoperative swelling is still a factor. Once implants have settled and the healing process is complete, cyclical breast tenderness typically returns to a patient’s normal level.

Breast cancer: facts and what else to look for

Many women’s primary concerns about breast health are related to breast cancer. The good news is that breast cancer rates have been in decline since 2000, but screening is critical as breast cancer still affects about one in ten women. The lifetime average risk of developing breast cancer as a women is ~12% and approximately 3% of all women die from breast cancer.

Your personal risk may be higher or lower, depending on genetics, age, weight, heredity, medication use, and lifestyle factors. Lifestyle factors known to increase breast cancer risk include obesity, heavy alcohol consumption, and a sedentary lifestyle—all factors you have some control over.

Along with an abnormal lump or mass, the following are possible signs of breast cancer that should be checked out by a doctor:

Dimpling on the breast skin (i.e. an “orange peel” look)
A normal nipple becomes inverted
Warm or itchy breasts
Bloody nipple discharge

When to see a doctor: If you notice any of the above symptoms or any other breast changes that worry you, see a doctor.

If you’re augmented…

Numerous studies have been performed to determine whether or not having breast implants increases breast cancer risk. To date, there is no scientific evidence verifying any increased risk of breast cancer. However, you can still get breast cancer and should be alert to any unusual changes in your breasts after you get implants.

Follow your doctor’s recommendations for mammograms and other screenings.

In many cases, breast cancer shows no noticeable symptoms until it has advanced. This is why it is so important to undergo routine screenings as recommended. With early detection, breast cancer survival rates are extremely high: nearly 100% of those diagnosed with early stage 0 or 1 cancer are still alive after 5 years.

Mammograms are still considered the best primary screening tool for breast cancer. In general, doctors recommend women get mammograms every one to two years starting at age 40 to 50, depending on an individual’s medical history and breast cancer risk. MRI and ultrasound are usually reserved for follow-up testing if something shows up on a mammogram, or for younger women, whose breasts are more dense.

Breast implants and mammograms

Mammograms are safe and generally effective for those with implants, and most imaging specialists today are trained and experienced in performing mammograms on augmented women. That said, if you have implants, do notify your imaging center beforehand.

Occasionally, breast implants may obscure a portion of the breast tissue and thus reduce the accuracy of the screening—this is more common in implants placed over the muscle. In this case, your doctor may recommend an ultrasound or MRI to achieve more thorough testing.

What you can do to keep your breasts healthy.

You can do a lot to keep your breasts comfortable and looking their best, in addition to lowering your risk of breast cancer:

Wear a good quality bra. It’s worth it to visit a professional bra fitter—not only will you be more comfortable, but a properly fitted bra will flatter your entire figure.
If you smoke, quit. This will reduce your risk of cancer and many other diseases.
Maintain a healthy, stable weight. This not only lowers your risk of breast cancer, but also prevents unnecessary stretching and sagging of breast skin and tissue.
If you’re considering surgery to enhance your breasts, choose an experienced, board certified cosmetic surgeon. Surgeon skill is one of the most important factors in getting a natural look and lowering risk of complications.
If you have breast implants, maintain a relationship with your cosmetic surgeon. While most patients go many years without a problem, it’s good to check in with your surgeon every few years.

We hope you have found this breast health guide helpful, but it’s not meant as a replacement for personalized medical advice. If you see anything concerning or have questions about breast health, be sure to contact your doctor.

If all is well, but you are looking to enhance or lift your breasts, we invite you to contact us—board certified cosmetic surgeon Dr. Sobel has helped hundreds of women improve their appearance with natural-looking breast enhancements.