Few studies have investigated the association of non-dense area or fatty breasts in conjunction with breast density and breast cancer risk. Two articles in a recent issue of Breast Cancer Research investigate the role of absolute non-dense breast area measured on mammograms and find conflicting results: one article finds that non-dense breast area has a modest positive association with breast cancer risk, whereas the other finds that non-dense breast area has a strong protective effect to reduce breast cancer risk. Understanding the interplay of body mass index, menopause status, and measurement of non-dense breast area would help to clarify the contribution of non-dense breast area to breast cancer risk.
Models of breast cancer risk odds ratios for breast dense area and non-dense (fat) area. A model from Pettersson and colleagues [1] is shown on the left, and a model from Lokate and colleagues [2] is shown on the right. Models are adjusted for age, age of menopause, family history of breast cancer, parity, body mass index, and alcohol use. Additional adjustments for the model from Pettersson and colleagues [1] are age of menarche and alcohol use. Additional adjustments for the model from Lokate and colleagues [2] are height, number of children, and hormone therapy use.
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The results reported by Lokate and colleagues [2], contrary to those of previous studies, show that non-dense breast area is associated with increased breast cancer risk. Why are the results for non-dense area less clear than those for dense breast area? One possible explanation is that the method to quantify non-dense areas differs across studies. Both Lokate and colleagues [2] and Stone and colleagues [9] used mediolateral oblique (MLO) views to quantify breast areas, whereas Pettersson and colleagues [1] and Torres-Mejia and colleagues [8] used craniocaudal (CC) views. This may be an important difference between studies. Total breast area, since it includes a greater amount of superior axillary breast tissue, is larger for MLO views compared with CC views. In MLO views, it is more subjective in regard to where actual breast adipose tissue ends and body subcutaneous adipose tissue begins, potentially leading to greater absolute non-dense breast area. Possibly, the body subcutaneous adipose included in MLO views is not associated with a protective effect because it reflects an increase in body mass index rather than breast adipose tissue. Elevated body mass index has been associated with increased breast cancer risk among postmenopausal women not using hormone therapy [12]. This hypothesis can be tested by stratifying postmenopausal women according to body mass index to determine whether increased non-dense area on MLO views has a strong association with breast cancer risk among normal-weight women and those with increased body mass index. Second, it would be important to know whether non-dense breast area measured on MLO or CC views on the same woman were associated with increased breast cancer risk. Lastly, examining the association of non-dense breast area on MLO views in premenopausal women to determine whether the results reported by Lokate and colleagues [2] in postmenopausal women could be reproduced in premenopausal women would support their findings.
Ptosis or sagging of the female breast is a natural consequence of aging. The rate at which a woman's breasts drop and the degree of ptosis depends on many factors. The key factors influencing breast ptosis over a woman's lifetime are cigarette smoking, her number of pregnancies, higher body mass index, larger bra cup size, and significant weight change.[2][3]Post-menopausal women or people with collagen deficiencies (such as Ehlers-Danlos) may experience increased ptosis due to a loss of skin elasticity. Many women and medical professionals mistakenly believe that breastfeeding increases sagging. It is also commonly believed that the breast itself offers insufficient support and that wearing a bra prevents sagging, which has not been found to be true.[4]
University of Kentucky plastic surgeon Brian Rinker encountered many women in his practice who attributed their sagging breasts to breastfeeding, which was also the usual belief among medical practitioners.[9] He decided to find out if this was true, and between 1998 and 2006 he and other researchers interviewed 132 women who were seeking breast augmentation or breast lifts. They studied the women's medical history, body mass index (BMI), their number of pregnancies, their breast cup size before pregnancy, and smoking status. The study results were presented at a conference of the American Society of Plastic Surgeons.[2][10]
According to Rinker's research, there are several key factors. A history of cigarette smoking "breaks down a protein in the skin called elastin, which gives youthful skin its elastic appearance and supports the breast." The number of pregnancies was strongly correlated with ptosis, with the effects increasing with each pregnancy.[2] As most women age, breasts naturally yield to gravity and tend to sag and fold over the inframammary crease, the lower attachment point to the chest wall. This is more true for larger-breasted women. The fourth reason was significant weight gain or loss (greater than 50 pounds (23 kg)).[2] Other significant factors were higher body mass index and larger bra cup size.[11]
Breast compressions help empty the breast by applying gentle pressure to the milk ducts. To do breast compressions while pumping, start with your same hand and breast (e.g. left hand and left breast) and form a C shape with your thumb and index finger. After you begin pumping, place the index finger under the breast and the thumb on the top of the breast, maintaining the C shape. Make sure you don't get too close to the flange or areola. Begin applying gentle pressure to the breast - you may even see milkflow increase while doing so! You can continue to apply pressure, or do a pulsating pattern along with your pump (for example, hold the compress for 3 pump cycles, release for 1, and repeat).
Using breast massage while pumping is a similar concept to breast compressions, except you will be stimulating individual areas when you massage. To massage your breasts, 'point' your index and middle fingers together firmly. Then, while pumping, begin at the top of the breast and apply gently pressure, moving your fingers in a circular movement. Slowly work down toward the areola - stop before reaching the areola and area under the flange. Repeat the process beginning at different areas around the breast, including underneath the breast and in the armpit area.
When breasts are made up of more fibroglandular tissue than fatty tissue, they are considered dense. Having dense breast tissue is usually inherited, but young age, weight loss with a reduction in body mass index or receiving hormone therapy can also influence your breast tissue. Breast density is classified into four categories. When you get a mammogram, the radiologist who interprets your images can determine if you have dense breasts and which category you match. Your breast tissue can be: 2ff7e9595c
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