The breasts, also known as mammary glands, are made up of glandular, fibrous and fatty tissue. They sit on the front of the chest and go up into the armpit. Ligaments and large muscles support them.
The glandular tissue contains lobes, with many smaller lobules inside each one. The lobules are milk producing glands. Milk is produced in response to the hormone changes of childbirth. Milk is carried through ducts to the nipple. The darker skin around the nipple is called the areola. Small raised bumps on the areola are called Montgommery glands. They produce fluid to moisten the areolar.
It is common and normal for one breast to be larger than the other. The nipples usually point forward, although they may look different on each breast. It is not unusual for one or both nipples to point inwards (inverted). This can be present at birth or can happen when the breasts are developing. The nipples are hairless but it is not uncommon for some women to have a few hairs around the areola.A small number of people have an extra breast or pair of breasts. These are usually in the lower armpit. Some women have an extra nipple or pair of nipples, usually below the breasts or above the belly button. Accessory breasts or nipples are not usually a problem and do not need to be removed.
Breast development and ageing
The breasts are constantly changing from puberty through to the menopause and are affected by changing levels of the female hormone oestrogen.
Most girls start to develop breast around the age of 9 – 11 years, but it can be earlier or later. It is not unusual for the breasts to grow at different rates. Breast lumps can occur while the breasts are developing. These are always benign and don’t usually require any treatment once they have been diagnosed.
Once the breasts have developed changes relating to the menstrual cycle are common. Just before a period the breasts may become larger, tender or feel a bit lumpy. After a period this can become less obvious or can disappear, some women though can have tender breasts all the time.
Many women have cyclical breast pain, which is related to the menstrual cycle.
During pregnancy the breasts generally get a lot bigger. This is due to an increase in the number of milk producing cells. The nipples may become larger and may stay this way following pregnancy.
Breast tissue changes with age. It begins to lose its firmness and the milk producing tissue is replaced by fat, this can make the breasts droop.
Being breast aware
Breast awareness is an important part of caring for your body. Being breast aware is about becoming familiar with your breasts and the changes they go through as you progress through life. It means knowing how your breasts look and feel normally so that you notice any changes unusual to you.
There is a 5-point breast awareness scale as recommended by breast cancer care.
- Know what is normal for you
- Know what changes to look and feel for
- Look and feel
- Report any changes to your GP without delay
- Attend for routine breast screening if you are aged 50 of over
How do I check my breasts?Checking your breasts regularly is important. You can do this in the bath or shower, when you use body lotion or when you get dressed. There is no right or wrong way to check your breasts for any changes. Breast Cancer Care has a short video giving advice on checking your breasts and what changes to be aware of.
What changes should I be aware of?
(Breast cancer care advice)
- a lump, area of thickened tissue or bumps in either breast
- a change in size or shape of one or both breast
- a lump or swelling in either of your armpits or around your collar bone
- skin that appears like orange peel
- crusting on or around the nipple
- a leaking nipple which may or may not be streaked with blood
- dimples or skin that has been drawn in
- a nipple that’s become turned in
What shall I do if I find a change?
You will know better than anyone how your breast look and feel. If you do notice a change see your GP. Never worry that you are making a fuss. Remember that most changes will not be cancer, even if they do sometimes require treatment or follow up.
When your GP examines your breast s/he may be able to reassure that there is nothing to worry about.
S/he may think that the change is related to your menstrual cycle (hormones) and ask you to come back at another time in your cycle, often after your period.
S/he may decide to send you to a breast clinic for a further examination.
Breast cancer screening
Eighty per cent of breast cancers are found in women over the age of 50. If you are between the ages of 50 – 70 you will be invited to take part in the National breast-screening programme every three years.
Your name will be taken from your GP’s list and you will be asked to attend a local centre for a mammogram (breast x-ray).
This may not happen the year you turn 50 but it should have happened by the time you reach 53. If you have not received your first invitation by your 53rd birthday contact the local screening service (for patients living in Dumfries and Galloway this is the South West of Scotland Breast Screening Centre 01294 323595 or 323506 or 323507).
Remember you will still need to be breast aware even if you are taking part in the breast-screening programme, report any changes to your GP straight away even if you have recently had a mammogram.
A small number of women will be asked to come back for further investigations after having a routine mammogram. This does not necessarily mean that you have breast cancer. It may be because the mammogram is unclear, or because it shows up something that needs further tests. If you are sent a recall letter it is important to attend the appointment.
It you are over the age of 70 you will not be invited to attend for breast screening. However you are still at risk of breast cancer and are encouraged to attend for free screening every three years. All you need to do is contact the local breast screening service (for patients living in Dumfries and Galloway this is the South West of Scotland Breast Screening Centre 01294 323595 or 323506 or 323507) or you can ask your GP or practice nurse to arrange an appointment for you.
For more information see the NHS Scotland leaflet Breast Screening – helping you decide. The leaflet provides information on the breast screening process, what to expect at your breast screening appointment and discusses the benefits and risks of breast screening to support women to make an informed choice about whether to attend for their screening appointment. Information is available in other languages and an easy to read format.
There is also short video of the Scottish actress Elaine C Smith’s experience of going for breast screening available on the NHS Scotland web site and YouTube.Women under the age of 50 are not currently invited to attend for regular breast screening. This is because it is currently not thought to benefit them.