The Healthy Breast

Dr. Hanna Ian

“Trabecular derangement and mazoplasia cystica with adenosis bilaterally.  Some prominence of the suspensory ligaments.  No evidence for superdensities, skin thickening, or unifocal hypervasculatity.  Scattered acinar, punctate, singular calcifications in both breasts, the largest 1.5 mm.  They are quite discrete and do not have the same appearance as microcalcifications associated with malignancy.

TRANSLATION: Completely normal findings on a routine mammogram screening.

We live in an era where women’s health topics are popular fare on morning talk shows and in women’s magazines.  From college campuses to health maintenance organizations, classes are offered to teach women about trendy topics that seem to change in popularity like the seasons.  From menstrual cramps to hot flashes, from osteoporosis to endometriosis, from vaginal yeast infections to the latest contraception hoopla, then perusing through the alphabet soup of PMS, PID, UTI, IUD, DUB, ERT, TSS, DES, CFS, BSE and STD.  They which permeate the airwaves and periodicals are not health issues but disease issues.  What really is being sold to women is not a women’s health consciousness but a women’s disease mentality.  Women are better informed about diseases than their sisters twenty years ago, but still in the dark when it comes to understanding how their normal, healthy bodies functioning beautifully and naturally.  Culturally a taboo still exists which discourages a woman from looking at, touching and knowing her own body. 

Several years ago I was asked by the American Cancer Society to give a lecture to a community women’s organization on breast cancer and the breast self-exam.  I readily agreed but explained I would lecture primarily on the characteristics of the healthy breast, concluding with a brief presentation on breast cancer risk factors followed by the breast self-exam.  My proposal was met with less than enthusiasm.  Was this perceived as a radical departure from the norm of “disease education?”  Why is it acceptable to educate women on a malady that most women will not get, instilling fear and anxiety while failing to teach women about the fascinating, uniquely changing composition of the healthy breast which most women will have throughout their lives? 

During the same period of time it was reported that most breast lumps were not discovered by the woman herself, but by the person with whom she was intimately involved.  What does this say about women’s attitude toward owning, loving, caring for and even touching their own bodies?  This discomfort was further exemplified following my lecture to the women’s group when, in discussing the fact that most breast lumps occur in the upper, outer quadrant of the breast, I made an appropriate gesture and in raising one arm, reached across with my other hand and touched my own breast – a gesture which distressed at least one women as evidenced by the overheard commentary, “Did you see that?  She touched herself! She touched her breast!” 

It is time to shake the cultural preoccupation with the breasts as a source of eroticism and sexual gratification for others; the breast as a determinant or a detriment to fashion; and the breast as the glorification and epitomized standard of beauty, and hence worth, for women.  In doing so, what significance do we, can we, and should we give to this pendulous, modified sweat gland whose size it largely determined by fat? 

The breast is truly remarkable and unique.  Imagine, for a moment, its ability to take from the blood stream the essential ingredients of water, sugar, protein and fat, and then combine them to create the perfect life-giving fluid.  Figuratively and literally, it is through her breasts woman gives and receives nurturance – the giving through breast feeding, the receiving through her own sexuality.  While exists a range of cultural attitudes and personal preferences which influence sexuality, conception and infant feeding, nevertheless, the breasts are intricately associated with the “whole” of sexuality and reproduction, and are specifically connected to the uterus.  Consider for a moment the harmonious relationship between the breasts and the uterus: 

  • Sexual arousal that results in heightened breast sensitivity and uterine congestion/engorgement.
  • Breast stimulation (touching, sucking) and enhanced uterine contractions during labor.
  • Breast feeding and postpartum uterine contractions (contributing to the constriction of uterine blood flow). 
  • Similar cyclic breast and uterine changed resulting from ovarian hormones.
  • Breast and uterine diminution associated with menopause. 

One cannot fully comprehend the breast outside the context of the whole body.  While the breast may seem different, based on its appearance and location from that of its sister- the uterus, indeed it is quite similar and comprised of comparable tissue.  As such, to understand the normal, natural breast is to understand the normal, natural uterus – and toward this end there needs to be a brief explanation of the effects of the ovulatory cycle on these sister organs. 

Most writings of the women’s cycle fail to acknowledge the whole or entirety of the process of ovulation.  They focus only on the occurrence of menstruation, describing it in linear terms with “day 1” being the first day of the menstrual bleed, as if there were a beginning and an end to this event.  A cycle it truly is, with no beginning and not end.  For everything that happens today will be conditional on that which happened yesterday and the week before.  Because of its cyclic nature, we can begin at any point in time to look at the changes occurring with the breasts and their sister uterus, all with the understanding that every ebb and flow, every growth and recession is the result of events already passed.  We could start with the onset of menses, but instead let’s begin fourteen days prior when ovulation took place.  The oocyte, commonly referred to as the egg, bursts through the surface of the ovary forming a small “scab” called the corpus luteum which will produce two hormones, estrogen and progesterone.  Estrogen and progesterone will have similar and simultaneous effects on both the breast and uterine tissue.  These hormones will cause the breasts and uterus to swell with secretions over the next seven to ten days; the breast in preparation for lactation, the uterus in preparation for the implantation of a fertilized oocyte. 

Approximately seven days after ovulation, if conception has not occurred, progesterone and estrogen levels will gradually diminish as the “scab” on the surface of the ovary heals to a “scar” and the corpus luteum begins to regress.  On the fourteenth day after ovulation two things happen, both caused by the diminished levels of estrogen and progesterone from the ovary.  The uterus can no longer hold onto the secretions in the spongy lining and menstruation begins; simultaneously the pituitary gland in the brain releases a hormone to stimulate the maturation of new ovarian follicles, appropriately called follicle stimulating hormone. 

Each ovary is made up of thousands of tiny little bags or follicles.  In Latin, follicle means “little bag” and within each follicle is an oocyte.  The follicle stimulating hormone causes not one, but hundreds of follicle of the surface of each ovary to begin maturation.  Eventually all but one of these maturing follicles will die, a process known as atresia.  However, prior to atresia, these maturing follicles will produce estrogen alone, and as they continue to mature they produce more and more estrogen which will have an amazing effect on the breast and the uterus: it causes them both to grow.  The uterus having just lost the previous month’s lining and secretions begins to proliferate and regenerate a new endometrial lining.  The glandular ducts of the breast also proliferate, as well as their terminal buds, the alveoli.  This is the preliminary growth needed for lactation, should a pregnancy occur.  This growth occurs with each and every cycle whether conception occurs or not.  Connective tissue in the breast also proliferates and becomes infiltrated with fat.  This creates the shape of the mature female breast. 

The follicular phase varies among women and is the factor causing the menstrual cycle to vary in length.  For some women follicular maturation will be accomplished in 6 days, for others 16.  Regardless of the length of time, when the estrogen level reaches its peak, as a result of an abundance of maturing follicles, it triggers the pituitary gland to release a different hormone called luteinizing hormone.  Luteinizing hormone causes three things to happen: first, it stops all follicular development; second, it causes one follicle in particular to rupture through the surface of the ovary (ovulation); and third, it gives the ruptured follicle the ability to produce progesterone in addition to estrogen. 

Having come full circle to where we began our study, let’s look at the effects of estrogen and progesterone on the breasts with greater clarity.  Following ovulation, estrogen and progesterone will cause both breasts and uterus to go through a secretory phase.  The uterus begins now to fill and swell with secretions.  The resulting abdominal fullness and heaviness are a common experience of women.  The glandular ducts of the breast dilate and the alveoli begin to secrete a small amount of fluid.  Increased blood flowing into the breasts following ovulation also contributes to the feeling of heaviness, fullness and tenderness, and in the week prior to menstruation the breasts do get larger. 

If conception occurs, both the breast and uterus undergo profound and rapid growth.  If no conception occurs, as previously mentioned, estrogen and progesterone levels will gradually diminish, causing the onset of menstruation.  With the process of menses, the uterus sheds or loses the proliferated endometrium and its secretions.  But what about the breasts?  The breasts do not have an equivalent of menses to lose their proliferation and secretions.  During the menstrual phase of the uterus the proliferated glandular ducts of the breast do begin to regress; the ducts become narrower, the alveoli become smaller and some fluid is reabsorbed.  But before the breasts can totally regress to their previous size a new cycle has begun.  Estrogen once again stimulates the glandular ducts and alveoli to proliferate before they have had an opportunity to completely regress, and each successive ovulatory cycle results in a little more and a little more mammary development.  While this development may be very small, the breasts do continue to grow with each ovulatory cycle until a woman is approximately 35 years of age.  It is at that time that peri-menopause begins with a gradual decline in ovarian function with estrogen and progesterone production, and as a result the breasts do stop growing. 

While the majority of women will spend a considerable amount of time and effort to prevent a conception from occurring during their reproductive years, the breast spend most of every month preparing for lactation in anticipation that a conception will occur.  But nourishing an infant is not the only benefit of lactation.  Breast feeding can accomplish for the breasts what menses accomplished for the uterus: elimination of fluid and tissue.  Pregnancy creates tremendous elongation of the glandular ducts and suckling provides the prefect process for the elimination of secretory fluids that previously had only been partially reabsorbed before the next ovulatory cycle set the whole process of proliferation in motion again. 

As it becomes apparent that the natural purpose of the mammary gland is to nourish an infant, the relationship between reproduction and its effect on breast development and breast cancer become apparent, as many of the risk factors associated with breast cancer are linked to fertility.  These risk factors include:

  • The early onset of menses and the late onset of menopause.
  • Never having a full-term pregnancy.
  • First full-term pregnancy after the age of 30.

Most breast cancers develop in the glandular ducts of women who have not had the process of breast development interrupted by periods of gestation and lactation.  It is well known that breast feeding is one of the greatest factors in the reduction of risk for breast cancer.  Pregnancy halts the continual changes and development associated with the ovarian cycle, and at the same time elongates the glandular ducts of the breast.  Lactation provides the vehicle to eliminate, through the elongated ducts, the accumulation of breast fluid and proliferated cells which may be the precursors to cancerous changes. 

While it is well known that dietary, genetic and environmental factors play a role in the development of breast cancer, there is now a growing awareness the emotional, psychological and spiritual factors also exist which create physical illness.  The quality of health is intimately linked to one’s ability to deal with life issues such as disappointments or frustration with relationships, the experience of loss or financial crisis.  While this has been more clearly articulated in recent times, it is not an entirely new idea.  In the late 1800’s physicians were writing about the association between breast cancer and sorrow, loneliness, anger and rage.  Today, more than 100 year later, the science of psychoneuroimmunology seeks to understand the effects of emotion, thoughts and stresses on the immune system.  When medical sciences began to look seriously at the varied influences on stress upon the body, it marked the turning point in how our culture perceives the very origin of disease – that disease originates not from outside, external agents, but from forces within.  Emotional tension is disruptive to the physical body and the majority of physical illnesses are manifestations of an overload of emotional, psychological and spiritual stresses. 

To this end, it is worth examining the deeper lesson to be learned through illness.  After documenting stories and listening to women describe their paths to recovery from breast cancer-whether they worked with surgical, chemical or radiological therapies, alternative dietary, visualization and inner spiritual work, or a combination of approaches- what becomes clear is that the process of healing their illness also had a profound effect on their personal lives.  It resulted in creating a deeper realization of the purpose of life, resolving old hurts and resentments, learning to forgive, expanding relationships with greater depth, openness and honesty, empowering them to move forward with life – in short, realizing the importance of loving and nurturing self. 

Once there is the realization, understanding and appreciation of the power of emotions and attitudes on health and wellness, it becomes difficult, if not impossible, to allow negativity of any kind to go unchallenged in one’s life.  For a woman to have a healthy body she must above all love herself and every aspect of her femaleness – her breasts, hips, abdomen and genitalia.  She must trust her feelings and the gifts of intuition that are bestowed upon her; respond to the needs of others as well as reach out for what she needs from a position of inner strength the confidence.  This comes from loving herself; form continually giving herself positive thoughts about the female body she has, regardless of the size or shape or her breasts or hips; from respecting, accepting and validating the very nature of her femaleness and her femininity; and above all, from giving attention to any unresolved or deeply consuming stress because every thought and every feeling can lead toward the creation of health or the creation of disease.