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Know Your Breasts

Breast care is an important part of women's health and well-being

From an aesthetic viewpoint to nurturing babies, breast care is an important part of women's health and well-being. Reader's Digest looks at complex ethical dilemmas that arise from breast cancer research, the various conditions that can affect the breast and the myths of breastfeeding. Plus, we get men to speak out on what they think of breasts

BREAST CANCER RESEARCH

Imagine you're 34 years old and yearning to marry one day and have kids. Then your mother dies of ovarian cancer after battling stage II breast cancer. You subsequently take the test for BRCA mutation, the genetic marker for breast and ovarian cancer, and discover to your horror that you have a 50 percent chance of developing breast cancer before the age of 50, and a 44 percent chance of getting ovarian cancer in your lifetime (where most women have a 1-2 percent chance).

What would you do? Would you commit to a lifetime of vigilant screenings and fight the disease if it came to pass? Or would you take the radical step of preventative surgery that includes mastectomy (surgical removal of the breasts) and oophorectomy (surgical removal of the ovary or ovaries)?

In her book Pretty Is What Changes, Jessica Queller chronicles the harrowing true story of a journey in which doctors provide plenty of survival statistics, but leave the hard decisions to her.

Still waiting for her Mr Right to come along, the television scriptwriter undergoes a double mastectomy (with reconstruction) and delays the removal of her ovaries until she turns 40. A passionate believer in using biotechnology to optimise her chance of a long and healthy life, Queller also considers safeguarding her future offspring from inheriting the deadly breast cancer gene she inherited from her mother. By a process of preimplantation genetic diagnosis, or PGD, Queller allows for the possibility of her embryos (created with the help of a sperm donor) being tested for the BRCA mutation.

Typically, mastalgia is either cyclical (linked to the menstrual cycle) or non-cyclical. When breasts become tender or painful just before a period, a warm shower or hot compress to the chest can reduce painfulness; alternatively, some sufferers prefer an icepack to reduce the fluid retention that hormonal activity triggers. Breast expert Dr Benjamin Norris of Silkwood Medical recommends that women drink as much water as possible, and cut down on caffeine intake, if they wish to reduce fluid retention and breast pain around period time.

Fibroadenomas If you're checking your breasts in the shower and you feel a small lump or two, don't panic. A biopsy could easily reveal benign masses of fat and fibrous tissue known as fibroadenomas. Commonly found in women under the age of 30, they also occasionally occur in older women. Typically they are small and firm to the touch, but painless. Patients can opt to have them removed – it's a straightforward procedure, although a general anaesthetic is required.

Nipple discharge When breastfeeding, it is normal for milk to leak from the nipples, but if a discharge occurs at any other time, and particularly if the discharge is watery or bloodstained, see your doctor for advice. Similarly, any inversion (pulling in) of the nipple should be checked. Although often caused by harmless conditions, these symptoms can also indicate breast cancer.

Benign fibrocystic disease Commonly found in women whose breasts are particularly sensitive to the menstrual cycle, benign fibrocystic disease is the most common cause of non-cancerous lumps, thickening of the breast tissue, and cysts. Cysts can be painful and are caused by fluid trapped in breast tissue. Although harmless, they should be checked by your doctor, who may recommend removal of the fluid using a syringe with a fine needle. If cysts recur, more permanent surgical removal may be necessary. Typically, an ultrasound is used to determine if the lumps are fluid or solid.

Mastitis (Inflammation of the breast) Mastitis is commonly caused by an infection during breastfeeding, but if symptoms occur when you're not breastfeeding, see your doctor immediately. Treatment with antibiotics is required to prevent abscesses forming. If you're too late, a simple surgical procedure can drain the abscess.

Here's what experts recommend you do to optimise your chance of healthy breasts: Eat a healthy diet, including plenty of fruit and veggies, and avoid excessive fat Avoid excessive alcohol consumption Don't smoke Avoid excessive caffeine Exercise regularly and wear a good sports bra while you do Massage your breasts regularly to increase blood supply and eliminate toxins Don't diet excessively – yo-yo weight loss causes your breasts' ligaments to stretch and ultimately sag Drink plenty of water Avoid excessive sun exposure, as this may damage the elastic properties of the skin Check for changes to your breasts, and report them to your doctor.

ALL ABOUT BREASTFEEDING

Too busy to breastfeed? Perhaps you might like to consider the latest A-list accessory: a wet nurse. In the 18th century, wet nurses were all the rage as noblewomen deputised their responsibilities. Now, Hollywood's rich and famous are doing the same, figuring quite rightly that there's nothing better than mother's milk – they just don't want their babies to feast on theirs.

While the wet nurse phenomenon is not commonplace in Asia, there are cases of mothers with milk surplus offering it at a price to those who are unable to provide it themselves for their babies. The good news, however, is that women don't have to avoid breastfeeding because they fear their breasts sagging. A recent study by the American Society of Plastic Surgeons has found that breastfeeding does not cause sagging, as many women believe.

''Women may be reluctant to breastfeed because they believe that it means the end to youthful breasts,'' says Dr Brian Rinker, author of the report. His study found that a history of breastfeeding, the number of children breastfed and the duration of each child's breastfeeding had little impact on breast shape. Rather, excess weight, a greater number of pregnancies, smoking and age were far more likely to cause sagging.

All of which will be welcome news for women who breastfeed in a bid to boost their babies' neural development and immunity to infectious diseases. Here are more breastfeeding myths:

MYTH 1 Some women fail to produce sufficient milk.
FALSE. Most women do have enough milk supply. If a baby fails to gain (or even loses) weight, this is more likely the result of the baby not latching properly onto the breast or not feeding often enough. It is common for newborns to feed eight to 12 times in 24 hours.

MYTH 2 A mother must drink milk to make milk.
FALSE. A healthy diet of vegetables, fruits, grains and proteins is all that a mother needs to provide the proper nutrients to produce milk. Calcium can be obtained from a variety of nondairy foods such as dark green vegetables, seeds, nuts and fish. No other mammal drinks milk to make milk.

MYTH 3 Mothers who have had cosmetic breast surgery cannot breastfeed a baby.
FALSE. Many women who have had breast augmentation or reduction have gone on to breastfeed. It is important that women consider the issue of breastfeeding before going under the knife, as some procedures reposition the nipple and areola. In these cases, breastfeeding may have to be partial rather than exclusive.

MYTH 4 Mothers who breastfeed cannot consume alcohol or spicy food.
FALSE. Usually, the body digests and processes all the food a mother eats before the body makes breast milk. An occasional glass of wine or beer would not hurt a nursing baby and the same goes for spicy foods. There is also no conclusive research to support the theory that mothers who consume gassy foods (such as beans or broccoli) will have a colicky baby.

MYTH 5 Breastfeeding is a great alternative for birth control.
FALSE. While in many instances ovulation is suppressed during breastfeeding, only abstinence will ensure that no little surprises happen. Nursing mothers can safely take low-dose birth control pills or use barrier methods of contraception without harming their baby.

MYTH 6 A breastfeeding mother should space her feedings so that her breasts will have time to refill.
FALSE. A lactating mother's body is constantly making milk. Her breasts function in part as ''storage tank'', some holding more than others. The faster the breast is emptied, the faster the body makes milk to replace it. Conversely, the fuller the breast, the more production of milk slows down. If a mother consistently waits until her breasts are full before she nurses, her body may get the signal that it is making too much and may reduce overall production.

Breastfeeding Support in Asia SINGAPORE Breastfeeding Mothers' Support Group www.breastfeeding.org.sgPHILIPPINESLa Leche League of the Philippineswww.llli.org/Philippines.htmlMALAYSIAIbu Breastfeeding Support Group www.ibufamily.org/lll.htmlWorld Alliance for Breastfeeding Action www.waba.org.my

MEN SPEAK OUT ON BREASTS

Singapore-based Dr Chua Jun Jin, consultant plastic surgeon has around 15 years of cosmetic surgery experience. About 5 percent of his procedures are breast augmentation or uplifts, with silicone implants typically used to increase bust size. Even before his career as a cosmetic surgeon, Dr Chua says it isn't breasts or legs that he finds attractive in a woman; it's a woman's face and eyes.

Hundreds of breast procedures later, Dr Chua is still more likely today to notice a woman's face first before her figure. However, he says that ''large and shapely breasts are captivating and can even be hypnotic.''

Dr Chua believes breasts are a ''most cherished part of a woman's femininity, sexuality and self-esteem.'' For most of his patients, ''breasts are their centre of self-confidence''. His patients fall largely into two groups: younger women below 35 seeking to enhance small breasts, and older women desiring to improve sagging after childbirth. He adds, ''Breast enhancement is self-improvement.''

The cosmetic surgeon says Asian women, being conservative, generally ask for bigger but natural-looking breasts. Few women want overly large breasts, he explains. For him, a ‘perfect' pair of breasts is of ''adequate size'', ''natural shape'' and in ''appropriate proportions'' in relation to the woman's body.

And does he derive satisfaction from his cosmetic-surgery career? Says the surgeon, ''Most rewarding is when patients are content with their results and become more secure and self-assured. This skin-deep surgery can greatly improve many aspects of their life.''

Painter, Teo Kim Liong has been scrutinising women in the nude for years in pursuit of his artistic career. Nude art has become his ''expression of natural beauty'' as opposed to artificial female beauty.

As an artist, he interprets the female form as ''curves and lines''. As a man, Kim Liong does not single out any part of a woman's body as particularly attractive, but instead, he sees that every part of the female form is necessary to ''achieve unity''.

Teo says he appreciates the ''smoothness and harmony of curves and lines'' and the ''gentleness and softness'' of the female breast when painting the female figure.

And as for women who are comfortable with posing nude for art, Kim Liong describes it as a ''simple beauty'' where there is no need ''to hide and nothing to be shy about''.

Ultimately, it is the femininity of the female breast which is, to him, the most important.

Australia-based Dr Bruce Mason from the Australian Institute of Sports is something of an expert on breasts. Having researched the biomechanics of breast movement for almost 13 years, he warns women to avoid breast pain and breast tissue deterioration by wearing an appropriate bra.

Just as one wouldn't wear a running shoe to cross-train, or a tennis shoe to jog, he suggests a woman shouldn't consider wearing a fashion bra if intent on playing netball. ''A push-up bra is fine if you want to enhance your cleavage or overall shape,'' he says, ''but you need a good sports bra if you're going to go running.''

Dr Mason was surprised to discover through the course of his clinical trials how many women suffer breast pain while exercising. The specialist says breast pain is a dead giveaway that something is amiss.

''Whether you're breastfeeding or exercising, stop immediately if you feel pain and ask yourself what is causing your discomfort. Then do something about it!'' He says women should update their bra sizes as their life circumstances (and body shape and weight) change.