OK, so maybe someone has let you know that having one side of your chest be smaller than the other is normal. But did you know that almost everything your breasts do is normal? Trust. What even is a body? It’s a fleshy suit that sustains our earthly consciousness. That’s pretty fucking weird, and yet totally normal. So! THE TRUTH.
Part One: Health
Breasts can be set wide apart or close together. They can have a fold underneath, or not! Two to six percent of the population straight-up has a third nipple. “Normal” doesn’t exist. Healthy does. Your mission is to know your own healthy so that you can pick up on any changes that might occur.
Now, there’s not a lot you have to do to make sure your breasts are OK when you’re young. Medical organizations disagree on how old someone should be when they get their first breast exam—or if they’re worth getting at all. The American College of Obstetricians and Gynecologists and the American Cancer Society both recommend starting at age 20. A breast exam at your age is just your doctor or clinician feeling your boobs to see if there’s anything that seems unusual. Usually this person is your gynecological practioner—and if you’re past puberty and/or sexually active, you should have one of those. If you’re in the U.S., Planned Parenthood is a good resource for affordable (sometimes free) health care.
Health-care providers used to recommend that everyone feel their own breasts at least once a month. But these recommendations have changed. After data came out showing that doing monthly self-exams didn’t have any affect on the rate of women who died from breast cancer—and, as a bonus, caused a lot of unnecessary testing and freaking out, the United States Preventative Health Taskforce changed its guidelines to recommend against breast self-exam entirely. But guidelines from other organizations, like the American Cancer Society, still recommend it, but only as an optional method for checking in—not to “find something,” but so that you’ll know your own enough to notice if anything changes. If you do want to learn how to do it, here’s an adaptation of the instructions from the American Cancer Society (ACS):
- Lie down with your right arm above your head in a dramatic faint position, like you were born into a culture that invalidates all feminine emotional expression as hysteria! Haha that’s nobody reading this, I know.
- Take the middle three fingers of your left hand and place the fingertips just inside your right armpit, up near your collarbone.
- Press your finger pads down and move them in a circular motion at three levels: light pressure “to feel the tissue closest to the skin,” in the ACS’s words; “medium pressure to feel a little deeper; and firm pressure to feel the tissue closest to the chest and ribs.”
- Repeat, moving in a vertical line with a little overlap to cover everything. I call this move “mowing the lawn,” but I am open to suggestions. Go as far up as your collarbone, as far down as your bra line, and as far out as the middle of your armpits.
- Switch the arm behind your head to your left, and repeat on the opposite side.
- Take a break to enjoy a refreshing beverage.
- Stand up, face a mirror, and press your hands on your hips like serious business, looking for, per the ACS< "any changes of size, shape, contour, or dimpling, or redness or scaliness of the nipple or breast skin.”
- Raise your right arm slightly and feel around your armpit. Switch and repeat.
What are you feeling for, exactly? Healthy breast tissue feels like the tops of broccoli when you press down on it. Since many people are visual learners, I’ve decided to go there.
If you do come across a change that seems suspicious, try not to think “cancer.” Also try not to think “Don’t think cancer!” because that’s ineffective, too. Try “Don’t think corgis! Don’t think corgis!”
People under the age of 25 have a ridiculously, ridiculously low rate of breast cancer (like, less than 1%). What are common in young women, though, are conditions that are considered “benign breast disease,” which is kind of a dumb name, because disease suggests something harmful and scary, and what we’re talking about here are basically boob zits. For teenagers, the most common kinds of these are fibroadenomas, fibrocystic changes/cysts, and infections like mastitis or abscesses. Most of you have never heard of any of those conditions, even though they’re incredibly common—and they’re feeling kind of resentful about it, because, what, do they have to be mean like cancer to get us to pay attention to them? “OK, fine. Listening.” In order of popularity:
- Fibroadenomas: Fibroadenomas are the #1 breast lump AND the #1 breast lump that is going to make you think you have cancer! Three-quarters of all breast lumps found in teenagers are fibroadenomas. They are usually round and feel solid, firm, or rubbery: aka exactly like you’d think cancer would feel. They seem to come out of nowhere, and usually grow to the size of a grape and then stay that size, shrink, or go away completely. Fibroadenomas are almost never painful, but can be tender around your period, especially if they’re larger.
- Cysts: About half of all the boobs in the world, if you really get in there and mush around, have a kind of ropy texture—sorta like a bunch of tiny beads all up in there. This type of texture has been called “fibrocystic breast changes” or “fibrocystic breasts,” because these breasts are more likely to develop cysts. Here is an unforgettably vivid explanation of a cyst: “A fluid-filled sac that is usually smooth, firm, movable, and sometimes tender like a water balloon without the water… [They] generally increase in size before the menstrual period and decrease afterwards. A large cyst may be round and feel a bit like an eyeball when pressed with the eyelid closed.” Whee! My doctor friend tells her patients: “Sometimes boobs are lumpy—whatever. Everyone’s boobs are at least a little lumpy. Some are lumpier than others. Check your boobs out every once in a while and see if they get lumpier over time, or if a single lump gets weird or anything.” Read more about cysts and fibrocystic breast changes here.
- Infections and abscesses: These are are pretty rare, and they’re usually preceded by a cause: breast trauma (e.g., soccer ball to the chest) is one. Another is nipple piercing: 10-20% of nipple piercings get infected, sometimes months or years after the piercing happens—picking a reputable piercing joint and practicing good after care will help prevent this from happening. Smoking cigarettes also puts you at higher risk for developing infections. Symptoms of an infection or abscess include breast tenderness, pain, heat, redness, swelling, and whole-body symptoms like chills and fever. This is something you should really get checked out! The first treatment is antibiotics, but in more serious cases the abscess may need to be drained surgically.