There are so many things for a mother to share with her daughter. Among the important lessons is breast care. The onset of puberty for girls is marked with the growth of the breast as well as the start of the monthly menstruation.
Learning to take care of the breasts and doing the self-examination from an early age is important, says Dr Harjit Kaur, consultant breast and endocrine surgeon.
Her advice is that as soon as girls start developing breasts they must be taught that it is not wrong to look at their own bodies in the mirror and that it is also not wrong to feel their breasts. In fact, they must be taught to do the self-examination and to be aware of anything abnormal.
“In our culture a lot of people still have this aversion to feeling their own breasts and looking at themselves. I get a lot of women who say they don't do their self-breast check because they're embarrassed.
“I think this is what we need to get the younger generation to understand – that the breast is just another part of their body.
“Just as how you would look after your heart, you should similarly look after your breasts because it can kill you if you don't,” she says.
According to Dr Harjit, she has patients as young as 17 and 18 who come in with lumps bigger than the size of their breast. They didn't realise it was abnormal and hence they kept quiet about it. Worse of all is that they were too embarrassed to even ask or tell their mothers about it.
Parents and children need to be aware that it is not only adults who get lumps and cancers. Dr Harjit confirms this is a myth
“You can start getting breast lumps from as young as 15 and 16. It needs to be followed up because the younger you get it the more aggressive it is. So you need to follow up on that because these are the lumps that grow very quickly and sometimes they become dangerous.
“Secondly, we now get a lot of patients in their 20s and 30s with breast cancer. No one is free from the risk of breast cancer. My youngest patient developed a lump at 19. By 20 she was already diagnosed with breast cancer. When you're 18 or 19, most GPs (general practitioners) might tell you not to worry and that the the lump will go away. That seems to be the standard myth but it should not be that way anymore because anything can happen.
“When you have a lump, see a specialist and get it assessed. That's very important. Don't just ignore it and say it's nothing and forget about it,” she adds.
While all lumps should be checked by a doctor, not all lumps are cancerous. According to Dr Harjit, 90% of breast lumps are non-cancerous. It could be fibroadenomas or breast cysts.
So, parents need to advise their daughters that if there is a lump, they need to get it checked but do not panic because only a very small proportion of lumps is actually a cancer.
However, if you do not get it checked by a professional, you won't know what that lump is.
Dr Harjit explains that if the lump turns out to be a breast cyst, nothing needs to be done.
If it's fibroadenoma, depending on the size, you will need a followup to keep an eye on it to see whether it's growing and to see whether it requires to be removed or not.
Parents also need to advise their daughters that the breast self-examination includes checking the armpit area, which is sometimes overlooked or forgotten.
The armpit area is where the lymph nodes are. Dr Harjit says the lymph nodes can get enlarged for many reasons.
“Any infection in the breast will cause your lymph nodes to enlarge. Sometimes when children start shaving their armpits, and if they don't do it well, they injure themselves. That little inflammation there itself can trigger your lymph nodes to get enlarged as well. So they end up with sore lymph nodes.
“For them, when they have enlarged lymph nodes, it is more likely to be all these inflammatory causes rather than cancers. Nevertheless you must always check because there are other kinds of cancers like lymphomas that can present itself in lymph node enlargement as well. So, it may be totally unrelated to the breast.”
Importance of self-image
According to Dr Harjit, it is quite common to find teenagers who are unhappy with the size of their breasts.
“They are at an impressionable age where they see movie stars and models, young girls with breasts, who dress up. I think it's very important for parents to first understand that full breast development takes a good four to five years before it achieves the maximum size. That means that after that you shouldn't expect it to grow further very much. So, if your child starts developing at about 12 years old, you would think that by 17, 18 – that's probably going to be their breast size. You won't expect it to grow any bigger unless of course when they get married and get pregnant. It's very important that children are advised of these things.
“I know that breast implants are something a lot of teenage girls think about these days especially when they're not happy with the size of their breasts because they compare themselves with other girls who have got much bigger breasts.
“The important thing to understand is to make sure that the full development has taken place before any decisions to get implants are made. At 15, 16, 17, that's not the right age to think of doing implants because your breasts are still developing so things are going to change. If you put in implants too early, you may not be happy because your breasts are still developing, the contour changes, the shape changes and you'll have a lot more problems.
“I think more importantly, parents should be able to talk to their children and speak to them about self-esteem, self-confidence, check the emotional status of the children rather than just saying 'Yes, your breasts are small'. If the implants are going to help you then fine but I don't think that's the answer.
“Children at that teenage age should not be subjected to these sorts of cosmetic procedures because they are still growing physically, mentally and emotionally. I think more importantly they need to be counselled by their parents, they need to be taught to learn to accept their body, love their body, appreciate what they have,” she says.
The exception would be if the child has amastia where one breast is developing while the other isn't.
Dr Harjit informs that many girls who have this problem suffer in silence. They don't know that there are options to rectify this problem and they are too embarrassed to come forward to get help.
“For those with amastia, it can be very, very obvious that one breast is not developing. The growth rate is tremendous in one but not in the other. In situations like this, they must see a specialist. Bring the child in because you can balance it out from the beginning. In such situations, you will require some sort of implant and expander to assist in the balance of the child so that one breast is adjusted to match the other.
“At what age you do this depends on the condition. If you have a very subtle discrepancy, I would not do anything until after the child turns 18. That would be the ideal because you still want to wait for the final development to take place. But if you have a condition where you feel one breast is growing and the other isn't growing at all, then even at 15, 16, you would want to put an expander and implant in the side that's not growing.
“The idea of the expander is to stretch out the skin. You know that this breast is not ever going to develop because there is some problem with it. You would want to get the breasts to balance and get it adjusted at that age itself because it would affect this child psychologically,” says Dr Harjit.
She explains that because the girl is still growing, the parents have to understand that there might be a series of surgeries in the future because you need to keep adjusting and balancing the size of the breasts until she reaches adulthood.
So, you keep matching it until the breast that is growing actually stops developing. Then you would be able to do the final surgery to make sure that she's balanced.
It is advisable to have the implant and expander put in because if you leave the child with one large breast and one not growing at all, it will affect her spine, posture, growth and most of all her self-esteem and psychological status.
Because implants do not last a lifetime, the girl will then have to keep replacing her implants as she gets older.
Girls who are extremely big breasted face another problem. They need proper support to ensure they do not develop back problems and bad posture. They might also need help to boost their self-confidence and accept their bodies.
Although breast reduction is an option, it should only be a last resort if it is seriously affecting the child psychologically and causing her to become withdrawn and depressed or if it is causing her pain.
How about boys with breasts?
Sometimes with boys who were obese when they were small, you will find that when they go into their teenage years they have “breasts” – a condition known as gynaecomastia.
Dr Harjit says these boys become conscious of how they look when they go for sports.
“They become very embarrassed because they look like they have breasts and they end up wearing two or three layers of T-shirts to conceal it. It affects them more psychologically.
“For boys, it's not an issue. It must be done. It's a very simple procedure called subcutaneous mastectomy where you remove the entire breast tissue with just a small little cut below the nipple areola and he'll have a flat chest after that.
“He would need to consult a breast surgeon for this procedure.
“Before doing any surgery we would rule out any endocrine problems first because for some of them it could be part of their hormonal status which is completely haywire that is causing the gynaecomastia.
“If that's the situation, then what we need to do is correct that before doing the surgery because you're not actually helping if you just do the surgery. In boys who were originally fat or obese and then have a sudden drastic weight loss causing this sort of a problem, then surgery is the definite answer.”
Common problems
Discharge of the nipple is very common, says Dr Harjit. It can happen in young children, especially teenagers. For some, it is a hormonal problem. If you have discharge of the nipple when you're not breastfeeding or lactating, it is not normal so you need to get it checked. Especially so in young girls because it could be related to certain conditions, the most common being a benign tumour in the duct.
If your child has it, just get an assessment by a medical professional because you need to make sure that there's nothing sinister underlying, adds Dr Harjit.
Sore nipples are another common condition. Initially, a child may complain that her breast hurts. When the breast buds are developing, some children tend to have sore breasts. This is all part of the breast buds developing, so they tend to get a little sore.
Hair on the breast is normal, says Dr Harjit. Around the areola you have the sebaceous glands with the little dots and bumps. Those are normal. Similarly you have hair follicles on the breast as well. Sometimes some hair may grow a little more than others. Dr Harjit advises taking a pair of scissors to snip these off at the base instead of plucking them out, if the sight of them really bothers you. It is not advisable to pluck those hairs out as it could trigger an inflammation and result in abscesses and infection of the adjacent oil glands.
Noticeable veins on the breast is very common because the fairer you are the more obvious your veins are going to appear on your chest, says Dr Harjit. However, if it's something that is new and it's never been there before, then you need to get it checked.
“Generally, I don't expect this in young teenagers. One of the reasons for dilated veins is cancers because you start developing bizarre blood supplies. Secondly, you can get SVC (superior vena cava) obstruction. That's when your large veins on the inside get obstructed for some reason, whether it's blood clots, trombosis or a lot of other conditions. So, what happens is your body starts to find new channels for the blood to go through and collateral pathways start opening up. So, these veins which were originally there but not very prominent all of a sudden become very prominent on your chest,” she explains.
Proper support needed
Importantly, Dr Harjit emphasises the need for children to have proper support. There's no point in wearing a bra for the sake of wearing one if it is loose or ill-fitting and not providing proper and adequate support.
“As long as their breasts are very small and they're not developed yet, girls can wear any slinky spaghetti strap bra. But as soon as their breasts start to develop and they have volume, I think it's very important to wear bras with proper straps. They don't have to wear the big broad ones but just proportionate to how big their breasts are. And make sure that the straps are firm, at least for the day-to-day bra used when they go to school and come back.
“When they go for parties at night, if they want to wear a slinky bra that's fine once in a while. But the regular bras that they wear most of the time, while they're active and playing games – those must have good supportive straps.
“Underwired bras are absolutely safe. It's a myth that underwired bras cause cancer. But what is important that we must stress is that the underwire must be under the breast. That means the breast must be in the cup. The problem is when people buy the wrong size and the wire ends up sitting on their breast instead of under it. This will cause damage to the breast tissue because of the constant pressure by a firm item against your breast tissue,” adds Dr Harjit.
She explains that this is one of the main causes of breast pain. If you have a good fitting bra, you will find most of the aches and pains – neck pain, breast pain – will actually disappear.
“When parents take their daughters to buy a bra, it's good if they go to places where there are sales ladies to help them measure their chest girth so that they get the right bra for their size. Make sure they're fitted properly so that they're comfortable. That is important,” she adds.
Listen up!
According to Dr Harjit, parents and children need to know that if they are not happy and think something is amiss with their breasts or bodies, they should seek advice. She urges parents and children not to suffer in silence and just think that it's some curse upon you or it's your bad luck because it's not. Medical conditions happen and they can also be rectified if looked into early.
“The main thing I want to stress for children is for them to get to know their breasts. That is one of the main problems that I see happening in our society. People are just too afraid to look at themselves, examine themselves and to seek help when they are not sure or when they find something wrong. They are just too embarrassed.
“They must know that these are issues they must see a doctor about. You don't need to run to a specialist straightaway if you don't want to but at least see the regular doctor that you're comfortable with first. Get a check to see if anything is abnormal and then they can make the necessary referrals. This is a very, very common problem and it's just not addressed well enough. The schoolgoing children are the most important. Teach them young, at that age, and they will continue fine.”
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