Breast Health 101: What is Normal and What is a Concern?
You may think you have breast abnormalities, but the truth is, most of what you’re experiencing is probably pretty normal. UnityPoint Health OB-GYN, Whitney Cowman, MD, tells us seven features of normal breasts that might seem odd, but are healthy, and when you should call your UnityPoint Health provider.
- Hair on/around nipples. Just like other skin surfaces on the body, the areola (dark circle around the nipple) contains hair follicles, so hair on the breast is considered normal. Shaving or plucking could lead to inflection, so if the hair is bothersome, it’s best to cut with a small scissors.
- Inverted nipples. This occurs when the nipple retracts into the areola. Approximately 10-20 percent of women have inverted nipples on at least one breast. Inverted nipples can also cause challenges for women who’d like to breastfeed.
- Discharge from nipples. Fluid can be expressed from the nipple ducts of at least 40 percent of pre-menopausal women, 55 percent of women who’ve had a baby and about 75 percent of women who have lactated in the last two years. The fluid generally comes from more than one duct and varies in color, either white, dark green or even brown. This type of breast discharge caused by manual expression is normal.
Spontaneous nipple discharge should be evaluated by your provider. This can be caused by a variety of situations, including medication, chronic breast stimulation, thyroid disease or other chronic medical conditions. Bloody or straw-colored (serous) breast discharge, especially from a single duct, should always be evaluated by a provider.
- Bumpy nipples. The areola contains numerous lubricating glands, called “Montgomery glands.” These show up as areola bumps and are completely normal.
- Areola color and areola types. Areolas come in all different sizes and colors, mostly due to hereditary factors. Some women notice dark areolas or an increase in size with pregnancy and breastfeeding, but these features usually return to pre-pregnancy appearance after breastfeeding is complete.
- Skin changes and stretch marks. Breast skin can be affected by common skin problems, including itchy, dry patches from psoriasis or eczema. It’s also possible to get a rash from anything that comes into contact with breast skin (contact dermatitis), like clothing. Stretch marks are also normal and appear as red spoke-like lines, which appear on the skin during times of rapid physical growth, such as puberty or pregnancy. Over time, the stretch marks often fade.
Some skin changes are not normal, including ulcerations, swelling (edema), scaling, crusting, redness, dimpling or skin retraction. Palpable breast masses should be evaluated by a health care provider. Most breast masses are benign and not cancerous, but it’s important to see a provider for an exam and to discuss family history.
- Breast shapes and sizes. Heredity is the most important factor in determining how big breasts will be. No creams, special exercises or clothing will permanently change breast size. It may change with weight loss/gain or during/after a pregnancy, but for the most part, the size of your breasts stays the same after puberty. It is not unusual to have uneven breasts, as well. Because of different breast sizes, women may find that during lactation, one breast may produce more milk than the other.
“It is normal to feel subconscious about the way our breasts look or feel, but we are all unique and special,” Dr. Cowman says. “As women’s health care providers, we would be happy to discuss any of your concerns. Sometimes, just hearing things are normal can be very reassuring.”