Does breast size really matter? It's a debate I have had with my girlfriends for years. The grass is often greener on the other side, and so women continually exchange reasons why it is enviable to have either larger or smaller breasts. But are there any significant medical differences between having large or small breasts?
First, it's important to understand a little anatomy of the breast. Breast size is dictated more by the amount of fatty and fibrous tissue than the amount of milk-producing glands. This is important when thinking about size and its relationship to breast milk production and risk of breast cancer.
Generally speaking, size does not make a difference for important biological functions and conditions. Below are facts about some common medical misconceptions about breast size.
Breast size does not influence how much breast milk you can or will produce. Because breast size depends more on the amount of supporting fibrous and fatty tissue than the amount of milk glands, women with larger breasts do not necessarily produce more breast milk. Breast milk production is stimulated hormonally and increases with demand. Increasing the frequency of breastfeeding sessions with a baby increases the milk supply. Supply meets demand in most cases. While many factors can affect breast milk production — fatigue, stress and depression — do not add worry about your breast size to the stresses of motherhood.
If you are thinking about breastfeeding, don't discount your ability to breastfeed or give up without talking to a lactation consultant or your pediatrician. There are many ways to try to increase your milk supply, and difficulties occur for many women regardless of size.
Breast size does not influence breast cancer rates or prognosis. Researchers have found that breast size does not affect your risk of breast cancer. In addition, breast size does not affect your treatment outlook. The most common type of breast cancer comes from the cells lining the ducts of the milk-producing glands. Since women with larger breasts do not necessarily have more gland tissue, it makes sense that women with larger breasts do not have a higher risk of cancer. If you are worried about your ability to detect and treat breast cancer if you have larger breasts, remember that the studies do not validate your concerns. You are only more likely to miss cancer if you don't go looking for it with routine screening tests or if you ignore your intuition about a new lump or asymmetry.
The only caveat here is that obesity has been found to increase the risk of breast cancer. Overweight women can have larger breasts, but based on studies mentioned above, it appears that obesity is the factor more than breast size. Greater amounts of fat tissue increase the estrogen level, which is probably the cause of increased cancer risk associated with obesity.
Breast size does not affect the amount of pain you will have during a mammogram. In one study surveying women about their pain, larger breast size did not make a mammogram more painful. Don't let your fears about pain prevent you from getting appropriate breast cancer screening.
For women with large breasts, physical discomfort is real. Getting past the myths, breast size can affect a woman's daily physical well-being. For instance, many women with larger breasts experience physical discomfort, such as significant neck, shoulder or back pain and headaches. For some of these women, a better-fitting bra may be a simple solution. In addition, losing weight to decrease breast fat probably will help. Despite these efforts, some women find a reduction mammoplasty — surgery to reduce breast size — necessary to relieve pain and discomfort.
Breast size has a strong impact on a woman's mental well-being. After all, it's impossible to ignore the emphasis our culture places on breast size. From puberty to adulthood, a woman faces idealized norms and contemplates her potential to measure up. Biases exist against women with large breasts as well as small breasts. A girl or woman with larger breasts may deal with assumptions about her sexuality. A girl or woman with smaller breasts may feel inadequate. Recognizing that these external and internal pressures exist, we must encourage girls and women to become comfortable with their own bodies and dispel the myths.
The bottom line for all women is that you shouldn't expect more or less from your body because of your breast size. In particular, your ability to breastfeed and your risk of breast cancer, two of the most important health concerns, are unrelated to size.
Alice Y. Chang, M.D. is a former instructor in medicine at Harvard Medical School. She is currently associated with University of Texas Southwestern Medical Center. Her clinical interests and experience are in the fields of primary care, women's health, hospital-based medicine and patient education.