Breasts

No - many women have "lumpy" breasts which is usually related to the combination of glandular tissue and fatty tissue in the breast, but lumpy is not the same as dense. Breast density refers to the appearance of the breast tissue on imaging, usually mammogram. Dense breast tissue appears more "white" on mammogram, which makes it harder to detect cancer, also usually "white" on mammogram. Younger women naturally have dense breast tissue, but some women still have dense breast tissue even as they get older. Hormone therapy will maintain the dense breast appearance on mammogram.

Women with dense breast tissue on imaging are at higher risk for the future development of breast cancer, and as mammograms may miss more cancers in women with dense breast tissue, additional imaging such as ultrasound or MRI may be helpful.

It sounds like a broken record, but this too varies from person to person. I'm one year out from my implant surgery and I'm still adjusting to them. Sometimes my chest feels tight. Sometimes it feels pretty good. I find at the end of the day they do feel heavy. I think I'll be adjusting to them for quite a while yet. And yes, I also miss sensation or feeling there. It's a major body alteration with many ramifications, no getting around that fact.

Yes, the silicone implants will definitely feel softer than expanders. You will still need to adjust to them too however.

The registration is necessary should there ever be a recall or problem with the implant then the company can find out which people have the affected implant.

If necrosis was removed and there is still hardness, then it is most likely from either 1) additional / remaining fat necrosis, or 2) edema (can feel hard, especially likely in radiated tissue). In either case, resolution is likely without additional surgery if you wait long enough (may take 1-2 years), although breasts will be smaller in either case. If pain is present, and fat necrosis is still present, then surgery to remove the rest of the dead fat may be indicated.

Richard M. Kline Jr., M.D.

That's a good question, especially with all the information we now have linking breast density to an increased risk of breast cancer. Density refers to relative proportion of fibrous or glandular tissue to fatty tissue in the breast and is most commonly evaluated by appearance of the tissue on mammogram. Dense tissue is not the same as "lumpiness" - a woman can have a lot of lumpy breast tissue but the tissue could be primarily fat. In general, breast density does decrease with age - the normal aging process makes the breast tissue more fatty over time. This results in easier interpretation of mammograms and other imaging studies as women get older as it is harder to "see through" the dense breast tissue on mammogram to identify tumors - this is a major reason why mammograms and even ultrasound and MRI have a harder time detecting breast cancer in younger women.

Breast density is not only influenced by age however. Women that are on hormone replacement therapy will generally continue to have dense breast tissue even after menopause, and some women even without HRT have dense breast tissue - genetics, body weight, diet, activity and other factors probably play a role as well.

It is important to know that your risk of breast cancer is increased if you have dense breast tissue, but the majority of young women DO have dense breast tissue. Density is reported on your mammogram report, but often only on the report that goes to the physician, not the "layperson letter" that you would receive. Several states have either passed legislation or have legislation pending that would require mammogram facilities to inform women of their breast density. It is reasonable to ASK your physician or mammographer about your breast density so that you are informed. Depending on your risk factors, additional testing such as ultrasound and MRI might be recommended, but they are currently not recommended for all women with dense breast tissue. However, this field is changing, so stay tuned!

I am not sure I understand this question. I can answer the following: Under what circumstances is radiotherapy considered necessary for women who DON'T undergo breast-conserving lumpectomies, but rather mastectomies? (I apologize if this is not the intended question.) Radiation is considered standard of care after lumpectomies (also called partial mastectomies). Radiation is also advised after mastectomy in certain clinical situations. And this is based on tumor size, extent of resection (ie were there positive margins at the time of mastectomy?), nodal status (and if so, how many nodes were involved?), and other factors associated with the mastectomy specimen that is reported by the pathologist. In general, radiation is suggested if the risk of local recurrence is significant enough to justify the risks.

Dense breast tissue causes 2 problems - one is that it is now known that women with dense breast tissue have a higher rate of developing breast cancer, and the second is that breast cancer is harder to detect in women with dense breast tissue. Mammograms will miss 10-20% of breast cancers, more often in women with dense breast tissue. Ultrasound and MRI examinations can be performed in addition to a mammogram, but no test is 100% sensitive and specific for diagnosing breast cancer. Ultrasound and MRI are also more difficult to interpret in women with dense breast tissue, just like mammograms. MRI in particular also has a relatively high (up to 20%) false positive rate - it will often show things that look suspicious and require further investigation and sometimes biopsy, and the finding then turns out to be normal - these are some of the reasons that MRI is not recommended as a general screening test for all women, but rather is recommended for use in specific situations.

I do feel that women should know their breast density - "lumpiness" on exam is not the same as dense breast tissue. This information is generally included in the formal mammogram report provided to the ordering physician, but is not required to be included in the "lay letter" - the letter that gets sent to the patient (the wording of the reports and the lay letter is regulated by the FDA under the Mammography Quality Standards Act: http://www.fda.gov/Radiation-EmittingProducts/MammographyQualityStandardsActandProgram/Regulations/ucm110906.htm#s9004

Connecticut and Rhode Island have passed legislation requiring that the patient be informed of her breast density, and this is pending in California as well.

There are no uniform recommendations for how to provide increased screening to women with dense breast tissue, but at the very least, make sure that when you get your mammogram, you get a newer digital mammogram, rather than an older, film-screen - you just need to ask the facility and they will let you know. The use of ultrasound and MRI should be discussed with your physician or breast specialist and will take into account your family history and other breast cancer risk factors as well as breast density.