My breasts are starting to sag as I get older. Why is this happening and is this going to get worse?

Puberty, pregnancy and menopause are times in women’s lives where hormonal changes are more physically noticeable especially as it relates to the breasts. The aging process also affects the tissue and fat of the breasts. The majority of women notice their breast tissue decreasing during menopause.

The size and shape of women’s breasts varies considerably. Some women have a large amount of breast tissue, and therefore, have large breasts. Other women have a smaller amount of tissue with little breast fat.

Factors that may influence a women’s breast size include:

• Volume of breast tissue
• Family history
• Age
• Weight loss or gain
• History of pregnancies and lactation
• Thickness and elasticity of the breast skin
• Degree of hormonal influences on the breast (particularly estrogen and progesterone)
• Menopause

The hormonal changes of menopause, including the loss of estrogen, makes the breast glandular tissue smaller, less dense and fattier. While some women going into menopause notice the breasts lose glandular tissue and fat. Breast tissue usually becomes smaller, less dense and feels lumpier. These changes also cause the breast tissue to become saggier. 

If I do not wear a bra will my breasts sag? 

If you do not wear a bra your breasts will sag. Poor support leads to saggy breasts regardless of your size.  If you don’t wear an everyday bra, the delicate and sensitive breast tissue becomes unsupported causing breasts to sag. A bra should be properly fitted and provide needed support to breast tissue during typical daily activities to prevent “sagging”.   Larger breast women (greater than a C cup) are more vulnerable to saggy breasts when unsupported breasts occur for extended periods of time.     

During exercise, a sports bra, with its stronger fabric and purposeful construction provides additional care and comfort to breast tissue in motion.

It is interesting to note in western cultures, 10-25% of women don’t wear a bra.  

Why do breasts become less firm with menopause?

The aging process affects the tissue and fat of the breasts. The hormonal changes of menopause, including the loss of estrogen, typically makes the breast glandular tissue smaller, less dense and fattier. These changes cause the breast tissue to become saggy. The majority of women notice their breast tissue decreasing during menopause.  It’s not typical for breast tissue to grow larger during menopause but 1 in 5 women do go up one bra size after menopause.                  

When should I worry about the changes in my breasts?

It’s important to know your own breast tissue. You could be the first person to detect something that is not your normal.  Pay attention to your own breast tissue detecting changes that are new.  Skin changes, new change in breast size and shape, nipple discharge and new lumps and bumps are important to identify and bring to the attention of your healthcare provider.

What is fibrocystic or dense breasts? 

Fibrocystic or dense cystic breasts are classically lumpy and tender, occurring in one or both breasts and can affect breast size and shape.  This common benign disease of the breast affects 60% of women and is caused by normal breast cysts. Fibrocystic breasts are not cancerous.

Is it common for nipples to change appearance with age?

During pregnancy and postpartum, the hormonal effects of estrogen, can make the breast tissue feel swollen, fuller, tender, and enlarged. The nipples can become darker, more prominent, tender and sensitive. Nipple discharge and crusty changes also occur throughout pregnancy and postpartum. The areola can become darker along with the nipples. 

When should I start doing self-breast exams?

Breast health awareness is every woman’s responsibility beginning at young age and continue throughout every stage of life.  During the first gynecology exam it’s ideal to learn how to examine your breasts.  Monthly self-breast exam is the start of knowing what your normal is when it comes to familiarizing yourself with your breasts.  It’s also equally important to look at your breasts in the mirror to see if there are any visible skin changes.  Changes including in the size or shape of the breasts, dimpling, puckering, swelling, redness or darkening of the skin, itchy, scaly sores or rashes seen on the nipples or nipple discharge. Feeling and visualizing your breasts should be a part of your monthly routine.  Early detection can be lifesaving when it comes to a breast cancer diagnosis.

Are breasts supposed to look exactly the same?

You know that saying about how no two snowflakes are alike? Well, the expression could refer to breasts as well. Any body parts that come in a set of two are never exactly a mirror image of each other. The medical term would be called “breast asymmetry”.  Your ears, eyes, lips, breasts and labia are, also, slightly different in shape and size.  This is completely normal. Different is normal and this is more common than not.

Breast asymmetry can include different cup sizes, shape, position and nipple position.

Can drinking a lot of coffee cause my breasts to be sore?

Caffeine-coffee, tea, chocolate, energy drinks- and nicotine-tobacco and vaping- cause breast tenderness and sensitivity by clamping down the blood vessels in the breast tissue leading to pain.  If you consume a large amount of caffeine or nicotine breast tissue will be more negatively affected. Cutting down on both will decrease breast pain with time.

What can I do to alleviate breast pain and soreness?

Treating painful breasts depends on the cause of why you having breast pain.   If you are on the birth control pill, you can change the birth control pill to another brand which often helps reduce the pain. Limiting, or better yet, stopping cigarette smoking and caffeine drinking, will quickly reduce your symptoms of breast pain.  If no real cause can be found over the counter remedies such as oil evening primrose, acetaminophen, ibuprofen, and vitamin E can help with the discomfort. Wearing a properly fitting bra, eating a healthy diet and reassurance are often easy suggestions to help ease the pain. If the basic suggestions to minimize breast tenderness do not relieve the symptoms, seeing a doctor and having a breast ultrasound may be necessary.

When should I worry about my breast pain and soreness? (11)

If you are noticing fevers, changes in the size or shape of the breasts, dimpling, puckering, swelling, redness or darkening of the skin, itchy, scaly sores or rashes seen on the nipples or nipple discharge, this would be a reason to see your doctor. 

Will   certain exercises help “perk up” my breasts?

Exercise can help strengthen your chest muscles which are underneath the breast tissue that can “perk up” your breasts. Since breasts are made mostly of fatty tissue muscle strengthening will have minimal effect on breast size but can help reduce the sag factor. Upper body strength training exercises will be helpful in supporting the muscles of the chest which ultimately reduce saggy breasts.

Aerobic exercise that helps control your body fat and weight may help in minimizing saggy breasts.  The size of your breasts primarily depends on your family genetics meaning what your female relative’s breast size are on both your mom and dad’s side of the family.  Less common factors affecting breast size include your weight, age and if you breastfed your baby.

Do certain lotions/oils/supplements help with sagging breasts?

Lotions and oil will definitely make the skin of the breast hydrated and soft but will not minimize breasts from sagging.  Supplements do not help reduce the sagging of breast tissue.

 If I wear a bra to bed will that help prevent my breasts from sagging? 

In a perfect world you would wear a bra at night to provide 24/7 breast support.  But in a practical and realistic world, your breasts need a break from being trapped in a bra all day. There is no medical evidence to show wearing a bra while you sleep is helpful in preventing saggy breasts.  The most common reasons breasts sag is pregnancy, breastfeeding, time, genetics and gravity.  If you are a firm believer that gravity is the main reason your breasts sag, you can wear a bra while you sleep but I wouldn’t encourage it.

Are underwire bras the best way to keep your breasts from sagging? 

Underwire bras support and lift the heaviest part of the breast tissue.  For small cup women, size A or B, it may not be as important to use an underwire bra but for larger breasted women it’s helpful in preventing sagging.

What determines the shape and size of my breasts and why are some breasts bigger than others?

The Hollywood red carpet, social media and fashion magazines have made it easy to see the endless assortment of breast shapes, sizes, and variations.  There are several natural factors determining your breast shape and size including:

• Family history and genetics-Ex if your mom and her 4 sisters are a 38 Double D chances are you will too. 

 

• Body type-Basal Mass Index (BMI) and significant weight gain or loss.

 

• Number of Pregnancies 

 

• Breastfeeding-The number of babies you have breastfed and length of time.

 

• Age & Hormonal Changes-Puberty v. Menopause

 

• Skin elasticity and breast density

 

• Ethnicity-Ex Asian women tend to have smaller breasts culturally compared to European women.

 

Are there things I can do to make my breasts look different (not including surgery?)

Intimate apparel including bras has changed the way breasts look in all styles of clothing.  The safest and most natural way to like the way your breasts look in clothing is to make sure your everyday bra fits properly.  It has been found that 80% of women wear bras that are not fitted correctly to their breasts.  Whether it is a special occasion or a vigorous workout, the appropriate bra can make all the difference in the world.

Lifestyle choices including diet and healthy living will help keep your body mass index (BMI) under 25 which helps keep your breast size consistent and true to their natural size. Medications such as the birth control pill and hormone replacement therapy can make your breast tissue making them slightly larger.  Caffeine and nicotine stimulate fibrocystic densities in breast tissue increasing their size as well.

I am 25years old, do I need to do a breast exam?

Yes, I believe it is important to know your breasts well starting at an early age. During your first visit with the gynecologist, which should be around 16 to 18 years old, you should be shown how to do a self-breast exam.  Breast tissue can be intimidating in the beginning but once you are familiar with your own breast tissue and all its normal lumps and bumps, you will be able to find abnormal changes if they occur. The best time to check your breasts is during the first week of your period when the hormonal effects on breast tissue have subsided.

How to do a breast exam?

You and your breasts have a long relationship together so it’s important to identify any changes in breast shape, size, skin changes or nipple discharge.  There are 5 steps of a breast self-exam. With each step you need to look at your breasts closely to identify any new changes. 

Step 1: Stand in front of the mirror with your hands on your hips. 

Step 2: Raise your arms over your head while looking for changes in the mirror.

Step 3: Look for any discharge or fluid coming from the nipples.

Step 4: Now, lie on your back and feel each breast looking for lumps and unfamiliar tissue changes. Extend the hand over your head of the breast you are examining. Use the opposite hand, running your fingertips firmly over the breast tissue in a circular motion, about the size of a quarter. Think of the breast as a “+” sign, feeling each quarter in a purposeful way each month. Once you have finished examining each breast, check each underarm to feel for similar changes. 

Step 5: Now stand up or sit and recheck your breasts in a similar fashion as Step 4.  

Sometimes checking the breasts in the shower, when the skin is wet and slippery, helps identify abnormal findings more easily.

What breast changes should I expect during pregnancy?

During pregnancy the hormonal effects, mainly estrogen, can make the breast tissue feel swollen, fuller, tender, and enlarged. The nipples can become darker, more prominent, tender and sensitive. Nipple discharge and crusty changes also occur throughout pregnancy. The areola can become darker along with the nipples. The veins of the breasts become more prominent.  Breasts enlarge 2 to 3 sizes during pregnancy and breastfeeding. The breast tissue tone can be noticeably saggy following breastfeeding. Stretch marks can be seen on the breast tissue during pregnancy due to the fast growth of the breasts.

What breast changes should I expect if I take the birth control pill?

The hormonal effects the oral contraception, the “pill” can make the breasts feel swollen, tender, enlarged and more sensitive.

 What breast changes should I expect during my period?

Painful, tender and swollen breasts, due to period hormones, are common especially a week or two before your period, but once your period starts these symptoms quickly go away.

What breast changes should I expect if I have gained muscle mass?

Weight training your chest muscles along with push-ups help strengthen these important muscles which keeps the breast perky and minimize sagging.

What breast changes should I expect if I have gained or lost weight?

Since breast tissue is made up a lot of fat, significant weight gain and lost can make the breasts larger or smaller.

What breast changes should I expect getting older? (same answer but different question)

The aging process also affects the tissue and fat of the breasts. The hormonal changes of menopause, including the loss of estrogen, makes the breast glandular tissue smaller, less dense and fattier. These changes also cause the breast tissue to become saggier. The majority of women notice their breast tissue decreasing during menopause.  It’s not typical for breast tissue to grow larger during menopause but 1 in 5 women do go up one bra size after menopause.                  

When should someone see a doctor about breast changes?  

Breast tissue can be intimidating in the beginning but once you are familiar with your own breast tissue and all its normal lumps and bumps, you will be able to find abnormal changes if they occur. The best time to check your breasts is during the first week of your period when the hormonal effects on breast tissue have subsided.

It’s important to know your own breast tissue. You could be the first person to detect something that is not your normal.  Pay attention to your own breast tissue detecting changes that are new.  Skin changes, nipple discharge and new lumps and bumps are important to identify.

When you find a new breast lump you need to take into account where you are in your menstrual cycle since hormonal changes can affect the breast tissue.  It’s always best to check your breasts immediately following your period, Day 4 through 8 are ideal.  This time of the month is where your breasts will have the least amount of hormonal influences and are less sensitive.

If you feel a new lump that feels like a M & M-“plain or peanut” or new found “gravel” in the breast tissue this would be a reason to bring it to the attention of your health care provider. Some breast lumps are tender and some are non-tender to touch-both can be abnormal.

 Once you see your health care provider, a breast ultrasound may be performed to determine if there is a cause for concern.

Is there such a thing as a normal nipple?

During different stages of life and hormonal surges, nipples change in size and appearance. Most nipples point away from the body, while others, known as “inverted” nipples point into the body.  The belly button has a similar, “inie” v. “outie” variation. These women with inverted nipples rarely have their “headlights on” which can be a good thing for many women.  Nipple variations are more common. The same factors that affect breast size and shape also affect the appearance of the nipple.  There is no such thing as “normal” nipples.

What causes my nipples to get sore and tender during my menstrual cycles? 

During different stages of life and hormonal surges, nipples change in size and appearance. The breast tissue, areola and nipple increase in size during puberty, pregnancy and breast feeding as a result of the hormonal surge of estrogen.

Swollen, enlarged, nodular and tender breasts and nipples are part of a woman’s menstrual cycle and those suffering from PMS can have exaggerated breast symptoms, especially nipple sensitivity.  Raising hormones, estrogen and progesterone, 1 to 2 weeks before your period, stimulate nipple tissue causing painful and sometimes, unbearable symptoms.  Once you start your period, nipple sensitivity quickly disappears. 

Puberty, PMS, pregnancy and menopause are times in women’s lives where hormonal changes make nipples change in size, sensitivity and appearance. 

What’s normal and what is not when it comes to nipple changes? 

Symptoms of nipple problems include pain, swelling, redness, burning, itching or stinging. The pain can often radiate deep into the breast tissue.  The skin of the nipple can appear shiny, scaly or flaky. Nipple discharge is also a cause for concern.

Normally nipples will vary in size, sharp and appearance. Nipple inversion, hardening, and heightened sensitivity can vary from breast to breast but are considered to be normal.

What can I do if I suffer from nipple soreness or pain? 

Depending on the reason you are experiencing nipple soreness or pain, the first step is to find the reason for the discomfort. Anti-fungal and antibiotic medication, anti-inflammatory cream, cleaning the nipple with warm saline and antibacterial soap, a warm compress, good bra support, moisturizing cream, and cooling gel packs can all be used to relieve nipple soreness or pain. Ibuprofen and Tylenol are also helpful remedies. 

Frequent hand washing, clean (and soft) bras and skin sensitive laundry detergent, soaps and body lotions have to be used to help eliminate nipple problems.

My nipples are hard all the time! My BF tells me my “lights are on” all day long. Why is that happening? 

Hard nipples happen normally when the weather is cold. The extent your nipples are perky, with hairless quarter size areola and perfectly round, eraser size nipples depend of many variables and luck. This is completely normal. Different is normal. During different stages of life and hormonal surges, nipples change in size and appearance. Puberty, PMS, birth control pills, pregnancy, breastfeeding and menopause are times where hormonal changes make nipples change in size, sensitivity and appearance. These hormonal changes will always occur in both nipples.

Other concerning nipple related medical conditions include a breast infection, breast feeding related infection (mastitis), benign breast papilloma’s, Paget’s disease and breast cancer. Fever, nipple tenderness, nipple discharge (sometimes bloody), breast rash and skin irregularities around the nipple will also occur if there is an abnormal medical condition happening.

If your nipples normally point outward and one changes to being inverted or newly tender, this may represent something abnormal. 

Any change in one of the nipples including red, swollen, or scaly skin or a nipple discharge is cause for concern. These changes don’t necessarily represent a breast cancer but need to be brought to the attention of your health care provider.

I run every day and I am noticing my nipples get irritated. Why is this happening and what can I do about it? 

When exercising, it’s so important to wear a sports bra for even more breast and nipple support. If you don’t wear a sports bra and chose to wear your everyday bra during exercise, the delicate and sensitive breast tissue and nipples will bounce and move in such a way where pain and trauma can occur.  If there is lack of proper long-term support, breast tissue with its fibrous ligaments and fatty tissue will stretch and become saggy. 

With highly sensitive nerves layering breast tissue, aggressive movements and activities disrupts and tears the tissue, creating painful symptoms.   During exercise the tissue bounces and moves around putting excessive strain on the ligaments, nerves, nipples and tissues composing the breast.

80% of women wear the wrong bra size. It is interesting to note in western cultures, 10-25% of women don’t wear a bra at all.   Poor support leads to tender breasts and nipples regardless of your size. The everyday bra tends to be form-fitting, prevents tenderness and sagging since it provides support to breast tissue including the nipples during typical daily activities.  The majority of the breast tissue is unsupported.  Wearing the correct bra size with adequate support will prevent breast tenderness and nipple pain.

Getting properly fitted and selecting comfortable bra material by an expert at your local women’s department store is the first step at improving nipple pain due to incorrect bra size or going braless. 

Avoid lace and other irritating fabrics that may rub and irritate the nipples. 

Jogging and other forms of exercise cause nipples to chafe and become itchy.  Creams, topical steroids, lanolin cream, extra virgin coconut oil, petroleum jelly and Aveeno baths help treat the dry skin and itchy feeling.

Sometimes my nipples itch. Can I get an infection on my nipples?

Normally, nipples should not itch.  Dry or damage skin on the nipple can cause them to itch.  Eczema is a common and abnormal skin condition causing this delicate area to become dry, scaly, red and itchy.

Symptoms of nipple thrush include pain, swelling, redness, burning, itching or stinging of the nipples. The pain can often radiate deep into the breast tissue.  The skin of the nipple can appear shiny or flaky. Blisters can also be a symptom of nipple thrush.

When I check my breasts, am I supposed to check my nipples too? 

I believe it’s important to know your body…very well!  During your first visit with the gynecologist, which should be around 18 years old, you should be shown how to do a self-breast exam.  Breast tissue can be intimidating in the beginning but once you are familiar with your own breast tissue and all its normal lumps and bumps, you will be able to find abnormal changes if they occur. Checking the nipples for irregularities, rashes, skin changes along with nipple discharge-white, milky or bloody, is an important part of the breast exam. If your nipples normally point outward and one changes to being inverted or newly tender, this may represent something abnormal. 

The best time to check your breasts is during the first week of your period when the hormonal effects on breast tissue have subsided.

I love my nipples played with during sex. Is that normal?  

Nipples are one of the many erogenous zones on the body with heightened sensitivity and become hard which may cause sexual arousal.  Not everyone has the same sensitivity when nipples are stimulated by gently touched or being kissed. Some women are able to have an orgasm through nipple stimulation alone.  It’s thought this heightened sensitivity and hardening is caused by the highly dense nerve innervation.

As an aside, other common causes of nipple pain in both breasts are the birth control pill, heavy cigarette smoking, excessive caffeine drinking, fibrocystic breasts, pregnancy and diets high in saturated fats.

What are some of the reasons I might experience breast discharge?

In pregnancy, as the breasts prepare for breastfeeding, a discharge from both nipples is generally seen as early as the second trimester.  This thick yellow nipple discharge is called colostrum and is completely normal during pregnancy.

Nipple discharge can be a very normal occurrence for non-pregnant women.  Galactorrhea is the medical term to describe a milky discharge by one of both breasts affecting 20-25% of women who are not pregnant. A clear fluid coming from the nipples can happen if they are excessively stimulated during intimacy and exercise.  During sex and intimacy, regular nipple stimulation either by the fingers or the mouth can cause a nipple discharge.  Tight tee-shirts or bras can rub the nipples also causing them to leak during exercise.  Commonly used drugs, such as the birth control pills, thyroid and psychiatric medications, can cause a normal nipple discharge as well.

Other causes of nipple discharge include breast infection, fibrocystic breasts, breast trauma, benign breast tumors, thyroid disease, illegal drugs including marijuana, and certain herbs, such as anise and fennel. More concerning causes of nipple discharge include pituitary gland tumors and a benign (noncancerous) breast growth called an intraductal papilloma and a rare form of breast cancer, called Paget’s disease of the nipple.

What does normal, healthy breast discharge look like?

If you are not pregnant or breastfeeding and notice a clear nipple discharge this can be normal if you are taking certain medications, wearing a tight sports bra or having your nipples stimulated with intimacy.

When the discharge is seen in both breast and the color is clear, there is less to worry about.

What does unhealthy breast discharge look like and what might cause this?

Nipple discharge can appear red, yellow, green, white and clear in color. If you see a bloody nipple discharge in one or both breasts this is rarely normal. Also if you notice spontaneous nipple discharge without any stimulation such as touching or fondling the breasts this is also a cause of concern.  Bloody nipple discharge and spontaneous nipple discharge are 2 circumstances that warrant seeing a health care provider.  More concerning causes of abnormal breast discharge include a pituitary gland tumor or a benign breast tumor.

 

How should I treat breast discharge? 

Regardless of the color, it’s always best to discuss any changes with your breasts with a health care provider. 

Once the cause of the nipple discharge is diagnosed, various treatment options are available to avoid this from continuing. If the cause of lactating is due to an extremely elevated prolactin level, medication can be given to bring down the high numbers. Bromocriptine is a medication used to lower the high levels of prolactin in your blood, which helps treat the symptom of lactation.

Can breast discharge be prevented?

It’s important to find out the cause of the nipple discharge in order to know how to prevent it. If the cause of nipple stimulation is as a result of touching with intimacy, then avoiding this behavior during sex would be the first step. If the cause is wearing a tight sports bra with vigorous exercise, then wearing a different, less restrictive bra, may be a better option. If an herbal medication is the culprit, then stopping that medication is an easy remedy. 

What medications cause breast discharge?

The birth control pill is one of the medications classically known to cause a clear nipple discharge in both breasts. The pill is also known to cause breast tenderness and enlargement. This effect on the breast tissue is temporary and should not persist over time.