Breasts: An Owner’s Manual: Every Woman’s Guide to Reducing Cancer Risk, Making Treatment Choices and Optimising Outcomes. Kristi Funk

those veins, making them more apparent—especially after exercise, or during pregnancy, or in certain cancers. Nipples can be dark or light, smooth or textured, pointing out, level, or inward, and range in size from flat to a pencil eraser or sugar cubes—it’s all normal. The colored skin around the nipple base is called the areola, and its diameter varies from dimes to saucers, generally 1.5 inches to 4 inches (4–10 centimeters). Some people have additional nipples, called supernumerary nipples, located along two vertical “milk line” arcs from the armpits to the normal nipples to the left and right groin. Occurring in 1 per 8,000 people, these either look like flat moles or have a raised bump.² Celebs with extra nipples include Mark Wahlberg (three) and Harry Styles (four), so no shame there.

      If you zoom in on the areola, there’s so much more to see. All women have hairs that grow at the areolar edge coming from hair follicles. We have fifty million follicles on our skin, so sometimes a few unwelcome strays grow right there. They usually show up in response to hormone changes: puberty, pregnancy, menstruation, menopause, or birth control pills. You can safely tweeze them out or get electrolysis. Tweezing sometimes leads to ingrown hairs, which then cause tiny raised pimples and white sebum to collect. Makes you wonder why you thought tweezing would make the area more attractive. Areolar bumps called Montgomery glands are tiny sebaceous glands whose function is to lubricate the nipple (per textbooks), but since that seems like a fairly useless function and doesn’t even make sense anatomically since they are not on the nipple, I just tell people they are normal and benign and won’t go away no matter how much you squeeze them. You can also get tiny blackheads at the edge of the areola; just wash the area and occasionally exfoliate as you would do to your face at night. If you notice an itchy, scaly, flaky rash on your nipple or areola, call your doctor.

       MORE NIPPLE FUN FACTS!

       • Some people are born without nipples, which is called athelia. There are about seven thousand diagnosed cases worldwide.

       • Nipple stimulation and genital stimulation affect the same part of the brain. One-third of women can reach orgasm solely through having their nips caressed.

       • If you use a magnifying glass to examine the areola, you will find hairs growing on the areolar border of all adult living human beings.

       • When supernumerary nipples occur outside the milk line, they’re called ectopic, and can be as far from your chest as the sole of your foot.

       • Why do men have nipples? Because we all start out as girls! Nipples show up in utero before sex organs do. And then they just stick around (and out).

      GET HANDSY IN THE NAME OF HEALTH

      Healthy breasts require regular at-home breast exams, but don’t let them stress you out. The goal here is to get a lay of the land and learn what all your lumps feel like. This way, if you develop something new or different, you’ll be the first to find it. Next to risk reduction, early detection ranks second as our best defense against cancer. I suggest starting a self-exam routine in your teens and doing one every month. Teenagers virtually never get breast cancer, but it helps them later to be familiar with their breasts now. Whatever your age, time exams to one week after your period since that’s when they’re the least lumpy, tender, and confusing. If you don’t menstruate anymore, make the first day of every month your exam day. The whole exam should take three minutes, and it may just be the most reassuring part of your day. If anything seems out of the ordinary, trust your intuition and see your doctor. Ready?

       1. First, give your breasts a good stare. Disrobe from the waist up, stand in front of a mirror, and then scrutinize the breasts peering back at you. Visually scan them for shape, size, or contour changes, plus skin alterations like thickening, redness, dimpling, retraction, and bulging out. Your nipples should be pointing the way they always point—straight ahead, left, right, naturally inverted, or headed south checking for spare change on the floor.

       2. Next, check to see if your breast tissue dimples or bulges out while watching your breasts in the mirror in two different positions. In the first posture, put your hands on your hips and push in so that you’re flexing your chest muscles. Any funny dents or bumps? In the second pose, raise both hands overhead like you’re getting arrested. All clear?

       3. Exam time! Either reclining on your bed or standing in the shower—whatever is comfortable for you—put a little lotion or shower gel on your fingers to help them glide across the breast tissue. Pick one of the following four patterns to trace over your breast tissue: (1) up and down the length of the breast vertically, (2) left to right across the breast like words on a page, (3) concentrically in circles like a target sign, or (4) radially like spokes on a wheel. Whatever pattern you choose, the results will be the same—just be sure to use the same technique every month so your fingers develop an unconscious memory of the tissue.

       4. Start with your left breast, and raise that left arm behind your head to flatten the tissue as much as you can (I know—some breasts are way too floppy to flatten). Use the fat pads of the three middle fingers on your right hand to do the exam. You’re feeling for a new lump or thickening. Start in your armpit, then transition to the upper outer part of your breast and make tiny circles gliding across the breast until you’ve evaluated the entire breast in whatever pattern you chose from number 3 above. Don’t ever lift your fingers off your breast skin as you do this. Repeat the entire exam three times—first with a light touch, then medium, then deeper still.

       5. Gently squeeze your nipple a few seconds. At some point in your life, you will probably elicit discharge from your nipples due to tiny amounts of fluid always present in the breast ducts. It’s normal to have discharge when you squeeze or stimulate the nipples, but fluid should never come out by itself without touching the nipple (e.g., staining your bra cup or PJs). If you squeeze out bloody or clear-like-water fluid, or if discharge is spontaneous, see your doctor. I don’t care about nonspontaneous discharge that’s any color other than bloody or clear like water.

       6. Repeat on your right breast. You’re done for the month!

       7. Visit easybreastexam.com to watch a demonstration video.

      WHAT TO LOOK FOR DURING A BREAST SELF-EXAM (BSE)

      In 2017 an image from Worldwide Breast Cancer depicting bright, cheerful lemons in an egg carton went viral with the caption “What Breast Cancer Can Look & Feel Like.”

      Worldwide Breast Cancer, “What Breast Cancer Can Look & Feel Like,” © Worldwide Breast Cancer, 2017. Used by permission. Knowyourlemons.org.

      So smart. I love this! Certain signs of breast cancer are seen and not felt, so they should be seen. It’s said a picture is worth a thousand words. And looking at lemons, well . . . they don’t make you squirm or feel embarrassed, and it’s hard not to associate these yellow balls of fruit with sunshine and lemonade.

      Here’s the list of signs shown in the picture:

       • a thick area

       • a dimple

       • nipple with crusting, itching, pain, rash, cracks, peeling, flaking, scaly, or bleeding skin

       • redness or heat

       • new fluid from the nipple (especially bloody/brown or clear like water)

       • skin sores (that are not typical skin conditions)

       • a bump

       • a growing vein

       • a sunken nipple that is pointing in a new direction, getting flatter, or inverting (retracting inward)

       • a change in size or shape (especially one side only)

       • skin that looks like an orange peel (larger pores, orange/red discoloration)