Archive for Breasts

Looking at Scientific Studies

In the previous article we reviewed the scientific method. This time we’ll look at how knowledge of this four-part process—observation, formulation of an hypothesis, prediction, and experimentation—can help us understand the many medical and scientific studies we hear about in the news. Let’s look at some questions you might ask about medical studies:

Why did they even bother to do that study? Isn’t the answer obvious?
Actually, no, the answer isn’t obvious. In fact, it runs counter to the scientific method for a researcher to assume that he knows the results before conducting the experiment.

The scientist “finds that he often makes mistakes himself and he must learn how to guard against them. He cannot permit himself any preconception as to what sort of results he will get, nor must he allow himself to be influenced by wishful thinking or any personal bias. All these things together give that ‘objectivity’ to science which is often thought to be the essence of the scientific method,” wrote physicist Percy W. Bridgman in “On Scientific Method” (30 Dec. 2000).

Why did they do that study? It’s already been done.
The answer to this question is one of the most important points about the scientific method: results must be repeatable . An hypothesis gains credibility when other researchers working in different laboratories get the same results. “In fact, most experiments and observations are repeated many times (certain experiments are not repeated independently but are repeated as parts of other experiments). If the original claims are not verified the origin of such discrepancies is hunted down and exhaustively studied” (Jose Wudka. “What is the ‘scientific method’?” 30 Dec. 2000).

The process of science itself is bigger than any one scientist because researchers are constantly checking and rechecking each other’s work: “the hypothesis must withstand the scrutiny of other scientists as well. They may repeat the experiment to retest the validity of the hypothesis, along with the validity of the methods used to test the hypothesis” (“The Scientific Method—Elegant Experiments.” 30 Dec. 2000).

The requirement of repeatability leads to what Wudka calls “the great advantage of the scientific method”: “it is unprejudiced: one does not have to believe a given researcher, one can redo the experiment and determine whether his/her results are true or false. The conclusions will hold irrespective of the state of mind, or the religious persuasion, or the state of consciousness of the investigator and/or the subject of the investigation.”

The requirement of repeatability also means that individuals cannot impose their will or beliefs on others: “A theory is accepted not based on the prestige or convincing powers of the proponent, but on the results obtained through observations and/or experiments which anyone can reproduce” (Wudka).

How can one research team reach one conclusion and another research team reach the opposite conclusion?
Although contradictory results can frustrate those of us who just want to know what foods we should eat to stay healthy or whether vitamins or herbal supplements will relieve what ails us, such contradictions are grist for the scientific mill:

An idea, model, or explanation that has been rigorously tested, analyzed, and accepted by the scientific community is referred to as a theory—a term used, perhaps, because most scientists believe nothing can ever be proved absolutely true. At best, they will say a theory hasn’t been proved false. The theory will continue to be an accepted explanation unless new information is uncovered—information that the scientific community agrees disproves the previous explanation. This continuous scrutiny is essential to the credibility and progress of scientific research (“The Scientific Method—Elegant Experiments”).
With all these studies, some of which contradict each other, what am I supposed to believe?
This question is really the crux of the matter for most of us. Unfortunately, the answer is that there is no definite answer. “A common misperception of science is that science defines ‘truth.’ Science does not define truth, but rather it defines a way of thought. It is a process in which experiments are used to answer questions” (Anthony Carpi, Ph.D. “SCI1.1-The Scientific Method.” 30 Dec. 2000)

The Scientific Method

Every day the news is full of reports about the latest medical research. Sometimes we read about two different studies that seem to contradict each other. It’s hard to know what to believe, whose advice to follow. Before trying to decide about a particular study’s findings, it’s helpful to review what exactly is going on behind all research.

Scientists devise studies and conduct research in accordance with the scientific method. “Scientific method is what working scientists do, not what other people or even they themselves may say about it,” says physicist Percy W. Bridgman in “On Scientific Method”. Bridgman continues, “science is what scientists do, and there are as many scientific methods as there are individual scientists.” But although a scientist constructing an experiment to study something may not consciously think about pursuing the scientific method, a review of the basic facts of scientific research can help us non-scientists understand what the research and its results mean.

The scientific method has four basic steps:

Observation
Scientific investigation begins when a scientist has observed some event or characteristic of the world around us and wants to explain it. “First of all, the scientist tries to learn as much about a subject as time—or funding—allows. This requires a thorough study of the available literature, gathering information and data from a variety of sources, discussions with colleagues, and a lot of thinking” (“The Scientific Method—Elegant Experiments.” 30 Dec. 2000).

Formulation of a hypothesis
Observations lead to questions about the nature of the world, writes Anthony Carpi, Ph.D.: “In attempting to answer a question about the nature of the world, a scientist will form a hypothesis (or some would say a guess) regarding the question’s answer” (“SCI1.1-The Scientific Method.” 30 Dec. 2000). “After data has been collected and analyzed, the scientist formulates a hypothesis. It may be a short leap of logic, or an intuitive leap of faith” (“The Scientific Method—Elegant Experiments.” 30 Dec. 2000).

Prediction
The scientist then uses the hypothesis “to predict the existence of other phenomena, or to predict quantitatively the results of new observations,” says Frank Wolfs, a physics professor at the University of Rochester (“Introduction to the Scientific Method.” 30 Dec. 2000).

Experimentation
Next, the scientist develops an experiment to test the predictions. “Of all the steps in the scientific method, the one that truly separates science from other disciplines is the process of experimentation. In order to prove, or disprove, a hypothesis, a scientist will design an experiment to test the hypothesis” (Carpi).

Finally, the scientist will “[r]epeat steps 3 and 4 until there are no discrepancies between theory and experiment and/or observation. When consistency is obtained the hypothesis becomes a theory and provides a coherent set of propositions which explain a class of phenomena. A theory is then a framework within which observations are explained and predictions are made” (Jose Wudka. “What is the ‘scientific method’?” 30 Dec. 2000).

Breast Self-Examination Aid

Disclaimer: I have no financial or other personal interest in this product, nor have I received anything for reviewing it. I bought my Sensability kit at my local Walgreen’s store, just as any other customer would.

The B-D Sensability Breast Self-Examination Aid is a circular pad about 10 inches in diameter. The pad consists of two plastic layers with a thin layer of a gel-like substance between them. The reasoning behind the design of this product is that the gel layer allows a woman’s fingers to move more freely and smoothly while she’s performing breast self-examination (BSE).
The kit contains both a videotape and written, illustrated instructions about how to use the Sensability pad. The videotape narrates the instructions in both English and Spanish. The written instructions explain the procedure in English, Spanish, French, and another language I don’t recognize. I found both the tape and the written instructions to be complete and easy to follow. The directions explain not only what to do, but why you are doing it. (For example, placing a pillow under your shoulder while lying down to examine your breast distributes the breast tissue more evenly than if you were to lie flat.)

The instructions direct you first to perform BSE with your bare hand, then to repeat the procedure with the Sensability pad. It may seem like overkill to perform the procedure twice, but the tactile sensation differs with and without the pad.

When you examine your breast with the Sensability pad, the bottom layer of the pad remains stationary while the top layer and the gel move. The gel acts as a kind of lubrication that allows your fingers to move freely. I found that the gel also seemed to make my fingers more sensitive than they were without the pad.

At my last clinical exam I asked my breast surgeon if she had heard of this product. She had not. I described it to her while she was performing an ultrasound examination on my breasts. She said that when she performs ultrasound, which uses a lubricating jelly, she thinks the jelly makes her fingers more slippery and sensitive. So, she said, there could be something to the Sensability design.

The pad is reusable and comes with a sealable plastic storage pouch. If the pad becomes soiled, you can rinse it in warm water. The kit retails for about $35 to $40.

Remember, though, that BSE should not replace other forms of screening for breast conditions. A complete breast cancer screening regimen consists of three components:

  • regular BSE
  • regular clinical examinations by a health practitioner
  • regular mammograms as warranted by your personal medical situation

Breast Cancer Awareness Month

According to the Susan G. Komen Breast Cancer Foundation, during the year 2000, 182,800 women will be diagnosed with breast cancer, and 40,800 women will die of breast cancer. Breast cancer is the leading cause of cancer deaths among women ages 40-59 and is second only to lung cancer in cancer deaths. The breast is the leading cancer site among American women.

Breast Cancer Awareness Month originated in October 1985, when the American Academy of Family Physicians and Cancer Care, Inc., distributed brochures, spoke to news reporters, and testified before a U.S. Congressional committee about the need for increased access to mammography. Today, the Board of Sponsors of National Breast Cancer Awareness Month comprises 17 national public service organizations, professional medical associations, and government agencies working to raise awareness and provide access to screening services.

In conjunction with Breast Cancer Awareness Month, National Mammography Day has been held on the third Friday in October since 1993. On National Mammography Day, or throughout October, radiologists provide discounted or free screening mammograms. In 1999, more than 2,200 American College of Radiology (ACR) accredited facilities took part.

In honor of Breast Cancer Awareness Month, has introduced a section entitled Breast Power. “Having breasts is an experience all women share, everything from buying their first bra to breastfeeding to facing the risk of breast cancer. We must acknowledge these ‘breast experiences’ and understand the impact they have on our lives and sense of self,” the mission statement proclaims.

One part of this new section is a cartoon featuring a superhero named Lacey Brazeer. “Whether she’s battling the body-image blues or combating crass comments and cleavage-vision, you’ll be glad Lacey is on your side,” the site’s mission statement further states.

Exactly who is this Lacey Brazeer? “Lacey spends her days as a mild-mannered marketing associate for Matracon, a women’s apparel company,” according to the introduction of this character. But “Breast Power is what this women’s champion is all about.” Further, “like most superheroes, Lacey Brazeer is strengthened by her secret weapon…Breast Power, an invigorating way of looking at life that she wants to help every woman achieve.”

But not everyone finds this cartoon superhero inspiring, as a check of the message boards on the Breast Power site soon reveals. And over at Salon, the online magazine that issues commentary on everything, Andrew Leonard lamented the first episode of Lacey Brazeer in a September 19, 2000, article entitled “Superbreasts to the Rescue!”

“With the appearance today of Women’s new cartoon superhero, Lacey Brazeer, the women’s Web has now officially struck rock-bottom. It is not only hard but actually painful to try to imagine something that might be more insulting to the intelligence of a person of any gender than ‘door-busting, case-cracking, butt-kicking, breast-powered’ superhero Lacey Brazeer,” Leonard says.

Adolescents and Cosmetic Surgery

n an earlier article about breasts and self-image during adolescence, we looked at a couple of news articles about the increase in cosmetic surgery for young girls eager to improve their bodies. Since writing that article, I’ve found three press releases from the American Society for Aesthetic Plastic Surgery (ASAPS) that present the other side of the issue.

(ASAPS is devoted to education and research in cosmetic surgery. Its members are plastic surgeons certified by the American Board of Plastic Surgery.)

In a release dated January 3, 2000, ASAPS says that media reports of “a significant increase in teen cosmetic surgery are not supported by current statistics”:

  • Results of a December 1999 survey of a representative sample of member surgeons of ASAPS show there has been no unusual increase in the number of teens seeking or receiving aesthetic surgery over the last 12 months.
  • Statistics compiled by ASAPS in 1997 and 1998 show an increase of only 0.2% in the total number of procedures performed on individuals 18 and younger. These individuals represented 2.9% of the total number of cosmetic procedures performed in 1997 and 3.1% of procedures in 1998.
  • Comparison of additional statistics compiled by the American Society of Plastic Surgeons (ASPS) for 1992 and 1998 shows that the percent of liposuction and breast augmentation procedures performed by board-certified plastic surgeons on those 18 and younger had either remained constant (liposuction, 1%) or had gone down (breast augmentation was 3% of the total procedures in 1992 and 1% of the total in 1998).
  • Surveys of public confidence in cosmetic plastic surgery have consistently shown growing acceptance of elective procedures, yet data so far conclude that those 18 and under are not seeking these procedures in disproportionately rising numbers.

The ASAPS further identifies the following procedures as “among those most commonly performed for patients 18 years of age and younger”:

  • Rhinoplasty: Nose reshaping is the most common aesthetic procedure requested by teens. It can be performed when the nose has completed 90% of its growth, which can occur as young as 13 or 14 in girls and 15 or 16 in boys.
  • Otoplasty: Cosmetic ear surgery can be performed in children as young as 5.
  • Breast reduction: Can help girls as young as 16 with overly large breasts, who may experience back and shoulder pain as well as restriction of physical activity.
  • Correction of breast asymmetry: Surgery can help girls as young as 16 when one breast significantly differs from the other either in size or shape.
  • Treatment of gynecomastia: In some teenage boys, excessive breast development can become a significant psychosocial problem. Excess tissue can be removed in boys as young as 16.
  • Chin augmentation: Often addressed with rhinoplasty to achieve facial balance.
  • Lipoplasty (liposuction): Recommended for patients of normal weight with localized fat deposits resistant to diet and exercise, often a hereditary condition. Those 18 and younger represented 1.4% of the total number of procedures performed in 1997, and 1.3% in 1998.

Finally, the ASAPS says that while the overall number of aesthetic (cosmetic) surgeries has increased, the rate of teens having cosmetic surgery has remained constant. “Additionally, most experts agree that for appropriately selected teenage patients, cosmetic surgery can have a positive impact on physical and emotional development.”

The society offers the following guidelines about teens and cosmetic surgery:

  • Assess physical maturity: Operating on a feature that has not yet fully developed could interfere with growth or negate the benefits of surgery in later years.
  • Explore emotional maturity and expectations: The young person should appreciate the benefits and limitations of proposed surgery and have realistic expectations.
  • Check credentials: State laws permit any licensed physician to be called a “plastic” or “cosmetic” surgeon, even if not trained as a surgeon. Look for certification by the American Board of Plastic Surgery. If the doctor operates in an ambulatory or office-based facility, the facility should be accredited. Additionally, the surgeon should have operating privileges in an accredited hospital for the same procedure being considered.
  • Explore risks and expected recovery times: Teens and their parents should understand the risks of surgery, postoperative restrictions on activity, and typical recovery times.

Mammograms and Breast Exams

This month we’ll look at two recently published studies that involve detection of breast cancer.

In one study Janet Kay Bobo, Ph.D., and colleagues from the Centers for Disease Control and Prevention in Atlanta, reported on the efficacy of clinical breast examinations (CBEs) in screening for breast cancer. While the use of mammograms for cancer detection has been widely publicized and studied, the use of CBEs for this purpose has not been documented.

Their research, published in the June 21, 2000, issue of the Journal of the National Cancer Institute, suggests that CBEs may aid in the efforts toward early detection of breast cancer. The researchers analyzed data from the National Breast and Cervical Cancer Early Detection Program, which provided CBEs to more than 750,000 low-income women between 1995 and 1998.

About 74% of the records included mammograms as well as results of the CBE and thus allowed for comparison of the two screening methods. “The cancer-detection rate among records reporting an abnormal CBE and normal mammography was 7.4 cancers per 1000 records,” they report. “When the CBE was normal but the mammography was abnormal, the rate was 42.0 cancers per 1000 records.”

While mammography is clearly effective in revealing cancer, Bobo and colleagues conclude that CBEs offered as a screening technique in breast cancer detection programs “may modestly improve early-detection campaigns.”

While Bobo’s research suggests the importance of the old hands-on approach to diagnosis, another study examines the expanding possibilities of medical technology. Ruey-Feng Chang, Ph.D., and colleagues from the Department of Computer Science and Information Engineering of National Chung Cheng University in Taiwan looked at computer-aided diagnosis for breast lumps thought to be malignant.

This study, published in the June 2000 issue of the Archives of Surgery, notes that ultrasound (US) has become “the most useful adjunctive technique to mammography” in evaluating breast masses. Ultrasound uses high-frequency sound waves to produce a picture of tissue inside the body. Chang and colleagues used a computer-aided diagnostic (CAD) system to analyze results of digital ultrasound studies of breast masses. They found that the CAD system diagnosed breast cancer with an accuracy rate of 90%, slightly better than the accuracy of an experienced radiologist.

When a surgeon is unsure about the significance of US findings, the CAD system can quickly provide a second opinion about the diagnosis. And use of the system would be easy to implement: “For most available diagnostic digital US machines, all that would be required for the CAD system is only a personal computer loaded with CAD software.”

Breast Pain

“Breast pain is the most common breast symptom causing women to consult primary care physicians and surgeons,” writes Monica Morrow, M.D., in a recent article in American Family Physician (2000;61:2371-8, 2385). Morrow is professor of surgery and director of the Lynn Sage Comprehensive Breast Program at Northwestern University Medical School in Chicago and director of the Cancer Department of the American College of Surgeons. The article deals with nipple discharge and breast masses as well as breast pain, but we’ll focus on pain here.

Breast pain, or mastalgia, alone is rarely a symptom of cancer. There are two kinds of breast pain: cyclic and noncyclic.

Cyclic mastalgia, “generally described as a heaviness or soreness,” says Morrow, usually occurs in both breasts and is poorly localized. Often associated with the menstrual cycle, it is most severe before a woman’s period begins but often wanes after menstruation starts. Cyclic mastalgia is more common than noncyclic mastalgia in younger women.

Noncyclic mastalgia “is most common in women 40 to 50 years of age,” writes Morrow. It often occurs in just one breast and is described as “a sharp, burning pain that appears to be localized in the breast.”

The cause of mastalgia, which is more common in premenopausal than postmenopausal women, is unknown. Its frequent association to the menstrual cycle (cyclic mastalgia) has suggested that it may be related to hormones, but no scientific studies have been able to demonstrate a link between breast pain and hormone levels. However, “menstrual irregularity, emotional stress and medication changes have been shown to exacerbate mastalgia,” according to Morrow.

Fibrocystic changes in the breasts apparently do not themselves cause mastalgia. “Although ‘fibrocystic disease’ is often present in the biopsy specimens of women with breast pain, studies have shown that fibrocystic changes are also present in the breasts of 50 to 90 percent of asymptomatic [having no symptoms] women,” writes Morrow. In other words, 50 to 90 percent of women who have no breast pain do have fibrocystic breast changes.

Although breast pain does not usually indicate a serious problem, women should discuss it with their physicians. Keeping notes about the pain’s frequency, location, severity, and relation to the menstrual cycle can help the physician and patient evaluate the pain and look for a cause or an appropriate treatment.

“Breast pain should be treated when it is severe enough to interfere with a woman’s lifestyle and occurs for more than a few days each month,” says Morrow. Avoiding caffeine has been a popular recommendation for easing breast pain, but Morrow says that recent scientific studies have failed to demonstrate any benefits of caffeine restriction. Likewise, studies have shown no benefits for another popular breast pain treatment, vitamin E.

Scientific studies in Great Britain have, however, demonstrated the effectiveness of evening primrose oil in relieving the pain of 58 percent of women with cyclic mastalgia and 38 percent of women with noncyclic mastalgia, Morrow says. The U.S. Food and Drug Administration (FDA) recognizes one drug, danazol (Danocrine), for the treatment of breast pain. But this drug’s potentially significant side effects make it appropriate for only the most severe cases of mastalgia.

Taking over-the-counter pain medications and wearing a support bra may also help to ease breast pain. And, if you suffer from mastalgia, keep in mind that, according to Morrow, 60 to 80 percent of breast pain goes away on its own.

Breasts and Self-Image: Women

Since we expect adolescence to be a difficult time as youngsters struggle to find their identities and become independent young adults, it’s not surprising that their physical development greatly affects their self-image at that time. However, we might think that girls would outgrow their body-related insecurities as they become young women. But, as Carolyn Latteier says, they don’t: “When grown women talk about their breasts, many of them are still gripped by strong memories from their adolescence” (p. 24).

In fact, the experience of breast development continues to shape the women that young girls become, as Ayalah and Weinstock discovered:

While putting the book together, we examined en masse all the material we had gathered. The cumulative insight gained from so many women discussing their lifelong experiences with their breasts in detail made us aware of a recurring pattern of cause and effect within each woman’s story. A woman’s current feelings about her breasts were often linked to or a result of particular attitudes and experiences—both positive and negative—she encountered in her life from earliest childhood, through puberty and adolescence, on into adulthood. (p. 22)

Many women continue to consider their breasts as symbolic representations of themselves, as one woman told Latteier: “My discomfort with small breasts was more than just cosmetic. I felt the lack as a poverty of being, as if my very nature were somehow stark and bony. A hollow chest equaled a hollow heart” (p. 4). The woman told Latteier that this feeling continued into adulthood. Here’s another woman’s evaluation of how her small breasts have influenced her life:

My breasts never developed as fully as I wanted them to…as fully as they were “supposed” to, so I think I am lacking in ego and in self-confidence somewhat. I think most men are attracted to breasts and sometimes judge women by their breasts. I suppose I’ve been judged many times because of my breasts and that I’ve been dismissed once or twice—or maybe even more—because my breasts are so small.” As an adult, I’ve been teased about my breasts by men and it’s probably had a bad effect on me. (Ayalah and Weinstock, p. 80)

But it’s not only small breasts that can have a profound affect on women. Remember Laura Danker, from Judy Blume’s novel Are you there God? It’s me, Margaret? Carolyn Latteier talked with Beth, who has had large breasts since adolescence. Beth feels that men respond to her not as a person, but as the possessor of those breasts. “She believes men’s admiration is false in the deepest sense because it is not centered on her as a person. She is playing second fiddle to her breasts” (p. 21). Another large-breasted woman told Ayalah and Weinstock, “Sometimes…I would just love to be built like the woman next door. She is totally flat! I’ve often wondered…if I had not had these large breasts, whether my life would have turned out completely differently” (p. 117).

As we saw in an earlier article, “Breasts are public—visible. They exist ‘out there,’ as a sign, a password” (Latteier, p. 19). A woman cannot leave her breasts at home when she goes to work. “Women who work in male-dominated fields often complain that their breasts—overt signs of their femininity—get in the way, and sometimes trivialize their status as responsible and thinking coworkers, employers, or employees” (Spadola, p. 85).

Women continue to be concerned about the appearance of their breasts as they age:

Despite the predominance of talk about size, I found that most women were more concerned with the appearance of stretch marks and sagging. I heard women from their twenties through their eighties express fears about the changes in their breasts. (Spadola, pp. 225-226)

After living through adolescence, American women face a similar experience once again as they enter midlife:

Today media imagery communicates quite clearly that the best breast—the breast as it should be—is the adolescent breast. It is a firm, milky white globe. The nipple is smooth, not the lumpy, bumpy nipple of women who have nursed a baby or outlived their youth. (Latteier, p. 6).

One way that women can reclaim their breasts is by overcoming their embarrassement, shame, and self-consciousness and simply talking with other women: “there’s no denying that talking openly and honestly with our women friends, sisters, and mothers, can promote a healthier attitude about our breasts” (Spadola, p. 90). One of the major roadblocks to such dialogue is the problem of vocabulary:

In the course of writing this book, I came to understand that, in talking about their bodies, women still struggle to find a vocabulary that does not rely on Victorian euphemisms, medical nomenclature, or misogynistic slang. Ironically, we live with a legacy of reticence even in this time of disclosure. (Brumberg, p. xxxi)

But, as Spadola points out, the search for terminology can in itself be part of the reclaiming process:

Something as simple as what we call our breasts can be important in shaping our sense of ourselves. We’re so used to hearing men use slang words for breasts—usually in a derogatory way or as a joke. It’s interesting to look at the names that we use for ourselves and with our friends. For some women, using words like “boobs” or “tits” can be a way of reclaiming these names. (p. 97)

Once we find the right words, perhaps we can rediscover the conclusion that Ayalah and Weinstock reached a generation ago:

Breasts are a part of each woman’s personal power. In accepting that very important part of your body, you develop a form of power that is not like, say, political power; it’s different. It’s an acceptance of yourself. That is real power! (p. 125)

Breasts and Self-Image: Adolescence

In the previous article we looked at how America’s current obsession with the female breast shapes women’s perceptions of themselves. In this article we’ll examine how that cultural obsession affects young women during their formative years of adolescence.

“Are you there God? It’s me, Margaret. I just did an exercise to help me grow. Have you thought about it God? About my growing, I mean. I’ve got a bra now. It would be nice if I had something to put in it” (Judy Blume. Are You There God? It’s Me, Margaret [N.Y.: Bradbury Press, 1970], p. 50).

In Judy Blume’s well-known novel, we first meet Margaret Ann Simon, age almost 12, just after her family has moved from an apartment in New York City to a house in a New Jersey suburb. Margaret worries about fitting in with the other kids in her new neighborhood. Most of all she wants to be normal, to be like everyone else. For American girls like Margaret, being “like everyone else” usually means fitting the conventional media-projected image:

By age thirteen, 53 percent of American girls are unhappy with their bodies; by age seventeen, 78 percent are dissatisfied…talk about the body and learning how to improve it is a central motif in publications and media aimed at adolescent girls.
(Brumberg, p. xxiv)

It’s the image of well-developed, womanly breasts that Margaret tries to fulfill when she gets her first bra:

When I got home I carried my package straight to my room. I took off my dress and put on the bra. I fastened it first around my waist, then wiggled it up to where it belonged. I threw my shoulders back and stood sideways. I didn’t look any different. I took out a pair of socks and stuffed one sock into each side of the bra, to see if it really grew with me. It was too tight that way, but I liked the way it looked.
(Blume, p. 44)

“Clearly it is difficult to feel good about one’s breasts if they do not correspond to the body ideal of one’s time and place,” writes Marilyn Yolom (p. 7). Adolescence is the time that young people begin to develop an individual identity. For girls, that individual identity is inextricably tied up with their developing bodies:

Love them or hate them, we construct our self-image in response to our breasts. And puberty is where it all begins…Not only are our bodies changing faster than we can come to terms with, this public change attracts more attention than we may be able to handle.
(Spadola, p. 18)

Carolyn Latteier describes her own adolescence this way:

But for me, at least, body consciousness remained dormant during childhood. My body troubled me when it fell down and got scabs on its knees, but otherwise, it was invisible. Body consciousness came about the same time as this girl’s small nipples began to swell. Breast consciousness arrived, at adolescence, feeling like a small fall from grace.
(p. 14)

Latteier’s description of adolescence as a “fall from grace” may be more than a clever metaphor. At adolescence, girls begin to lose the developmental advantages they’ve previously enjoyed over the opposite sex:

Until puberty, girls really are the stronger sex in terms of standard measures of physical and mental health: they are hardier, less likely to injure themselves, and more competent in social relations. But as soon as the body begins to change, a girl’s advantage starts to evaporate. At that point, more and more girls begin to suffer bouts of clinical depression. The explanation of this sex difference lies in the frustrations girls feel about the divergence between their dreams for the future and the conventional sex roles implied by their emerging breasts and hips.
(Brumberg, p. xxiii)

Because of the physical changes taking place in both boys and girls, adolescence is the time when their search for individual identity becomes enmeshed with their physical appearance:

Adolescent boys are often perceived (and perceive themselves) in terms of their growing physical power and their potential for useful work or for physical violence. More often, girls are assessed (and judge themselves) in terms of their new sexual allure…Messages about how their breasts should look, and about what kind of girl their breasts make them, find fertile ground in the adolescent psyche.
(Latteier, p. 24)

The adolescent girl’s search for identity can lead to ambivalence toward her developing breasts. One large-breasted woman told Ayalah and Weinstock about receiving an award for having the best figure in junior high school:

My self-image was very tied up in my body, and yet I was terribly ambivalent about it. I liked my body but I didn’t like other people liking it. See, I didn’t know if I liked anything else about me, but I knew my body was good! I sort of felt that at least I have this to hold on to.
(p. 74)

Adolescent girls have no control over when and how their breasts develop. Yet American society tends to stereotype girls by their breasts. There’s a stereotype of “early-maturing girls, as promiscuous” (Latteier, p. 17). Latteier writes about interviewing “Beth, who spent her adolescence believing her large breasts were her fault. ‘My breasts were too big,’ she said. ‘I thought maybe I was to blame. Maybe I should be ashamed’” (p. 20).

Judy Blume’s fictional Margaret learns about this stereotyping and the pain it can cause in the person of classmate Laura Danker, a tall, well-developed girl who has worn a bra since fourth grade. Margaret’s new friends tell her that Laura has a bad reputation, that she goes behind the A&P and does bad things with boys. They warn Margaret that, because reputations are catching, she’d better not be friendly with Laura. But when Margaret takes the time to talk to Laura, she learns that Laura is miserable because of both her lack of friends and the untrue stories the other girls spread about her. Margaret also learns that having breasts that are too large can be just as bad as having breasts that are too small.

…psychologists find girls who develop medium-sized breasts and whose development coincides with the herd are less traumatized than the early or late developers; they suffer less than the big-breasted and small-breasted girls. [footnote in original omitted]
(Latteier, p. 23)

And the relationship between breasts and a woman’s self-image doesn’t end once she’s made it through the physical and emotional turmoil of adolescence. In the next article we’ll look at how breasts continue to shape a woman’s sense of self through adulthood.

Breasts and Self-Image: Introduction

Although women have always had breasts, only in America over the last half of the twentieth century have breasts become a consuming passion of the culture, invoked and visible everywhere. This twentieth-century fascination with the breast has led to a media image of the ideal breast—or perhaps the media’s push to create the image has led to society’s fixation. But whichever came first, the cultural fixation and the ideal image are undeniable. They shape the way women evaluate themselves and complicate the adolescent girl’s passage into womanhood.

It hasn’t always been this way, of course. In earlier civilizations, and even today in many non-Western cultures, women’s breasts are accepted as natural, normal, and therefore unremarkable. But in the U.S., the cult of the breast began to develop during the period of prosperity after World War II:

…breasts were the particular preoccupation of Americans in the years after World War II, when voluptuous stars, such as Jayne Mansfield, Jane Russell, and Marilyn Monroe, were popular box-office attractions. The mammary fixation of the 1950s extended beyond movie stars and shaped the experience of adolescents of both genders. In that era, boys seemed to prefer girls who were “busty,” and American girls began to worry about breast size as well as about weight.
(Brumberg, p. 108)

Writer Carolyn Latteier describes her experience of coming of age during this era like this:

I grew up in the late 1950’s, the era of “mammary madness.” Breasts were practically the definition of femininity during those years. They had to, above all, be big. Brassieres of that era were highly engineered structures, with two conical cups stitched in precise spirals and carefully labeled from small to large: A, B, C, and D. The goal was to get as deep into the alphabet as possible. Size was everything.
(Latteier, p. 4)

This fascination with breasts—and particularly breast size—has deeply influenced all females who have grown up during the last half century. As Ayalah and Weinstock discovered while compiling their ground-breaking study in the late 1970s:

In one interview after another, as we observed the numerous and varied instances of causality which linked a woman’s breasts to her personality or lifestyle, we were amazed at how basic and profoundly fundamental the experience of having breasts actually was in women’s lives.
(Ayalah and Weinstock, p. 23)

A generation later, Meema Spadola found that this attitude had not changed:

…every time I did an interview or gathered together a group of women to discuss breasts, what always amazed me was just how much our breasts shape our lives, and, more than that, how eager so many women are to talk about what breasts mean to them.
(Spadola, p. 239)

Another factor that perhaps reinforces society’s focus on breasts is that they’re just so darned obvious:

Breasts are public—visible. They exist “out there,” as a sign, a password. They define and determine other people’s perceptions of a girl’s femininity. They express what kind of person she is without her will or consent.
(Latteier, p. 19)

The media have capitalized on this high visibility:

The tremendous anxiety and self-consciousness that women exhibited while being photographed, another factor we hadn’t anticipated, confirmed our notion that women were negatively affected by the ever-present media images of “ideal” breasts.
(Ayalah and Weinstock, p. 13)

When Ayalah and Weinstock undertook to counter the media-created image of the ideal breast, they initially envisioned simply a book of photographs showing breasts as they really are. But they soon found that women wanted to talk about their breasts as well as allow them to be photographed. We’d like young girls today to be aware of the discovery made by Ayalah and Weinstock’s subjects more than 20 years ago:

The one observation that most women made during their brief exposure to the photographs was about the variety of breasts. “I always thought breasts looked pretty much the same. How amazingly different they all are. They seem to have different characters—like individual faces.”
(Ayalah and Weinstock, p. 15)

But, unfortunately, most young girls today don’t think of their bodies as personally unique. They’re caught up in cultural expectations about what they and their bodies should be—a situation that underlies and molds their development from girls into young women. As Joan Jacobs Brumberg concludes in the preface to her eye-opening cultural study:

…although young women today enjoy greater freedom and more options than their counterparts of a century ago, they are also under more pressure, and at greater risk, because of a unique combination of biological and cultural forces that have made the adolescent female body into a template for much of the social change of the twentieth century.
(Brumberg, p. xxv)

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