Instant Genius - Breasts, with Dr Philippa Kaye

Episode Date: May 21, 2023

It goes without saying that breasts get a lot of attention. But less focus is given to the science behind them: why do we have them? Why are they all different, and does it matter? What happens when things go wrong? GP and author Dr Philippa Kaye is out to change that in her latest book, Breasts: An Owner’s Guide. In today’s podcast she tells us about the science of human breasts, the benefits – and costs – of having them, current research in breast cancer and sports, and how to take care of yours. Learn more about your ad choices. Visit podcastchoices.com/adchoices

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delivering digital precision with analogue warmth. So you can experience exceptional sound at home. Music just as the artist intended. Visit name audio.com. to learn more. Hello and welcome to Instant Genius, a bite-sized masterclass in podcast form. I'm Noah Leach, news editor at BBC Science Focus magazine.

It goes without saying that breasts get a lot of attention and have done throughout human history, in art and in culture. But less focus is given to the science behind them. Why do we have them? Why are they all different? And does that matter? What happens when things go wrong?

GP and author, Dr. Philips, Piquet is out to change that in her latest book, Breasts and Owners Guide. In today's podcast, she tells us about the science of human breasts, the benefits and costs of having them, current research in breast cancer and sports, and how to take care of yours. Dr. Philippa K, your book Breasts and Owners Guide aims to spread awareness about everything breast, from sports bras and puberty to breasts in culture and mythology. Why do you think it's important that we all know more about the them. My books are always born from the need that walks through my door. And I see people every day

who ask me about whether or not they're normal. They ask me about all kinds of problems. And it's very clear to me that whilst we talk about breast cancer and yet we need to do far more talking about breast cancer, we don't talk about what it's like to live with breasts. We talk about what they look like. And sometimes we talk about making them bigger and making them smaller or have they drooped. But we don't talk about what it's like to have monthly breast pain or anything like that or how it impacts your ability to run for the bus. And if you think about how many slang words you know for breasts, it's clear that we talk about them all the time. But I would like to expand the conversation to include something which might help women and people who live with breasts. Yeah, and that thinking and talking about breasts all the time, there are questions that people don't ask because they're nervous about it. And breast can be a sensitive topic when it comes to having concerns about your body, from stretch marks to asymmetry to even nipple sizes. So when it comes to breast, is there a normal?

There's only your normal. And actually that's true of so much of your body, be that your bowel habit or your menstrual cycle, your normal and my normal might be two very different things. But the important thing is that we know what our normals are. So for example, it is normal to have one breast that is bigger than the other. And actually that difference can be up to about a cup size. But if that's your normal, then that's okay. It might be normal, your normal, that you always had inverted nipples. But if you didn't, and and one nipple suddenly points in a different direction or turns inward, then that needs to be checked. And your breasts change throughout your life before puberty, during puberty, on contraception, if you get pregnant, if you breastfeed after the menopause, and you need to know what your normal is like at all of those stages. And it's only if you know you're normal, can you notice if something has changed and become potentially abnormal for you? So unless you know you're normal? How could you know when something's gone wrong? And we're talking about normal for humans, but objectively human breasts are a bit abnormal in the natural world. Why do humans only have

two breasts when, say, dogs, cows have multiple? Is this a case of animals losing their mammary glands as animals get smaller litters? I think that's the most likely reason we aren't producing as many babies in a pregnancy as a rabbit or hamster or something. But interestingly, if you only have one breast, you can still breastfeed even multiple pregnancies. Because once milk is established, once milk production is established, it works on a use and demand basis. So the more that is used, the more you make. And that's why you can feed multiple pregnancies, so twins, triplets from one person or why in days gone by that women were able to be wetness. And But even within that, how we differ from even our closest mammalian relations is really interesting.

So, for example, chimpanzees and other primates, when they're about to ovulate and they're ready to mate, their genitals become much pinker, much more swollen, and it's obvious. And you're walking around on all fours and it's obvious. There is a visual signal, I am ready to mate. And at some point, humans decided to stand up. and when we stood up, the female genitals are hidden and you can't see it. So maybe we need another visual sign that says, here I am, I'm ready to reproduce. You say, okay, so that might explain the development of breasts at puberty, but breasts actually

don't go away again. They don't go away when you can't have any more eggs to make any more pregnancies, but you still have breasts after the menopause. And in the animal world, actually, often you only have breast during pregnancy and breastfeeding, and then they shrink down again. done all kinds of studies. They're very heteronormative studies about what males, heterosexual males want when they look at a breast. I mean, there's definitely space for far more research there. But they looked at size, but also density, so firmness. And it seemed that men preferred a firmer breast.

And after the menopause, your breasts become a lot softer. So there are lots of reasons, potentially why we have breasts about sexual attraction. And even within that, whether or not you would potentially prefer a smaller breast or a larger breast has so many variables, including whether or not the man was hungry when they were filled in the questionnaires, essentially, because breasts are fat stores as well. So maybe if you've got big breasts, maybe it shows that you had enough food to eat. So there are lots and lots of sort of theories as to why we have them and what we do with them and how we differ from other mammals. But I think that it's really clear that we have a long way to go from thinking that solely breasts off to feed young and potentially

for something for babies to hang on to. I think that there's a lot more to-than-than-that, and we need to do a lot more research around it. Can anyone who has nipples lactate? That is an interesting question, technically. But whether or not you can produce enough to feed an infant is a slightly separate question. So breastfeeding, the changes that begin to happen to your breasts happen every single month. But men have some breast tissue and men have nipples and your nipples are formed in utero before the Y chromosome turns on, which is why men have nipples in the first place. But in order to answer the question, I guess you sort of need to understand how your body makes milk. And estrogen and progesterone in your menstrual cycle will start

to develop milk glands in the breast. And then as you become pregnant, the level of a hormone prolactin rises to stimulate milk production. And the combination of those hormones mean that you might stop to produce colostrum. And then as the levels of progesterone fall after you deliver your placenta, that sort of unmasks the effect of prolactin and milk will begin to come in. Now, up until that point, that milk production is solely hormonally driven. But once the milk is in, and once you feel that they fill up after that initial colostrum, milk production is related to the amount of milk is used. And you will then continue to produce milk for as long as you continue.

you to have milk used up. So a supply and demand basis. Well, I mean, really it's like a supply equals needs basis. So the more that you remove, the more that you are going to make. And the size of your breast doesn't make a difference. But can you breastfeed if you haven't given birth? So yes, you might need medication to help stimulate those hormones and then breast stimulation with a breast pump. And those hormones are released from the pituitary gland of the brain. So you can chest feed if you are trans, if you are non-binary. And it might need hormones and it might need breast stimulation again.

You might also need milk supplementation because you might not make enough because you don't have quite as much breast tissue. And if you've had top surgery, there might still be enough tissue left to make milk. There might not be. and actually the same is true of milk of breast reduction. And breastfeeding itself is perhaps more complex than we might think. How does that actually work? So when a baby sucks or suckles or a breast pump stimulates the areola and nipple,

there are nerves in the areola and nipple that lead to the production of the hormone oxytocin. And that oxytocin triggers the let down reflex, which is sometimes called the milk ejection reflex. And that stimulates the muscles in the glandular tissue of the breast to contract that squeezes the milk into the milk dachs and out through those multiple, multiple openings in the nipples. Actually, you might be aware of that as a sort of tingling, prickling, whushing, heat sensation. Sometimes it's a bit painful as the milk comes in. And the baby might only be sucking on one side, but the other side will leak at the same time. And there's actually now little devices that you can catch that in. But you might not be aware of it, but lots of people,

will be aware of it in their feelings themselves, but they will also notice what happens to the baby. So the baby initially will go suck, suck, suck, suck, suck, suck to trigger the letdown reflex. So they suck really rapidly. But as the letdown then happens, there is a real flow of milk and the sucking changes into a slower, more deeper rhythm with swallowing. Now that hormone oxytocin helps you hopefully feel relaxed and decreases stress and seems to help with bonding. And I was lucky enough to be able to breastfeed my children that I see very clearly from women that in some women that let down reflex causes a dysphoric reaction and it makes them very sad. And in other women, they're completely fine and happy. And I think that we need to be sensitive

to all of that. But also, we need to understand that people need to be offered a lot of support. and we don't have the village structure that we used to where your mum, your sisters, your aunties would help and say, oh, turn the baby's lip, or put more pillows, change this position, and that we used to be able to support each other much better in that ways. And there is support available, and I would really encourage people to ask for it. And there's absolutely no shame in that, something that we definitely still need to talk about much more.

So our breasts don't shrink down after breastfeeding, like other animals. Once grown, we have them our whole lives. But in your book, you talk about the costs of having breasts for so long, like the risk of cancer. It's not the only gene mutation which causes or increases your risk of breast cancer. So we think that it's about somewhere between 1 in 10 and 1 in 20 cases of breast cancer are related to gene mutations. And it might be a BRCA gene, but there are other ones, TP53, PTE, and there's lots of them. But BRACA is the most famous one. and there are two kinds, Bracquah 1 and Brac 2.

And what those genes do is that they are involved in the production of protein that repairs damaged DNA. So your cells are multiplying all the time and mistakes will get made. And we have systems in our bodies of trying to correct some of those mistakes. And when you have the Bracca 1 or Bracchia mutation, that can be affected. So that there's lots of cell growth. Now, generally, the Bracker gene mutations is about one in every 300 to 400. people. But in some particular ethnic groups, that rate is a lot higher. For example, in the Ashkenazi Jewish population, who come from Eastern Europe, the brackogene mutation rate is about

1 in 40 people. And the question as to whether or not you should screen everybody is actually being researched right now because there's a trial which has looked for people in that community to come forward for testing. So we might have some answers at some point. in the future about whether or not we screen everybody, whether or not we screen particular groups. But when it comes to genetic testing, you need to sort of know the answer before you ask the question. Because if you are told that you are going to have a test that is going to potentially give you information that you might have a higher risk of developing breast cancer and ovarian cancer, you need to know what you might do if you're positive, potentially, before you

ask the question. Because if you know that you aren't going to do anything and you're not going to have more screening and you're not going to change your lifestyle, maybe you don't want to know. And if you do know that you want to have a mastectomy, then it's worth knowing. And if you do know and you would say, you do want to know because you'd say, well, I'm going to have more regular screening on the back of that, which would need to be investigated. as to what would be the right interval at that point or that that would give me the drive to ensure that I always exercise, then it's worth knowing. But the implications of you being tested is not just for you, but also potentially for your family. So there isn't a right or a wrong

answer and it's complicated and it's very individual. But there's definitely a lot more research to be done. This podcast is sponsored by name, audio and trocal. With over 100 years of combined expertise, name and focal have been bringing music to listeners just as the artist intended. Since day one, this mantra has shaped every innovation in hi-fi design, technology and acoustic engineering, balancing craftsmanship and tradition with pioneering thinking. Name audio pushes cutting-edge technology to ensure digital precision whilst sustaining Pratt, pace, rhythm and timing.

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You can't know that you've got breast cancer. And I think that's a really clear and important difference because the fear of finding something is a reason that people give they're not looking in the first place. And so we would like people ideally to be checking their breast chest area about once a month. And I say that because that's everyone. should be doing it irrespective of what your gender is and what your age is. The breast change throughout the menstrual cycle, and it will be a good idea to know what your breasts feel like throughout your menstrual cycle, but actually they're most likely to be lumpy just before your period.

And so we would often say that once you know what your breasts feel like in general throughout your cycle to feel in a few days after your period, at least likely to be tender at that point as well. And if you don't have periods that you don't have your womb, you've gone through the menopause, your mail, that feel on the first is a really good way of just remembering. Set a reminder on your phone, you know, let's use the tech to help us. There's no official right or wrong way to examine your breast chest area, but I would recommend

looking and then feeling. And when I say look, that means that you strip to the waist and you look in the mirror and you look with your hands by your sides, your hands on your head like your sunbathing or hands up in the air, and then hands on your hips pushing in slightly because that tensing of the peck muscle or brings the breast tissue forward. You're looking for changes. And that might be nipples pointing in a different direction, might be skin changes,

so a new rash or an area of ulceration, or that your skin looks like the skin of an orange or cellulite, and that's called poe d'orange, and that's a change, that you're looking for a change in shape and outline of the breast that maybe you always had one breast bigger than the other, but now that smaller breast looks bigger. Or maybe you can see some tethering that it looks like something's pulling on an area of breast from underneath. And then you want to feel the breast.

And you might choose to do it in the shower and the bath with a wet, safety hand. Or if you've got big breasts where the breasts hang down, the breasts are pendulous, that sometimes lying on your side and rolling away from the breast you're examining can bring that breast tissue forward onto the chest wall. Because what you're doing when you examine your breast is that you're pushing the breast tissue against the the chest wall. And then I would say that you would use the flat of your three or four fingers to feel the breast. Divide your breast up so you know that you're checking all of that. Be that into quarters, be that like a clock and that you're going to feel down from every number. Or you start in the middle and you work your way out in ever increasing circles or the other way around. It doesn't

matter as long as you feel everything. And it might be a lump and it might be just an area of thickening or it might be something that just feels different. You need to be sure. that you check the nipple all the way up to the collarbone because the breast extends up there and round into the armpit as well because the tail of spence extends into the armpit and the lymph nodes that drain most of the breast are in the armpit so you need to check there as well. And another form of screening is the mammogram. Can you explain a bit about what these are, how these work and why for some people they're so painful? So that's definitely something that people are concerned about, but they should have

be too painful and if they are, then that might be that your breasts are very tender, but also that you're coming up to your period. But generally, even if they are, that it tends to last only a few seconds. So what a mammogram is, is that it's a low-dose x-ray and that cancer shows up as denser so that you would be able to hopefully see a change on the x-ray. And when you go in, you will be asked to take off your top and your bra, and the radiographer will position you so that your breast is placed in between the x-ray plates. And they take two images, sort of one from above, and then one sort of looking diagonally up into the armpit. And so you'll be asked to change position, and the radiographer will help you put your breasts into the right

position to do that. And they're hugely important because we can decrease your risk of having a breast cancer that you haven't found until later. So unlike cervical screening where you can pick up changes before they even happen. So you pick up pre-cancerous changes, breast screening aims to pick up changes before you might have had a symptom. And that's the difference there. So before a cancer is big enough to cause you a symptom and when it comes to cancer time matters. The earlier that you pick up a cancer, the more likely it is that you'll be able to have treatment and reach a full recovery. You'll be asked to remove nipple piercing, jewelry, and if you have implants, you've got to tell us because some of the breast tissue might be hidden behind that implant,

so we might want extra views. So be sure that you tell people. When you compress the breast, it can cause a squeezing sensation discomfort and it can be painful, but it really should only last a few seconds, hopefully, until the pressure is released. Now, some people do say that they notice a tenderness for a few days, but that from the majority of people, it's only for a few minutes. But in the UK, screening prevents about 1,300, 1,300 deaths from breast cancer every single year. And when you look at an international review for every 2,000 women that are screened for a decade one life can be saved. These numbers aren't insignificant. And so for most people,

this is something that you are called for and it takes a small amount of time. And for, I would say, very strongly that the benefits outweigh the risk. And when my time comes, I will go. So there are a range of reasons why people might get implants or have reconstruction. So maybe cosmetic reasons or following mastectomy or for people who are undergoing gender transition. So could you talk a bit about the difference between reconstruction and implants? Reconstruction is part of breast cancer treatment. So it's offered as part of breast cancer treatment. Not everybody says yes. And actually about 70% of people who have a mastectomy choose not to have a reconstruction. But it's offered as part of the treatment and there's various different ways

that it can be offered and it might be that you have it straight away. It might not be. You can have surgery that involves an implant as breast cancer reconstruction or you can have what's called a flat-based reconstruction where you don't use any implant or any device. You use your own fat or muscle which you take from another site of the body and is rotated around. And there's pros and cons to each of them and that's personal choice.

And breast reconstruction is available on the NHS as it's part of cancer treatment. When it comes to other forms of breast cosmetic surgery, sometimes it's available, but often not. So it might be available if, for example, you have an abnormality of breast development and one breast doesn't develop at all, for example. Breast reduction surgery is often not done on the NHS, but potentially can be done. And that will depend on the local guidelines and the impact that it's having on your life. because heavy breasts really do have an impact both physical and psychological, but often that unfortunately isn't covered. And then there's breast lift surgery and you might actually have a whole sort of combination of surgeries.

And yes, then there's breast augmentation for people of all genders. And when you have implant surgery, there's two ways of doing that. And you can either put the implant behind the breast or you can put the implant behind the muscle under the breast. if that makes sense. And actually we've been doing breast surgery, breast cosmetic surgery, for over 100 years. And the first documented one was in 1889. And they used paraffin oil. And they've been trying to do all kinds of different things for a long time. They've used implants made of ivory and sponges and glass. They've injected silicon directly into the breast, which sometimes led to gangrene. And before they came to implants,

So it's, and that's another area where it sort of seems clear that this fascination about having bigger breasts or whatever size breasts you might have has been going on for a long time. It's not something which is new. But breast surgery, the boob job, the breast augmentation is the most common cosmetic surgery performed globally. And you write about breast being a barrier to girls in sport. Actually quite a big focus of your book is about physical, exercise and the relationship between that and breasts. You may have seen the recent study from the University of Memphis found that the right sports bra can improve running performance by an astonishing 7%, which is a lot, especially for anyone considering their personal best. And in your book, you also mentioned that the first designers of the bra were the same people who designed some of the first spaces. So there's this link between kind of sports and bras. So could you tell us about why it's important to get the right bra and whether research like this can help us to design better sports bras and help us perform better physically?

I think that example about platex being involved in spaces suits is a real marker about how women's health shapes the world, but how the world shapes women's health. So at the end of the course, it was not to do with medicine. Even though doctors were talking about restricted breathing and all kinds of things, it was World War I when all the metal had to be put into the war effort. And that was the death knell for the corset. So, you know, women's health may shape society and society shapes women's health. When it comes to bras, prepare for a rant, because it is not a wonder that it's often quoted

that about four out of five women are wearing ill-fitting bras. The system is complex, complicated, and not standardized at all. And started off being called something like, you know, coffee cup and tea cup, egg cup. And you don't even have to standardise within the same brand, what a 32D even means, never mind between brands. Breasts are heavy. And we know that having breasts is a barrier to exercise, yet we know how important exercise is.

So in one study, almost one and five adult women report that their breasts are a barrier to exercise in adolescence. And actually, adolescence is really important because we know that girls are giving up sport. About one and three girls give up sport by about age 12, 13 in puberty, and about 60% of women do no sport at all. And that will have an impact on their physical and their psychological health always. So we want to keep girls in sport. And there was a study done that involved over 2,000 girls between 11 to 18, and almost half of them avoided some physical activity due to their breasts. And that number is higher if they have larger breasts. And it's not even just that they stop sport because of breast pain, but also because of embarrassment due to

things like bouncing and comments, remembering that not everybody develops at the same time. And often girls will start puberty before boys whilst they're still doing sport altogether. And so there's lots and lots of factors involved. And yet, most of the participants in the study wanted to know more about breast health. And if we could teach people about sports bras, if we were to do something as simple as putting a little reminder on your school uniform list that says, consider a sports bra, just so that it's in the minds of the parents as well, something as simple as that might have the ability to keep girls in sport, which would then have a great impact potentially on the rest of their health. And it's only in the past decade or so that even big organizations like Sport

England have been thinking about this in terms of elite athletes. And the research is being done on elite athletes whereby a difference of a millisecond might be the difference between gold and silver. And if you think about how if your foot hurts, you limp, if your breasts, maybe you don't breathe as much. You know, maybe you don't take as deep enough breath. Maybe you're a javelin thrower and that's going to get in the way. But whereas we need the research on not just on elite athletes, but on the person who jogs down the street, on the person who does swimming, on the person who does all kinds of activities, because even activities such as yoga and Pilates, there might be lower impact, but there is still breast movement. Because we need to know

what the movement is in order to think about it and think how we can best help it. And breast move, if you're doing jumping jacks, about 20 centimeters. not just up and down, but also sideways and forwards and backwards. And there's a lot of movement there of heavy breasts that causes discomfort. It allows you to still do whatever it is that you want to do. And if normal bra sizing is complicated, when it comes to sports bras, they then just sometimes go into small, medium and large, and then they talk about high impact and low impact, but without any standardisation at all.

And so the scientist in me says, oh my goodness, how can anyone find a bra? But the pragmatist in me says, well, if there aren't sort of standard sizes, then there must be a bra for everyone out there. But it takes time and money to find it. And then you need to look after those bras because they begin to lose their elasticity with wearing and with washing and all kinds of things. But when it comes to a sports bra, something as simple as knowing that the higher the neckline, the more support you have might make a difference. And if when you were little, your mum put you in a pair of shoes in the shoe shop and you were told to go for a little walk, actually I think most of us still do that now when we put on a pair of shoes. If you're in the bra shop and you're a jogger, jog up and down a bit and see what happens to your breasts. So when it comes to breasts, what's the most exciting thing in research currently?

Breasts are such a big topic that that's a very difficult question to answer. Now, the vast majority of money when it comes to breast health goes to breast cancer, as it should. But within that, most of that money goes to primary breast cancer. And what I would like to see is not less money for breast cancer, but more money for people with secondary or metastatic breast cancer. And more money and research into other areas of breast health, such as breast pain and sport and things like that. And if you compare the number of studies into running shoes versus sports bras, the running shoes win by a ton. And so research is being done all the time. And that, to me, is fascinating because I think that that can have a real impact on every woman and girl, actually.

And lots of that is being done at the breast health unit at the University of Portsmouth. and they were even talking about, you know, changes in trends throughout lockdown and now what's happening afterwards. So I think there is a lot more work to be done. And I would say, watch this space. But what is also interesting to me is that when we look at the evolutionary bit about breasts and when we looked about, you know, what do men look for in a breast, I would like to see that kind of research widened as well. If there was one thing about breasts, you could leave with our listeners today, what would that be? That they're yours. And whilst we often talk about the functions of the breast related to other people,

be that in sexual attraction or in feeding a baby or a child, actually they're yours. And we need to change the narrative from women saying they're a part of a body which doesn't really belong to me to their mind. because unless you know them, how can you look after them and never mind begin to get pleasure from them? So I would say, go find yours and learn to be comfortable with yours and then spread that message on. That was Dr. Philippa Kay, GP and author of Brests, an owner's guide. Thank you for listening to this episode of Instant Genius, brought to you by the team behind BBC Science Focus magazine. The current issue of BBC Science Focus is out now. Get your copy. be in supermarkets, newsagents, or wherever you buy your favourite magazines. You can also download a

digital version via our app and visit us online at sciencefocus.com. This podcast is sponsored by Name, Audio and Focal. The texture and emotional depth of music can be lost through digital sources or poor signal. Name audio believes you can have digital precision with analog warmth. Alongside French acoustic specialist Focal, Name creates high-end audio system. combining innovation with craftsmanship, so you can listen to music, just as the artist intended. Discover more at name audio.com.

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