Risks Of Breast Asymmetry
Breast asymmetry is perfectly normal. Over half of all women have some degree of unevenness between their breasts. The larger breast is typically on the dominant side, and the asymmetry is usually quite mild. But what could be the risks of breast asymmetry?
In some cases, the asymmetry may be more exaggerated. The difference could be a cup size or more. If there is more than a 20% difference in size, then you may have a slightly increased risk of developing breast cancer.
Addressing The Aesthetics Of Breast Asymmetry
Theres nothing wrong with breast asymmetry, but some women do find that uneven breasts make certain parts of their life difficult. Finding clothes that fit you well can be particularly challenging. If you decide that the unevenness of your breasts is bothersome to an extent where you would like to have it surgically fixed, then that is your choice.
You can have surgery for breast asymmetry in Houston to even out the symmetry of your breasts. You may choose to have an implant on one side, have a breast reduction on one side, or you may have a fat transfer from one breast to the other. Its up to you, and your board-certified plastic surgeon will be more than happy to discuss your options with you.
Breast Asymmetry And Mammogram Results
A mammogram is an X-ray of the breast, which can test for any abnormalities, including lumps.
A mammogram might reveal that the breasts have different densities. This is referred to as breast asymmetry or focal asymmetry. Focal asymmetry does not always mean that breasts look or feel any different.
Although dense breast tissue is typically as healthy as less dense breast tissue, a mammogram result may suggest a slightly higher risk of developing breast cancer.
If breast asymmetry is new or changes, it is called developing asymmetry. If a mammogram screening identifies developing asymmetry, there is a 12.8 percent chance that the person will develop breast cancer.
Other possible causes for an asymmetrical breast density mammogram result include:
- normal variation in the composition of fats and fibrous tissue in the breasts
- a cyst in one breast
- fibrosis, or a large amount of fibrous tissue
According to the
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Breastfeeding And Uneven Breast Size
Experiencing a certain amount of breast asymmetry is a normal part of breast feeding, especially if one of your breasts receives more stimulation than the other as a result of your baby preferring one breast over the other or if you feed on the same breast most of the time.
This can cause one breast to grow larger as it produces more milk, and alternating which breasts you feed from can help to avoid this problem.
For most breastfeeding mothers, asymmetrical breasts are not a medical concern. However, if one of your breasts has remained smaller from the beginning of your pregnancy and did not get any larger, visit your doctor for a consultation.
What Is Dense Tissue
Breast tissue that is not fatty is considered dense tissue. Glandular and fibrous tissues are dense tissue, including milk ducts, glands, and connective tissues.
Breast density is categorized into one of four groups:
- Extremely dense: In about 10% of women, the entire breast is very dense.
- Heterogeneously dense: In about 40% of women, dense tissue spreads evenly across the breast.
- Scattered fibroglandular density: In about 40% of women, specific areas of the breast have dense tissue.
- Almost entirely fatty breast tissue: In about 10% of women, the entire breast is fatty.
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Should Women With Dense Breasts Have Additional Screening For Breast Cancer
In some states, mammography providers are required to inform women who have a mammogram about breast density in general or about whether they have dense breasts. Many states now require that women with dense breasts be covered by insurance for supplemental imaging tests. A United States map showing information about specific state legislation is available from DenseBreast-info.org.
Nevertheless, the value of supplemental, or additional, screening tests such as ultrasound or MRI for women with dense breasts is not yet clear, according to the Final Recommendation Statement on Breast Cancer Screening by the United States Preventive Services Task Force. Ongoing clinical trials are evaluating the role of supplemental imaging tests in women with dense breasts. NCIâs Cancer Information Service can tell you about clinical trials and provide tailored clinical trial searches to help you learn more about clinical trials related to breast density and breast cancer screening.
Recent research has suggested that for women with dense breasts, a screening strategy that also takes into account a womanâs risk factors and protective factors may be the best predictor of whether a woman will develop breast cancer after a normal mammogram and before her next scheduled mammogram.
As you talk with your doctor about your personal risk for breast cancer, keep in mind that:
- risk factors increase your chance of breast cancer
- protective factors lower your chance of breast cancer
Imaging Acquisition And Analysis
Mammography was performed using the Hologic-Lorad M-IV . HHUS and ABUS were performed using the GE logiq E9 with an ML6-15 liner probe at 1014 MHz, Apollo 500 and a PLT-1005BT liner probe at 1012 MHz, and GE invenia ABUS with a C15-6XW arc probe at 10 MHz. Preset ultrasonic instrument scanning conditions were used. Depth, gain and focus point was adjusted according to the thickness of the breast lesion area. The field of view was adjusted to include the area from the subcutaneous fat to the pectoral muscle layer.
The NML was located in the central region of the ultrasonography image, and two-dimensional longitudinal and transverse sections and CDFI were stored. All NML features were evaluated and recorded, including location, maximum diameter, echo pattern, structural distortion, ductal changes, microcalcification , and posterior echo. To describe the distribution of microcalcification more accurately, scattered and aggregated point hyperechoic was used.
All NMLs were classified according to BI-RADS categories . CDFI was evaluated according to Adlers grade. The category in two-dimensional sonography was used as the reference for ABUS classification. However, if the coronal appearance of ABUS was consistent with mass, the lesions were classified according to the lexicon of ACR BI-RADS. All mammography and MRI features were evaluated using the lexicon of ACR BI-RADS .
Fig. 2Fig. 3Fig. 4
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How Is Breast Density Categorized
Doctors use the Breast Imaging Reporting and Data System, called BI-RADS, to group different types of breast density. This system, developed by the American College of Radiology, helps doctors to interpret and report back mammogram findings. Doctors who review mammograms are called radiologists. BI-RADS classifies breast density into four categories, as follows:
- Almost entirely fatty breast tissue, found in about 10% of women
- Scattered areas of dense glandular tissue and fibrous connective tissue found in about 40% of women
- Heterogeneously dense breast tissue with many areas of glandular tissue and fibrous connective tissue, found in about 40% of women
- Extremely dense breast tissue, found in about 10% of women
If you are told that you have dense breasts, it means that you have either heterogeneously dense or extremely dense breasts.
The four breast density categories are shown in this image. Breasts can be almost entirely fatty , have scattered areas of dense fibroglandular breast tissue , have many areas of glandular and connective tissue , or be extremely dense . Breasts are classified as âdenseâ if they fall in the heterogeneously dense or extremely dense categories.
D Digital Tomosynthesis Results
A BIRADS category was given to lesions identified on 3D digital tomosynthesis according to the Mammography BIRADS Lexicon and accordingly 38/57 lesions were considered benign , while 19/57 lesions were considered malignant.
After revising the pathology results, 15/18 lesions were true positives, 4/39 lesions were false positive, 3/18 lesions were false negatives, and 35/39 lesions were true negatives.
The false-positive results are less when compared to digital mammography. Tomosynthesis overcame the tissue overlap in focal asymmetries and was able to verify if there is an underlying mass or is it only overlapping fibro-glandular tissue. The false-positive results were due to dense breast or irregular margin of the lesions.
The false-negative results were diffuse subtle infiltration in two cases with diffuse edema and one case with a deeply seated lesion not included in the mammography film view.
Durand et al. found that the use of tomosynthesis compared with conventional mammography is associated with a lower recall rate of screening mammography, most often for asymmetries.
Nam et al. stated that lesion characterization of digital breast tomosynthesis was more specific than that of full-field digital mammography , and focal asymmetry or mass terminology was more frequently used in DBT than in FFDM , whereas asymmetry terminology was less frequently used in DBT than in FFDM by the informed radiologists.
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What Causes Focal Asymmetry
Your breasts, just like your extremities, may be difficult to tell apart. However, theyre rarely identical or completely symmetrical. Small differences are typical and expected. Slight internal asymmetries may not be visible to the eye, but you can see them on imaging tests.
Focal asymmetry in breast tissue is common. It can be due to natural differences in breast volume, form, and size. In some instances, a developing cancer may be the cause.
Focal asymmetry may also be due to problems with mammogram technology. The superimposition of regular breast tissue on film can look like an area of increased density, or mimic the appearance of a lesion, where none exists. Doctors refer to this as a summation artifact.
What Are Clip Markers And Why Are They Used During Biopsies
After a mammogram screening, a small percentage of women will have afinding that may require additional diagnostic imaging. This is called arecall. If a patient is recalled, additional imaging will be performed, andonly about 2 percent of women may need a biopsy. During a biopsy, aradiologist with breast imaging expertise inserts a small metallic clip inthe breast to help locate the biopsy site in case further testing isneeded.
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What To Do If Your Mammogram Shows Focal Asymmetry
If your screening mammogram shows focal asymmetry for the first time, a doctor may recommend further testing. Theyll consider your breast density and breast cancer risk factors in determining which tests you need. In most cases, they will eventually rule out breast cancer after these tests.
The next step may be a diagnostic mammogram. Like screening mammograms, diagnostic mammograms are X-rays of the breast. Diagnostic mammograms focus on specific, suspicious areas that doctors identify on your screening mammograms. They show more detailed images.
You may get a breast ultrasound. Breast ultrasounds do not screen for breast cancer because they dont always pick up images of microcalcifications. They are, however, beneficial for viewing inside dense breast tissue.
If doctors still suspect cancer, they may recommend an MRI scan or a biopsy.
Breast MRIs are imaging tests. They allow doctors to view breast tissue in people with very dense breasts and those at high risk of breast cancer. If a doctor does find cancer, an MRI scan can also help determine the extent of its spread, if any.
A biopsy is the only way to definitively diagnose breast cancer. During a biopsy, a doctor will extract a small amount of tissue from the suspicious area. Theyll send the tissue sample to a laboratory, where lab technicians will check for cancerous cells.
Data Abstraction And Quality Evaluation
Two reviewers searched all the literature, collected data and related information after evaluating the quality of the study. For different papers based on the same research, we selected the paper with the largest sample size or the most recently published paper or one with sufficient data for analysis. Collected data included first author, year of publication, study type, sample size of cases/controls, quantity, source of cases/controls, and contingency table or OR/RR value related to the risk factors. Among these, OR/RR value was obtained from the result of univariate analysis only, not from the result of adjusted multivariate analysis. The Newcastle-Ottawa Scale recommended by the Cochrane Collaboration was used, and eight criteria were established to evaluate the quality of the included case-control studies and cohort studies , such being the case, studies could receive a score of 0-9 points, based on the three criteria of subject selection, comparability between groups and measurement of exposure factors.
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Technique Of 3d Tomosynthesis
For 3D digital tomosynthesis, two views were obtained. 3D DBT involved the acquisition of 12 to 15 2D projection exposures by a digital detector from a mammographic x-ray source which moves over a limited arc angle. The 3D volume of compressed breast was reconstructed from the 2D projections in the form of series of images through the entire breast. Images were assessed in the workstation.
Newly Developed Gene Classifier Identifies Risk Of Pre
by Duke University Medical Center
Cancer Cell
A team of researchers mapping a molecular atlas for ductal carcinoma in situ has made a major advance toward distinguishing whether the early pre-cancers in the breast will develop into invasive cancers or remain stable.
Analyzing samples from patients who had undergone surgery to remove areas of DCIS, the team identified 812 genes associated with cancer progression. Using this gene classifier, they were then able to predict the risk of cancer cells recurring or progressing.
The study, which published this week in the journal Cancer Cell, was led by E. Shelley Hwang, M.D., of the Duke Cancer Institute, and Rob West, M.D., Ph.D., of the Stanford University Medical Center.
“There has been a long-standing debate over whether DCIS is cancer or a high-risk condition,” Hwang said. “In the absence of a way to make that determination, we currently treat everyone with surgery, radiation, or both.
“DCIS is diagnosed in more than 50,000 women a year, and about a third of those women have a mastectomy, so we are increasingly concerned that we might be overtreating many women,” Hwang said. “We need to understand the biology of DCIS better, and that’s what our research has been designed to do.”
Hwang, West and colleagues analyzed 774 DCIS samples from 542 patients who were a median of 7.4 years post-treatment. They identified 812 genes associated with recurrence within five years from treatment.
More information:Cancer Cell
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Combined Digital Mammography 3d Tomosynthesis And Ultrasound Findings
Combined digital mammography, 3D tomosynthesis, and ultrasound BIRADS category was given for each lesion according to the BIRADS mammography morphology descriptors 36/57 lesions were considered benign while 21/57 lesions were considered malignant.
After revising the pathology results, 18 lesions were true positives, 3 lesions were false positive, 0 lesions was false negative, and 36 lesions were true negatives.
Kim et al. found that previous prospective clinical studies have demonstrated that appropriate use of US as an adjunct to mammography improves sensitivity and specificity of breast cancer diagnoses, particularly in women with dense breasts and in younger women.
In this study, combined digital mammography, 3D tomosynthesis, and ultrasound had a sensitivity of 100.00%, a specificity of 92.31%, a positive predictive value of 85.71%, and a negative predictive value of 100.00%.
However, some points made were usage of 3D is limited, like relatively higher dose of radiation, higher cost, and less availability than FFDM. Considering this study, decreased number of patients may make the results a matter of discussion.
What Causes Breast Asymmetry
Breast asymmetry occurs when one breast has a different size, volume, position, or form from the other.
Breast asymmetry is very common and affects more than half of all women. There are a number of reasons why a womans breasts can change in size or volume, including trauma, puberty, and hormonal changes.
Your breast tissue can change when youre ovulating, and can often feel more full and sensitive. Its common for the breasts to look bigger because they actually grow from water retention and blood flow. However, during your menstrual cycle, theyll return to normal size.
Another cause for asymmetrical breasts is a condition called juvenile hypertrophy of the breast. Though rare, this can cause one breast to grow significantly larger than the other. It can be corrected with surgery, but it may lead to a number of psychological issues and insecurities.
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How Do I Know If I Have Dense Breasts
Radiologists are doctors who read mammograms . They check your mammogram for abnormal areas, and they also look at breast density.
There are 4 categories of breast density. They go from almost all fatty tissue to extremely dense tissue with very little fat. The radiologist decides which of the 4 categories best describes how dense your breasts are:
Category A: Breasts are almost all fatty tissue.
Category B: There are scattered areas of dense glandular and fibrous tissue .
Category C: More of the breast is made of dense glandular and fibrous tissue . This can make it hard to see small masses in or around the dense tissue, which also appear as white areas.
Category D: Breasts are extremely dense, which makes it harder to see masses or other findings that may appear as white areas on the mammogram.
Mammogram reports sent to women often mention breast density. Your health care provider can also tell you if your mammogram shows that you have dense breasts.
In many states, women whose mammograms show heterogeneously dense or extremely dense breasts must be told that they have dense breasts in the summary of the mammogram report that is sent to patients .
The language used is mandated by each law, and may say something like this: