What keeps your breasts healthy in your 30s, 40s, 50s

What symptoms are normal as you get older? Which cancer screenings are best? And where the heck can you find a supportive bra? We've got your girls covered.
Let's face it: There's no body part we obsess about more than our breasts — their size, shape, sag factor, and whether those strange pains stem from monthly PMS hormones or something more ominous, like breast cancer. All this nipple-gazing makes sense: Your chest changes over the decades, meaning you're continually facing new questions and concerns. To help you troubleshoot at every stage, Health asked experts to get age-specific. Here's the latest on how to keep your breasts healthy and looking great — now and in the years to come.

Your 30s
Your breasts now: Typically, in your 30s your breasts still have good elasticity and tone, says Shirley Archer, a health-and-fitness educator at the Stanford University School of Medicine and author of Busting Out. If you have kids now, you'll notice changes postbaby. While your breasts get bigger during the actual pregnancy, you may, alas, permanently go down a half-cup or cup from your original size once you've given birth and/or breast-fed. (This phenomenon is called breast involution, a process where the milk-making system inside the breast shrinks because it's not needed anymore.)

Your most common concern: Breast pain. Many thirtysomethings have fibrocystic breasts, a grab bag term for tender lumpiness resulting from hormonal changes, says Holly Smedira, MD, a medical breast specialist at the Cleveland Clinic Breast Center. Although uncomfortable, the condition is benign and doesn't increase breast-cancer risk. Cutting back on caffeine may help alleviate some of the pain, as may taking evening primrose oil (1.3 grams orally twice a day), a natural form of fatty acid believed to interfere with the body's production of prostaglandins (inflammatory compounds that trigger breast pain). For severe cases, doctors sometimes prescribe Danazol, a steroid derivative that decreases levels of the reproductive hormones FSH and LH, or tamoxifen, a breast-cancer drug that helps relieve breast pain by blocking estrogen receptors, thus preventing estrogen's effect on breast tissue.

Best breast-cancer-screening strategy: Talk to your doctor. Discuss having a baseline mammogram between the ages of 35 and 40, suggests Julia Smith, MD, director of the New York University Cancer Institute Breast Cancer Screening and Prevention Program. You should also get a yearly breast exam from your gynecologist and do monthly breast self-exams. Although the American Cancer Society (ACS) issued new guidelines for breast cancer screening in 2003, making self-exams optional, experts say they're still a must-do. "The more you examine your breasts, the more likely you are to differentiate between normal hormone-related bumpiness and a potentially precancerous growth," Smith says.

A woman who is at higher risk (that is, one who has a family history with one or more first-degree relatives with breast or ovarian cancer) should begin having regular annual mammograms at least 10 years earlier than the age at which her relative was diagnosed with cancer. So, if your mom found out she had cancer at age 45, you should start having mammograms done at age 35. Also, if you have a strong family history of the disease (two or more first-degree family members like a mother or grandmother), ask your doctor about receiving genetic screening to see if you're a carrier of the BRCA gene and ask about an annual MRI.

Best breast-saving move: Wear a good exercise bra. This will help stave off future droopiness, Archer says. When you run sans bra, your breasts bounce up and down 2.6 inches for every step you take, according to a recent study done at the University of Portsmouth in England. The reassuring news: The study also found that wearing a sports bra reduces bounce by 74 percent. "I recommend women do the bounce test when trying on exercise bras. If your breasts move when you jump up and down, you're not getting enough support," Archer says. If one sports bra doesn't do the job for you, she adds, try wearing two.

GOOD NEWS! Your breast-cancer risk is still very low — only 5 percent of all cases occur in women younger than 40, according to the ACS. (Your risk during this decade is about 1 in 233, according to the National Cancer Institute.) One way to lower your odds even further: breastfeed. It protects older moms against the increased risk of breast cancer noted for women who have their first child after age 25, according to a recent University of Southern California study.

Your 40s
Your breasts now: In your 30s, your chest is made up mostly of breast tissue. But as you enter this decade, the percentage of fat in your breasts increases, breast specialist Smedira says. Fat's less likely to withstand the effects of gravity, so your breasts will start to droop and sag.

Your most common concern: Breast cysts. As breasts change from their lactational state, fluid can be trapped in the ducts, causing fluid-filled cysts, Smedira explains. They are harmless (though sometimes painful) and can be evaluated by ultrasound and then aspirated if they are large or uncomfortable. They won't increase your future risk of cancer, Smedira says.

Best breast-cancer-screening strategy: Annual mammograms. Starting at age 40, "it's crucial to get a mammogram every year, especially since the test has only about 80 percent sensitivity in younger, premenopausal women," Smith stresses. "This way, if an early-stage cancer is missed one year, it most likely will be caught the next."

It's also important to do monthly at-home breast checks and see your doctor for yearly breast exams, says Rachel Brem, MD, vice chairman of radiology and director of breast imaging at the George Washington University Medical Center in Washington, D.C. A must for premenopausal women: Find a center that offers digital mammography, which takes an electronic image of your breasts and stores it directly into a computer, Brem says. A recent National Cancer Institute (NCI) study found that digital mammography picks up more cases of cancer, but only in women who are premenopausal and/or have dense breasts.

Best breast-saving move: Stand up straight. "As a woman gets older, her back muscles weaken, and she tends to slouch, which gives her breasts the appearance of hanging down to her belly button," Archer says. "If you strengthen your upper-back and torso muscles, you'll have a nice open chest and shoulder line, which will help make your breasts look perkier."

Try the Back-Shoulder Blade Squeeze: Stand with shoulders relaxed and arms at your sides. Hold the end of an exercise band in each hand in front of your body. Exhale as you squeeze shoulder blades together, keeping your shoulders relaxed, torso stable, and wrists flat; inhale as you return arms to starting position. Do 8-12 reps, working up to 1 minute. And increase band resistance as you get stronger.

GOOD NEWS! Premenopausal women who get three servings of low-fat dairy every day and pop a calcium supplement with vitamin D daily reduce their risk of breast cancer by about 40 percent, according to a Harvard study.

Your 50s
Your breasts now: You may notice some slight shrinkage. As you get older, hormonal changes cause body fat to accumulate in your lower regions — fat often decreases in the face or breasts and increases in the butt or thighs, Archer explains. You'll also notice more sagging because, as menopause approches, fat (which is more gravity-prone) replaces almost all breast tissue, and skin loses elasticity. Age also stretches out the Cooper's ligaments. These fibrous, semielastic bands of tissue are found in breasts, and "they're like rubber bands that get stretched over time," Archer says.

Your most common concern: Breast cancer. Your risk of developing the disease is now 1 in 38, the NCI says. So in your 50s, it's more important than ever to get to a healthy weight. Several major studies have found a link between postmenopausal weight gain (especially if you tend to gain around the waist) and breast cancer. "I recommend that every woman in this age group measure her waist, which should be less than half her height in inches," Smedira says.

Best breast-cancer-screening strategy: Annual mammograms. These are a must, as are physical examinations by your doctor and monthly self-exams.

Best breast-saving move: Chest exercises. While nothing will magically save you from sagging, doing chest moves two or three times a week will pump up breasts temporarily (by increasing blood flow to the area) and tone underlying muscles. Here's a good exercise to try before a big event: Lie on your back across a bench with your knees bent and your feet on the floor. With both hands, hold a dumbbell directly over your chest. Inhale as you lower the weight in an are past your head, going as far as shoulder flexibility allows. Pause, then exhale as you lift the weight overhead in an are until your hands are above your torso. Start with 8-12 reps; work up to 1 minute.

GOOD NEWS! Since your breasts are fattier now, mammograms can better detect cancer: The false-negative rate drops from about 25 percent under the age of 50 to about 15 percent, Brem says.

4 healthy tips for every year
Don't be a yo-yo dieter. Every time you gain then lose weight, you get stretch marks around your breasts that are hard to get rid of, says Shirley Archer, a health-and-fitness educator at the Stanford University School of Medicine.
Map out a family-health history. Even if you don't have breast cancer in your immediate family, you may still be at risk if you have first-degree relatives with other hormonally driven cancers, like prostate or ovarian cancer, which are also linked to the BRCA 1 or 2 genes, says Julia Smith, MD, director of the New York University Cancer Institute Breast Cancer Screening and Prevention program.
Move a little more. No time to exercise? Research shows walking just 10 minutes a day starts slashing your breast-cancer risk. A 2005 University of Southern California study found that women who exercised just 1.3 hours a week lowered their chances of developing the disease by 20 percent.
Wear sunscreen. Protect your upper chest from sun damage and signs of aging. Our picks (below): Clarins SPF 30 Sunscreen Cream High Protection for Sun-Sensitive Skin ($28.00; specialty stores) and Origins Sunshine State SPF 20 ($22.50; www.origins.com).
How to buy a better (more supportive!} bra
"Eighty percent of the women who walk into my store are wearing the wrong size bra — and they don't even realize it," says Dan Koch, owner of Town Shop, a New York City bra-fitting emporium. Here, his expert tips on finding the perfect bra.

Be strap savvy. The thicker the shoulder strap, the more support it gives; this is crucial for full figures (D cup and up). Also, straps should be adjusted to stay put without pressure or cutting.

Get the right cup. A bra's cups should completely contain the breasts and fit smoothly, with no bulges at the top, sides, or bottom. The ideal bra is one with molded cups; they're the least visible underneath clothes, and they offer the most support.

Don't ignore seams. They actually provide a lot of support.

Test for fit. Proof of a good fit? When you sit down, the position of your bra doesn't change.

Look for gaps. The center of the bra (the piece that connects the two cups in the front) should lie flat against the breastbone, without leaving a gap between the torso and the bra. If it protrudes in the center, the bra is too small; try a larger cup size.

Check underwires. They should relieve shoulder stress from bra straps by adding support below the breast. Also, they should fit to the rib cage and not cut into breast tissue.

Watch your back. The back strap should be completely straight and rest at or below shoulder blades for maximum support. If it's riding up, the bra is too big. If it feels tight, 75 percent of the time a larger cup size is needed, not a larger bra.

What derms want you to know
This advice from the pros will keep your décolletage dazzling at every age.

30s You'll start to notice brown spots and uneven pigmentation, says Debra Jaliman, MD, professor of dermatology at Mount Sinai School of Medicine in New York City.
• Beat back the clock: Try an over-the-counter product like Nia 24 Sun Damage Repair for Décolletage and Hands ($44; www.amazon.com), which contains nicotinic acid, a substance proven to reduce age spots and discoloration, Jaliman says.
40s Your concern: vertical wrinkles up and down your chest.
Beat back the clock: Talk to your derm about collagen-stimulating lasers. Recently developed ones like the Genesis or Medlite actually stimulate skin to make new collagen, which makes the chest appear more plumped up. Most women need three to six treatments, costing about $400 each (results usually last three to five years).
50s Years of sun exposure can leave your skin with a crepey look.
Beat back the clock: At-home or in-office glycolic peels will stimulate collagen production. A Photosome-based treatment will repair damage; try Remergent DNA Repair Formula ($125; available through dermatologists). And OTC products with hyaluronic acid, which retains moisture, will improve your skin's appearance temporarily.
Plastic surgery by the decade
Here, the most-sought-after breast-enhancing procedures.

Early 30s: Almost half of all procedures now are implants, according to the American Society for Aesthetic Plastic Surgery (ASAPS). "I see a lot of women who have lost virtually all their breast tissue through pregnancy and nursing," says Laurie Casas, MD, associate professor of surgery at Northwestern University's Feinberg School of Medicine in Chicago. "They come in with breasts that look like empty bags with a lot of skin."
35 to 50: The lift accounts for more than half of all breast cosmetic procedures in this group, according to the ASAPS. "Most women want to get rid of the sagging due to the combined effects of gravity and years of having babies," Casas says. Also, almost half (48 percent) of all breast-reduction procedures are done on women in their late 30s and 40s. "As women get older and muscles weaken, they really feel the impact of heavy breasts — backaches," adds Lawrence S. Reed, MD, assistant professor of surgery at New York Presbyterian Hospital in New York City.
51 to 64: Women in this range make up a small amount of total breast procedures — only 9 percent of breast enhancements and 18 percent of breast reductions. "They're more comfortable with their bodies," Casas says.
How your age affects your cancer risk
Intuitively, it makes sense that if you're young, you've got better odds of beating breast cancer. But that's not always the case. Women under the age of 45 have slightly poorer prognoses: Their five-year survival rate is only about 81 percent, compared with 85 percent of women in the 45-to-65 range, according to the American Cancer Society. "Younger women are more likely to have tumors that are hormone-negative, which are more aggressive," explains Julia Smith, MD, director of the New York University Cancer Institute Breast Cancer Screening and Prevention Program.

Because most under-40 women don't get annual mammograms, cases often aren't caught until a woman or her doctor notices a lump, when the cancer is more advanced. But even when a woman finds something suspicious, she's more likely to be blown off by her physician, Smith says.

If you do find a lump, don't panic, but do call your OB-GYN right away. Screening tools such as a mammography and/ or an ultrasound can help your gyno pinpoint whether it's something that requires a biopsy. If she tells you not to worry, get a second opinion.

What has your bra done for you lately?
If the answer is "not much," it's time to update your support system. Check out the big change a lingerie makeover gave these three women.

Alison Mummers, 36 She thought she was a 36C, but… She's really a 34DD The bra fitter says:
"Even before I measured Alison, I could tell she was wearing the wrong size — her back bra strap was very low, which indicated she was wearing a size too large," says bra expert Eyvette Manigault of Town Shop in New York City. "She also had pushed her bra straps all the way up to her neck to try to prevent her breasts from drooping, which meant her cups weren't giving her enough support."

Alison says:
"Since my new bras provide more support, I notice I look taller and thinner in clothes. I was worried about sagging after having kids, but wearing the right bra definitely helps. I also have less pressure on my neck and back."

Jessica Lavine, 46 She thought she was a 38D, but… She's really a 32G The bra fitter says:
"Jessica came in complaining her bras made her breasts hang low, but it was because she was wearing a bra that was too large in the chest and didn't offer enough cup support," Manigault says. "Her breasts were literally sinking down to her stomach. Once we gave her the proper-size bra, it corrected the problem."

Jessica says:
"I was astonished when she said I was really a 32. I told her I hadn't worn that size since I was 16. Once I put on a bra that was the right size, though, I felt like a different woman. My breasts felt much more snug and secure."

Alva Chim, 58 She thought she was a 34C, but… She's really a 32D The bra fitter says:
"Alva was wearing her bra on the tightest hook, which was a sign to me that the fit was wrong. Your bra should always be on the middle hook," explains Diane Clark of Town Shop. "The result was her bras rode up on her breasts. The underwire should never rest directly on your boobs."

Alva says:
"I was always having to readjust my bras; the straps always seemed too loose. Now I feel like I'm wearing a much better fit. I hate bras with underwire, too, so Diane suggested a molded bra, which doesn't hurt but gives me just as much support."


By Hallie Levine Sklar

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