Breasts. The Rest of the Story.

Published on 04 /16 /2014 By: Breast Center HackensackUMC Mountainside

Last week we talked about what’s normal when it comes to nipples. This week, I thought I’d share some information about the rest of the breast—how it’s constructed and how that can translate into a wide range of breast variations.

Breasts the rest of the story The breast is made up of tissue and fat. Breast tissue is white and rubbery (kind of like cooked lobster) and the fat is just like the fat you peel off a chicken breast. The breast becomes more fatty as you age.
Breast tissue is made up of ducts and lobules. A cartoon illustration of the breast might look like several bunches of grapes with the big stem going out to the nipple for breast-feeding and all the little stems going back to the grapes which are the lobules where milk is formed. Of course, in reality it’s a whole lot smaller than a bunch of grapes; the duct and lobule system can only be seen under a microscope.

The breast sits in an envelope of skin, which is part of the integumentary (skin) organ system. So issues involving the skin overlying the breast, like sebaceous cysts, freckles, moles, etc. are not breast issues, they are skin issues.

Infections of the breast, and rarely some breast cancer, may manifest in this overlying skin envelope.

Underneath, the breast is attached to the skin, sort of like sod to the underlying ground. It is not a clear separation, which is why even with a mastectomy some breast tissue will always remain

Breast tissue usually feels firm with a lumpy surface like an expensive cultured carpet with skin and soft fat overlying it. At one extreme, and this is rare, a woman’s breast tissue can feel like a bag of marbles and on the other end of the spectrum, some breasts feel like a foam pillow. Most breasts lie somewhere in between, and all are normal.


Are My Nipples Normal?

Published on 04 /10 /2014 By: Breast Center HackensackUMC Mountainside

are my nipples normalThe nipples, also known as the nipple areola complex, include the part that sticks out as well as the flat ring of colored skin surrounding it.  Because they are not generally exposed—many women aren’t aware of how much this part of our anatomy can vary from one woman to the next.  


Color and size: Nipples range widely in color from the palest pink to dark brown, and it’s normal for nipples to darken after childbirth. The whole complex can range in diameter from as small as one inch to four inches in women with larger breasts

Shape: When we’re born, nipples are flat. Over time, the whole complex gets softly pushed out by breast tissue. Nipples may be inverted from birth (think: “inny” belly button) or one or both may gradually invert due to duct ectasia (dilated central ducts). If this happens, they can usually be everted with gentle pressure. If your nipple is newly inverted on one side only, it is good to get it checked out, only because in rare instances this can be related to a cancer pulling it in. Normal nipples may stick out a little bit or be long enough to “hang”.  They get longer with childbirth and breastfeeding.  If you are uncomfortable with the way your nipples look beneath your clothing, a padded bra or strategically placed Band-Aid will help.

Texture: The multiple bumps on the areola are completely normal. They are called Montgomery glands.  These glands secrete an oily substance that keeps the skin soft. They can get infected, so it’s important not to pick at them. Occasionally a nipple duct will get blocked and it will look like a whitehead on the tip of your nipple. Once again avoid the temptation to squeeze. Warm compresses might encourage it to resolve, but it will go away on its own.

Irritation: We’re just getting out of the “itchy nipple” season. This is a common complaint in winter when women take long hot showers. I recommend applying a generous amount of Vaseline-like ointment with a nursing pad to protect your bra and clothes.

If you experience a dry crustiness of the nipple, it may be eczema—and a Vaseline like ointment—with or without steroid—can help. This can also be a symptom of Paget’s disease, but it is extremely rare. As always, if something feels abnormal and does not get better in a few weeks, see your doctor.

If you’re in the Montclair area, and we can be of help, please don’t hesitate to call.

Dr. Huston



10 Questions to Ask When Choosing a Breast Center

Published on 04 /04 /2014 By: Breast Center HackensackUMC Mountainside

10 Questions to Ask When Choosing a Breast Center HackensackUMC Mountainside1. Is the center convenient?  Choosing a center close to home or work makes annual screening easy. A center that offers early morning, weekend or evening appointments is ideal for working women.

2. Does the center offer digital mammography and ultrasound? Mammography is the “gold standard” for breast cancer screening.  Digital verses the more dated analog is pretty standard now.  Ultrasound is an important diagnostic tool to further characterize an area of concern identified by mammography or physical exam. I do not feel MRI or tomosynthesis are essentials, as these studies are not in the guidelines for screening of women at average or increased risk. That being said most breast centers will have one or both.
3. How  quickly will I get my results? It is reasonable to expect results in 1-3 days.
4. How will the results be delivered? Some centers deliver results by phone, others by mail. This is good information to know up front, so you know what to expect—and are not unduly alarmed when you receive a phone call or letter.
5. What happens if my results are abnormal? It is not uncommon to get the dreaded “call back” meaning you are asked to return for extra studies, usually magnification views of a part of your breast or possibly an ultrasound targeted to an area of concern on your mammogram.  Although this is not an emergency you should be able to get an appointment in less than a week.  Usually these appointments will be during the weekday when a radiologist is present.
6. Are biopsies performed at the center? There are ultrasound guided biopsies and stereotactic (mammogram guided) biopsies.  If you are scheduled for either kind of biopsy, the procedure should be explained carefully ahead of time.  Of course a little “fear of the unknown” is normal but you should be made to feel comfortable and secure that all will go very easily.  I think it is important to have a relationship with a breast surgeon before the biopsy so you have someone to explain any implications of your pathology report.  Some of the most anxious women I see are women who have had a biopsy elsewhere and were left alone with their pathology report.  If the center does not perform biopsies often the breast specialist will do them.
7. How quickly will I get my biopsy results? The wait for biopsy results is very stressful for many patients—so it’s important to choose a center that understands this and delivers results within 1-2 business days.
8. Is the staff warm, caring and compassionate? A quality breast center will treat every patient in a kind, calm and caring fashion—making them feel as at ease as possible. You should not experience unreasonable wait times or be left alone for long periods in a cold exam room. You have the right to be informed throughout your visit of what is happening and what’s to come. If you leave feeling afraid, you are at the wrong center!  Every week I see women who have been so frightened by the information or misinformation imparted by other breast centers and we strive to put them at ease.
9.  If I need to see a specialist can I have copies of my mammogram? I cannot emphasize this enough. Centers love to load your mammograms on a disc.  I guess this is more expedient and less expensive.  However, often we cannot “open” the disc, the images are no bigger than Barbie doll breasts and once we had a video of galloping horses!  The reason to get mammograms is so if there is an abnormality you can see a specialist for an evaluation.  Insist on the actual films and check that they are yours and this years studies.  If you can bring previous films for comparison that can be invaluable.
10. Does the center send reminder cards? A quality breast center takes a proactive approach to optimizing patient health. They should send an annual reminder when it’s time for your next mammogram and make scheduling easy and hassle-free.
Dr. Jan Huston is a renowned breast surgeon and Medical Director of The Breast Center at HackensackUMC Mountainside. 

Is Thermography an Alternative to Mammograms?

Published on 03 /27 /2014 By: Breast Center HackensackUMC Mountainside

thermography vs. mammograms no comparisonYou’ve heard the phrase “no pain, no gain.” Well, it’s a good one to keep in mind when considering breast cancer screening. Women are attracted to thermography because it uses infrared light to measure temperature differences on the surface of the skin. No radiation. No uncomfortable compression. And it’s been around a long time.


But here’s the thing: thermography is totally unreliable.

While breast cancer can cause an area of increased heat, which thermography might detect—so can many other benign conditions. Thermography cannot distinguish between malignant and benign. And it can’t detect cancers deep in the breast, because it only measures surface temperature.

In 2012 an extensive review of research found that thermography failed to detect three out of four cancers known to be present. That’s a sensitivity of 25%, which makes it ineligible as a standalone screening test. That’s why the FDA, the American Cancer Society and the American College of Radiology (among others) do not view thermography (AKA thermographic device) as useful for breast screening. To put it bluntly, you’d be better off getting a massage and flipping a coin. It pains me to see professionals promoting misinformation that may cause women to avoid potentially lifesaving screening while wasting their money.  

On the flip side, the sensitivity of mammography is about 80%, which makes it the best  tool for breast cancer screening.

Get your annual mammograms, ladies. It’s your best defense.

Did You Receive a Letter About Breast Density and Cancer Risk?

Published on 03 /20 /2014 By: Breast Center HackensackUMC Mountainside

letter regarding dense breastsBreast density is a hot topic. New Jersey is the 14th state to pass legislation requiring that women be informed about breast density. The New Jersey law requires a generic statement, included in your mammogram letter, to inform you about the increased risks for breast cancer associated with breast density. Considering no information is given regarding your personal breast density, the information is not very helpful–and has created unnecessary alarm among many women.

We have no idea why density is a risk factor, and it’s important to note that it’s only a moderate one. The biggest risk factors are being a woman and getting older. Ironically the risk for breast cancer increases with age but breast density decreases. As you get older more fat mixes with glandular tissue and makes the breast less dense–and (sad face) more saggy.

The fact is, most women under 60 have dense breasts. A report of mammograms in NYC showed that 44% of women in their 60′s and 36% of women in their 70′s have dense breasts. Dense glandular tissue can make it difficult to see breast cancer–kind of a “find a snowman in a snowstorm” phenomenon.

What to do if you are told you have dense breasts? First, join the club, so do I. Second, continue getting regular mammograms. Most cancers can be seen on mammogram even in women with dense breasts. Finally, there is no evidence to support screening ultrasound or MRI. Unfortunately these tests are less specific and result in three times as many biopsies. Unlike mammograms, there is no evidence that either increase survival from breast cancer.

Springtime is a great time to schedule your mammogram! Don’t hesitate to call us if you have questions.

Beware of Studies that Question the Value of Mammograms

Published on 03 /13 /2014 By: Breast Center HackensackUMC Mountainside

one mammogram saved our livesPerhaps you’ve read about the recent Canadian National Breast Screening Study 25-year follow up for breast cancer incidence and mortality that calls into question the value of regular mammography.

I have carefully read and re-read (and re-read) the study, and I am very concerned about the conclusions drawn by its authors and imparted to the community.

For starters, many members of the medical community have published concerns about the quality of the mammograms and the methods of randomization used in the study. But that’s not even my biggest beef with the results.

My problem is this: the study took 89,385 women, ages 40-59, and randomly assigned them to one of two groups, an annual mammogram group and a no-mammogram group, for a period of five years.

There were 666 breast cancers diagnosed in the mammogram group and 524 in the control arm. But here’s the problem: 68.2% of the cancers in the mammogram group were palpable (which means they could be felt by hand) and 30.6% had spread to lymph nodes, whereas in the no-mammogram group, all of the tumors were palpable and 32.4% had spread to lymph nodes.

So while the study concludes that “25-year survival for women with a palpable cancer was similar between women in the mammography and control arm”(66.3% vs. 62.87%.)”, it glaringly neglects to tout the fact that the survival rate for women who were diagnosed by mammogram before the tumor was palpable was 79.6%. That’s an improved survival rate of nearly 20%.

It’s a fact. Treating smaller, node-negative breast cancer is less harmful, more effective and less expensive. And mammograms are the only way to identify such cancers. Mammography is the only screening test that has been proven by multiple randomized, controlled studies to reduce deaths due to cancer—and when you take time to dissect this study, it actually proves rather than refutes the effectiveness and validity of regular mammograms.

If you are a woman age 40 or over living in the Montclair area, please schedule your annual mammogram. You can even click the green “contact us” tab above for help with scheduling. The earlier you catch it, the easier it is to cure it.

Dr. Huston




Will eating soy give me breast cancer?

Published on 02 /27 /2014 By: Breast Center HackensackUMC Mountainside

do soy beans cause breast cancerHere’s why that myth–and yes, once again, it is a myth–originated. We know that exposure to estrogen is linked to an increase in breast cancer risk. And soy does contain isoflavones that bind to estrogen receptors and have similar effects as estrogen. But the effects are not nearly as strong; human estrogen is over 1000 times stronger. In fact, multiple highly respected studies have associated eating soy with lower rates of breast cancer, particularly in many Asian countries where the diet is high in soy. Soy is also good for your heart, lowering blood pressure and decreasing cholesterol. So eat up! Soy is a very healthy choice. 

Ask Dr. Huston: Do hair relaxers increase breast cancer risk?

Published on 02 /20 /2014 By: Breast Center HackensackUMC Mountainside

Hair Relaxers

Some of my patients who are African American women have expressed concern about increased breast cancer risk due to the use of hair straighteners and relaxers. They’ve heard that the chemicals in these products can enter the scalp via the skin, a burn, or an open sore. Once again at Kernel of Truth headquarters (aka The Breast Center at HackensackUMC Mountainside), it’s another myth busted.

Hair straighteners and relaxers are NOT linked to breast cancer. Breast cancer incidence in relation to hair relaxer use was assessed in the Black Women’s Health Study, and there was no increased risk of breast cancer in women who used relaxers seven times per year for 20 or more years. Different types and brands of relaxers, age at first use, and number of scalp burns were also not associated with increased incidence of breast cancer.

Content on The Kernel of Truth is provided to educate women about breast health and breast cancer risk and is sponsored by the Breast Center at HackensackUMC Mountainside. To schedule your annual mammogram with the Breast Center at HackensackUMC Mountainside, you may contact (973) 873-7787 or toll-free (877) 523-7787 or email . To learn more about Breast Health services at HackensackUMC Mountainside, please call (973) 429-6120. 



Ask Dr. Huston – Breast Implants and Cancer Risk

Published on 02 /12 /2014 By: Breast Center HackensackUMC Mountainside

Do breast implants increase breast cancer risk? Ask Dr. Huston - HackensackUMC Mountainside Breast CenterI’ve heard that silicone breast implants may put me at greater risk for breast cancer—should I be concerned?  

No. I can assure you there is no link between saline or silicone breast implants and breast cancer. And contrary to what many believe, breast implants do not impede the detection of breast cancer via physical exam. In fact, I often find it is easier to examine a breast with an underlying implant as the breast tissue is pushed forward and thinned over the implant making it easier to feel. If you have a silicone or saline implant, it is likely  that your annual mammogram will require additional pictures, called displacement views.  The implant is pushed against the chest wall and the breast tissue is pulled forward off the implant so that most of it can be examined. As with all women,annual  mammogram after age 40 is the recommended screening exam.   Damage to the implant during the mammogram is extremely rare  and the benefits of a yearly mammogram far outweigh any risks.

Have a question for Dr. Huston? Leave a comment or submit via the Contact Us button above.

Be Well,

Dr. Jan

Content on The Kernel of Truth is provided to educate women about breast health and breast cancer risk and is sponsored by the Breast Center at HackensackUMC Mountainside. To schedule your annual mammogram with the Breast Center at HackensackUMC Mountainside, you may contact (973) 873-7787 or toll-free (877) 523-7787 or email . To learn more about Breast Health services at HackensackUMC Mountainside, please call (973) 429-6120. 

From Parabens to Power Lines: 3 Breast Cancer Myths Put to Rest

Published on 02 /06 /2014 By: Breast Center HackensackUMC Mountainside

Breast cancer mythsThanks to the Internet, women are exposed to a daily deluge of misinformation and pseudo-scientific research about the causes of cancer. We’re led to believe that even the most basic tasks of daily living are riddled with land mines, just waiting to be detonated by our ignorance.

Relax. Take a deep breath. Your push up bras, power lines and powder fresh antiperspirant are not going to give you cancer.

Here’s the kernel of truth about underwire: the misconception is that underwire blocks the breast’s lymphatics and traps “toxins” in the breast which leads to breast cancer. Not so. First off, the lymphatics are not that easily blocked; and there are no toxins in the breast to get trapped. That said, heavier women may be more likely to wear underwire and since weight is a risk factor for breast cancer, this may be how the underwire myth was born.

What about power lines? Should you start house hunting for a farm far away from the hustle and bustle of electromagnetic fields? Not so fast. This myth popped up in the 1980s when women living in Suffolk and Nassau Counties of Long Island were shown to have a higher risk of developing breast cancer. There was concern that this was due to environmental pollutants or electromagnetic fields from power lines near their homes. After 20 years of gathering data, however, the increased incidence was attributed to known risk factors: having children later in life, family history and alcohol consumption. It’s for these reasons that the Northeast has higher breast cancer rates than the rest of the country, and this is most apparent in affluent suburbs.

How about antiperspirant? Is it time for your armpits to exist au natural? Only if that’s your thing. There is no scientific evidence that the parabens in antiperspirant increase breast cancer risk, despite their (very weak) estrogen-like characteristics. Not having children, late menopause and obesity cause the body to produce estrogen that is many thousands of times stronger and it’s this increased exposure of the breast to estrogen that increases a woman’s risk of developing breast cancer. In fact, parabens aren’t even present in most antiperspirants anymore. The reason we tell women not to apply antiperspirant or deodorant the day of their mammogram is because the tiny white specks can mimic microcalcifications.
We’ll be debunking more myths in coming weeks, but if you ever have questions or concerns that I can address, please feel free to leave a comment. Perhaps I can put your mind at ease.


Dr. Jan

p.s. Have you scheduled your annual mammogram? Mountainside makes it easy and hassle-free, with next day appointments and before- and after-hours scheduling for working women. Give us a call today at (973) 429-6120 or use the contact form above.