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If a recent mammogram showed you have dense breast tissue, you may wonder what this means for your health. Healthcare professionals know that dense breast tissue makes breast cancer screening more difficult. It also increases the risk of breast cancer.
The breasts are made up of dense breast tissue and fatty breast tissue. Dense breast tissue includes the milk glands, milk ducts and supportive tissue in the breast. Fatty tissue is made of fat cells. A person with dense breast tissue has more dense tissue than fatty tissue.
On a mammogram image, the fatty breast tissue is transparent. It's easy to see through to look for anything concerning. The dense breast tissue looks solid white on the mammogram image. It's hard to see through. Breast cancer, which also looks solid white on a mammogram, could be missed.
The healthcare professional who looks at your mammogram images decides whether you have dense breast tissue. This health professional is typically a radiologist. Radiologists are doctors with special training to interpret the images from an exam. The radiologist compares the amount of fatty tissue to dense tissue. Then the radiologist decides the level of breast density. Sometimes a computer program figures out the level of density in the images and the radiologist checks to make sure that it's correct.
Mammogram results often include information about breast density. Healthcare professionals use the Breast Imaging Reporting and Data System to report breast density. According to this system, the levels of density are (from left to right) A: almost entirely fatty, B: scattered areas of fibroglandular density, C: heterogeneously dense and D: extremely dense.
Levels of density are described using the American College of Radiology's Breast Imaging Reporting and Data System, which is sometimes shortened to BI-RADS. The levels of density are often included in a mammogram report using letters. The levels of density are:
In general, you're considered to have dense breasts if your mammogram report says you have heterogeneously dense or extremely dense breasts. About half of people having screening mammograms have dense breasts.
Having dense breasts can make it harder to detect cancer on a mammogram. But mammograms are still effective for breast cancer screening if you have dense breasts. Mammograms have been proved to reduce the risk of dying of breast cancer.
Newer mammogram technology gives healthcare professionals more detailed views of breast tissue. This may help improve the chances that cancer will be detected. For instance, nearly all mammogram machines in the United States make digital pictures instead of film pictures. Digital pictures let health professionals zoom in to take a close look at anything concerning.
Additionally, most healthcare facilities in the United States offer 3D mammograms. A 3D mammogram uses computers to combine X-ray pictures of the breast into a 3D image. The 3D images allow healthcare professionals to see past areas of density to look for anything concerning in the breast tissue.
There's some evidence that additional tests, such as ultrasound and MRI, may make it more likely that breast cancer is detected in dense breasts. There also is concern that tests such as ultrasound and MRI may find things that need additional testing but are later found to not be cancer. This is called a false-positive result. More research is needed to know which test is best. None of the other tests has been proved to reduce the risk of dying of breast cancer.
Fibrocystic breast changes lead to the development of fluid-filled round or oval sacs, called cysts. The cysts can make breasts feel tender, lumpy or ropy. They feel distinct from other breast tissue.
It's not at all uncommon to have fibrocystic breasts or experience fibrocystic breast changes. In fact, medical professionals have stopped using the term "fibrocystic breast disease" and now simply refer to "fibrocystic breasts" or "fibrocystic breast changes" because having fibrocystic breasts isn't a disease. Breast changes that fluctuate with the menstrual cycle and have a ropelike texture are considered normal.
Fibrocystic breast changes occur most often between 30 and 50 years of age. These changes happen rarely after menopause unless you're taking hormone replacement medicine such as estrogen or progesterone.
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Each breast contains 15 to 20 lobes of glandular tissue, arranged like the petals of a daisy. The lobes are further divided into smaller lobules that produce milk for breastfeeding. Small tubes, called ducts, conduct the milk to a reservoir that lies just beneath your nipple.
Fluctuating hormone levels during the menstrual cycle can cause breast discomfort and areas of lumpy breast tissue that feel tender, sore and swollen. Fibrocystic breast changes tend to be more bothersome before your menstrual period and ease up after your period begins.
Screening involves testing healthy people for signs that could be due to cancer. It aims to find breast cancers early when they are too small to see or feel. These small cancers are usually easier to treat than larger ones.
"I noticed my left nipple was permanently inverted. I went to my GP as I knew this could be a warning sign of breast cancer. My doctor referred me to the local hospital for a 2 week One Stop Breast Service appointment."
The information on this page is based on literature searches and specialist checking. We used many references and there are too many to list here. Please contact patientin...@cancer.org.uk with details of the particular issue you are interested in if you need additional references for this information.
Breast screening aims to find breast cancers early, when they have the best chance of being successfully treated. Find out about the UK breast screening programme, who has screening, and how you have it.
Women who choose to have their breasts rebuilt have several options for how it can be done. Breasts can be rebuilt using implants (saline or silicone). They can also be rebuilt using autologous tissue (that is, tissue from elsewhere in the body). Sometimes both implants and autologous tissue are used to rebuild the breast.
Surgery to reconstruct the breasts can be done (or started) at the time of the mastectomy (which is called immediate reconstruction) or it can be done after the mastectomy incisions have healed and breast cancer therapy has been completed (which is called delayed reconstruction). Delayed reconstruction can happen months or even years after the mastectomy.
Implants are inserted underneath the skin or chest muscle following the mastectomy. (Most mastectomies are performed using a technique called skin-sparing mastectomy, in which much of the breast skin is saved for use in reconstructing the breast.)
Different sites in the body can provide flaps for breast reconstruction. Flaps used for breast reconstruction most often come from the abdomen or back. However, they can also be taken from the thigh or buttocks.
After the chest heals from reconstruction surgery and the position of the breast mound on the chest wall has had time to stabilize, a surgeon can reconstruct the nipple and areola. Usually, the new nipple is created by cutting and moving small pieces of skin from the reconstructed breast to the nipple site and shaping them into a new nipple. A few months after nipple reconstruction, the surgeon can re-create the areola. This is usually done using tattoo ink. However, in some cases, skin grafts may be taken from the groin or abdomen and attached to the breast to create an areola at the time of the nipple reconstruction (1).
Some women who do not have surgical nipple reconstruction may consider getting a realistic picture of a nipple created on the reconstructed breast from a tattoo artist who specializes in 3-D nipple tattooing.
A mastectomy that preserves a woman's own nipple and areola, called nipple-sparing mastectomy, may be an option for some women, depending on the size and location of the breast cancer and the shape and size of the breasts (4,5).
One factor that can affect the timing of breast reconstruction is whether a woman will need radiation therapy. Radiation therapy can sometimes cause wound healing problems or infections in reconstructed breasts, so some women may prefer to delay reconstruction until after radiation therapy is completed. However, because of improvements in surgical and radiation techniques, immediate reconstruction with an implant is usually still an option for women who will need radiation therapy. Autologous tissue breast reconstruction is usually reserved for after radiation therapy, so that the breast and chest wall tissue damaged by radiation can be replaced with healthy tissue from elsewhere in the body.
Another factor is the type of breast cancer. Women with inflammatory breast cancer usually require more extensive skin removal. This can make immediate reconstruction more challenging, so it may be recommended that reconstruction be delayed until after completion of adjuvant therapy.
Even if a woman is a candidate for immediate reconstruction, she may choose delayed reconstruction. For instance, some women prefer not to consider what type of reconstruction to have until after they have recovered from their mastectomy and subsequent adjuvant treatment. Women who delay reconstruction (or choose not to undergo the procedure at all) can use external breast prostheses, or breast forms, to give the appearance of breasts.
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