Breasts in a woman may be small. There is a misconception that unusually small breasts may not be normal, and it is seen that females, especially young unmarried girls, take hormonal treatment (oestrogens) unnecessarily which has severe adverse side-effects. If a woman has normal menstruation and the secondary sex characters are normally developed, such small breasts should be taken within normal limits, and no treatment is required. However, the woman may also be checked up by a gynaecologist for any pathology in the uterus/ovaries, etc.. A simple per vaginal (PV) examination, and transvaginal sonography is all that may be required. But in spite of this, the woman with small breasts usually feels perturbed, which may be due to cosmetic considerations. In a young girl, who felt constantly disturbed, and was taking hormones, of course, with no signs of improvement. She was asked to stop the hormones immediately, and was examined by a gynaecologist, who reported that she was perfectly all right, the only finding was that she had very small breasts. In spite of repeated assurances, the girl hardly felt satisfied, and was not convinced that her breasts were normal, though smaller in size. This is not unusual. It seems to be analogous to other conditions in which a normal person has an organ that does not develop quite as much as would be expected. In some men, the penis is smaller than usual, although they are perfectly normal. We have found that when a woman is endocrinologic ally normal, i.e., all other secondary sex structures are normally developed and ovulation and menstruation are normal, there isn't much that can be done about small breasts. The explanation seems to be that there is an individual variation in responsiveness of the tissues. The breasts simply do not respond in the usual amount to normal hormone values. It is generally found that they will not have significant growth of the breasts even though large amounts of oestrogen are given. Perhaps there is some difference in the levels of the other factors than oestrogen that are important for normal breast development. Some of these women have considerable growth of the breasts when they become pregnant and lactate. Probably this is due to the influence of pituitary or placental lactogenic substances..." Hence it is obvious that probably there is an individual variation that in some females breasts remain small, while in others they are normal and even large. However, such small breasts will not in any way affect the health or growth of the female concerned. Many of such cases which we could follow, showed that their breasts worked in a normal way i.e. for lactation following delivery, and the breasts also, to some extent, increased in size. There is a word of great caution that a female should not take hormones indiscriminately. These should only be taken with the advice of a specialist for the period specified. Even when the woman is on an oral contraceptive, a regular check-up of blood pressure is required, as all oral contraceptives cause a significant rise in blood pressure. Even a heart attack/stroke may be precipitated with the use of hormones. Also, the hormones may cause an increase in blood sugar levels, various blood lipids and body weight. Likewise, blood coagulability may also be increased with their continuous usage. Hence the need for precaution at every step. In older women, while administering hormones, say to tide over the troublesome period of menopause, it must be ensured that she has no hidden malignancy. It is, therefore, advisable that the breasts are examined for any lump, and mammography of both the breasts is done. At the same time, a Pap smear and an ultrasonographic examination of the uterus must be carried out to exclude the malignancy of the uterus, especially of the cervix. It should be noted that hormones increase the risk of cancer of the uterus and breast. Hence awareness in this respect is an important step in the prevention of cancer of these parts of the body.
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