October is breast cancer awareness month, and who better to help us put our breast features forward than an uber-hip OB/GYN with a wealth of information delivered in sassy pink packages? Modern Love is talking about Lissa Rankin, MD, founder of owningpink.com and author of the recently published bestselling What’s Up Down There? Questions You’d Only Ask Your Gynecologist If She Was Your Best Friend (September 2010).

Lumpy, lopsided, different sizes, maybe you’ve got an extra nipple? Rankin reveals what’s normal and what’s not in the boobilicious section below.

Recently named by Forbes as one of the top 20 inspiring women to follow on twitter, Doc Lissa is the kind of physician who inspires devotion from women who just won’t let any ol’ Tom, Dick or Harry take care of their va ja jays. (I know. She used to take care of mine, before we both moved to separate cities). With the publication of What’s Up, she’s breaking ranks with the traditional guard to put a real and human face on the person peaking at your privates to ensure your optimal sexual wellbeing.

Funny, astute and as endearing as the girl next door, Doc Lissa is, in her own words, devoted to “empowering women to love, honor, respect, and know their breasts.” What follows are her guidelines (reprinted with permission) on What’s Normal, and What’s Not, When it Comes to Breast Health.

BOOBS: What’s Normal

1. As we get older, boobs sag. It’s just a fact. We have babies, gravity takes its toll, the elasticity of our skin changes, and boom - saggy boobs. But look what comes with it! Wisdom, life experience, children, sexual pleasure, and the knowledge that our breasts served us well and deserve to be nurtured and protected.
2. It’s totally normal to have breasts that are two different sizes. One of my friends calls hers “Flip and Flop: A Tale of Two Titties.”
3. Breast tissue that feels uniformly lumpy, like tapioca pudding, is normal. Somewomen just have lumpy, bumpy breasts, and while it can make them tougher to examine, they’re nothing to worry about.
4. If your nipples are inverted on both sides - and always have been - you’re totally normal.
5. If your nipples are the same shade as the rest of your skin - or even lighter - you’re perfectly normal.
6. If your nipples darken after pregnancy, you’re normal. During pregnancy, high doses of estrogen course through your body. Because estrogen can affect skin pigmentation, you may notice certain parts of your body darkening during pregnancy, including your nipples.  These changes may persist once your pregnancy ends, especially in women with darker complexions.
7. If you have a few dark hairs around your nipples, you’re normal. Many women are just like you.
8. It’s normal for breasts to get sore at certain times in your cycle, often just before your period, when you’re more likely to retain water and your breasts may swell.  While breast pain can be uncomfortable, it’s almost never a sign of serious breast disease.
9. It’s normal for nipple sensitivity to change after nursing - and it can go eitherway. Some women say their nipples become uber-sensitive. Some say they nolonger feel sexual pleasure from stimulation of their nipples. Most report nochange. 
10. Extra nipples are perfectly normal. Sometimes, things go awry in fetal development and you wind up with an extra nipple or two, which we call supernumerary nipples. Rarely, women will have multiple nipples on both sides,along the “milk line.” These nipples may be mistaken for moles until a woman gets pregnant or starts nursing, when all of the sudden, the nipple grows and may lactate (zoinks, Shaggy!). If you have a supernumerary nipple, you are not a mutant. Instead, you might consider yourself breastfully blessed.
11. If you’re still able to squeeze a drop of milk out of your nipple months after youstop nursing, you’re normal - and just need to stop squeezing! Every time you stimulate those nipples, you trigger hormones that tell your brain (and your breasts) that a baby wants to eat.
12. Good news for small-breasted woman everywhere! You’re normal if taking the Pill makes your breasts grow. Because breasts are estrogen-sensitive and the Pill contains estrogen, the Pill can make your boobs grow. Many women notice that their breasts increase a whole cup size when they’re on birth control pills (and the same is true for the hormonal birth control patch or the vaginal ring).
13. If your boobs shrink after you stop nursing, you’re normal, especially if you lose weight beyond your pre-baby weight, which may happen to breast-feeding Moms. But take heart. You’ve done your baby a huge service by sacrificing your breast size to raise a healthy, nourished child with a breast-feeding head start.
14. It’s normal if you have to stop breast-feeding sooner than you hoped. Some breasts just peter out, and some babies just demand more milk than you can make. Pat yourself on the back for doing what you can and honor yourself for a job well done.

BOOBS: What’s Not (Translation: When to seek help)

1. If you notice a lump in your breast that feels distinct from the rest of the breast - like you can pick it up and move it around - that’s not normal. Anything that feels like a rock or a marble may be nothing more than a simple benign cyst, but it needs to be investigated.
2. If your nipples have always protruded out and now, all of the sudden, one of them is inverted, this isn’t normal. Sometimes a unilateral inverted nipple can be a sign of breast cancer.
3. If, in addition to having hair around your nipples, you also have hair in the middle of your chest, you may have too much testosterone, which is stimulating a male pattern of hair growth.
4. If your breast hurts - and it’s red, dimpled, or you find a lump - this could signal infection or cancer. While bilateral breast pain rarely signals either, unilateral pain, especially in the presence of other findings, needs to be checked.
5. If you’ve never nursed - or it’s been more than year and you’re not stimulating your nipples, milky nipple discharge is not normal and could signal the presence of a pituitary gland tumor called a prolactinoma.
6. Bloody nipple discharge is never normal. While it may often signal a benign breast condition, such as an intraductal papilloma, it always needs to be investigated to rule out breast cancer.

SPECIAL THANKS TO DR. LISSA RANKIN AND OWNINGPINK.COM FOR PROVIDING THIS RESOURCE TO THE READERS OF MODERN LOVE.

I invite you to visit me at www.tinamariebernard.com.

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