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observationFrom: Robert J. Woolley (wooll005@tc.umn.edu)Tue Jan 16 19:47:16 2001
I've noticed something over the last several years. I'm curious whether anybody else has ever noticed the same thing. It started with one patient perhaps 4 years ago who had--well, there's simply no politically correct way to express this--the most gravity-defying breasts I've ever seen. What struck me is that she also had just about the most fibrocystic breasts I had ever seen. Since then, it has been quite consistent, I think. The few percent of women with the greatest elevation of the areolar complex above the inframammary fold--apparently independent of breast size--have all been heavily fibrocystic. And, conversely, those with the most ptotic breasts--whether large or small--tend to have little if any fibrocystic content. (Nearly all of my patients are in a narrow age spectrum of 18-28 or so, and nulliparous, so this observation is reasonably independent of age.) I can convince myself that this makes some sense: relatively more internal connective tissue would feel fibrocystic on exam and perhaps also provide more resistance to the inexorable effects of gravity. But this is, of course, after-the-fact reasoning, which is dangerously susceptible to bias. And my entire observation of such a trend may be bogus, the result purely of a confirmation bias induced by that first patient in whom I noticed the association. I may have subconsciouly noticed cases that confirm the hunch, and ignored those that don't. So I ask for the cumulative vast experience of this distinguished group of my colleagues. Am I just nuts here, or am I onto something? Would it be of sufficient interest to persue objectively? (E.g., make some sort of measurement of the degree of ptosis, have a blinded radiologist count the cysts or make some other quantitative measurement of fibrocystic content, and look for a statistical association.) Would anybody care if it happened to be demonstrably true? That is, would it be an observation that would shed any light on the nature of fibrocystic change, or how cosmetic breast surgery might be improved, or whatever?
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