Florence Williams is a contributing editor at Outside magazine, and her articles and essays have been widely anthologised. Breasts was named a finalist for the 2011 Columbia/Nieman Lukas Work-in-Progress Award. Williams lives in Boulder, Color- ado. textpublishing.com.au florencewilliams.com The Text Publishing Company Swann House 22 William Street Melbourne Victoria 3000 Australia Copyright © Florence Williams 2012 Every effort has been made to trace copyright holders and obtain their permission for the use of copyright material. The publisher apologises for any errors or omissions and would be grateful if notified of any corrections that should be incorporated in future re- prints or editions of this book. All rights reserved. Without limiting the rights under copyright above, no part of this publication shall be reproduced, stored in or introduced into a retrieval system, or trans- mitted in any form or by any means (electronic, mechanical, photocopying, recording or otherwise), without the prior permission of both the copyright owner and the publisher of this book. First published in the USA by W. W. Norton & Co. 2012. Published in Australia and New Zealand by The Text Publishing Company, 2012. Cover design by WH Chong Image by Levi Brown National Library of Australia Cataloguing-in-Publication entry: Author: Williams, Florence. Title: Breasts : a natural and unnatural history / Florence Williams. ISBN: 9781921922640 (pbk.) ISBN: 9781921834868 (ebook.) Subjects: Breast—Popular works. Breast—Health aspects. Breast—Diseases—Environmental aspects. Breast milk—Contamination—Environmental aspects. Dewey Number: 611.49 In memory of my grandmothers, Florence Higinbotham Williams and Carolyn Loeb Boasberg, and my mother, Elizabeth Friar Williams. Contents Cover Page About the Author Title Page Copyright Dedication Introduction • Planet Breast 1 • For Whom the Bells Toll 2 • Circular Beginnings 3 • Plumbing: A Primer 4 • Fill Her Up 5 • Toxic Assets: The Growing Breast 6 • Shampoo, Macaroni, and the Americal Girl: Spring Comes Early 7 • The Pregnancy Paradox 8 • What's For Dinner? 9 • Holy Crap: Herman, Hamlet, and the All-Important Human Gut 10 • Sour Milk 11 • An Unfamiliar Wilderness: Periods, the Pill, and HRT 12 • The Few, the Proud, the Afflicted: Can Marines Solve the Puzzle of Breast Cancer? 13 • Are You Dense? The Aging Breast 14 • The Future of Breasts Acknowledgements Notes Permission Credits Footnotes • Introduction • PLANET BREAST Save the Tatas — BUMPER STICKER FUNBAGS. BOOBSTERS. CHUMBAWUMBAS. DINGLE BOBBERS. Dairy pillows. Jelly- bonkers. Num nums. When I was growing up, my mother called them ninnies. That word, according to Webster’s, means “fools,” and lists nitwits, nutcases, and boobs as synonyms. For my own children, I amended the word to nummies, thinking it a bit kinder. Looking up its etymology recently, I found the word defined as “yummy,” but its origin may stem from numbskull. We love breasts, yet we can’t quite take them ser- iously. We name them affectionately, but with a hint of insult. Breasts embarrass us. They’re unpredictable. They’re goofy. They can turn both babies and grown men into lunkheads. For such an enormously popular feature of the human race— even today, when they are bikinied, bared, flaunted, measured, inflated, sexted, YouTubed, suckled, pierced, tattooed, tassled, and in every way fetishized—it’s remarkable how little we actually know about their basic biology. We know some things: they appear out of nowhere at puberty, they get bigger in pregnancy, they’re capable of producing prodigious amounts of milk, and sometimes they get sick. We know men even get them once in a while, and that tweaks us out. Not even the experts among us are certain why all these things happen, or even why we have breasts in the first place. But the urgency to know and understand breasts has never been greater. Modern life has helped many of us live longer and more comfort- ably. It has also, however, taken a strange and confounding toll on our breasts. For one thing, they are bigger than ever, according to lingerie manufacturers and purveyors who are ever increasing their cup offerings to sizes like H and KK. We are sprouting them at younger and younger ages. We are filling them with saline and silicone and trans- planted stem cells to change their shape. Most of us are not using them to nurture in- fants anymore, but when we do, our breast milk contains industrial additives never tasted by our ancestors and never meant to be digested by humans at all. More tumors form in the breast than in any other organ, making breast cancer the most common ma- lignancy in women worldwide. Its incidence has almost doubled since the 1940s and is still rising. Breasts are living a life they’ve never lived before. Fortunately, scientists are beginning to unveil the secrets of breasts, and with those secrets, a new way of looking at human health and our decidedly complicated place in nature. To understand the transformation, we need to go back in time, to the very beginning. We must first ask, Why breasts? Why us? We share 98 percent of our genes with chimps, but among that immeasurable 2 percent are the ones governing breasts. Chimps, unlucky sods, don’t have them. In fact, we are the only primates so endowed with soft orbs from puberty onward. Other female primates develop small swellings while lactating, but they deflate after weaning. Breasts are a defining trait of humanity, and mammary glands define our entire taxonomic class. Carolus Linnaeus understood. That’s why he named us mammals. Breasts are us. I DIDN’T THINK A LOT ABOUT MY BREASTS UNTIL I BECAME A mother. My breasts deve- loped about the normal time. I liked them fine. They were small enough not to get in the way of sports or cause backaches, big enough that I knew they existed, symmetric- al enough to look okay in a bathing suit on the rare occasions when I wore one while growing up in New York City. I wasn’t like Nora Ephron, who wrote an essay for Es- quire about how she obsessed over her small breasts in the 1950s, the era of the torpedo bra, in California: “I would sit in the bathtub and look down at my breasts and know that any day now, any second now, they would start growing like everyone else’s. They didn’t.” Poor Nora. Her worry acknowledged a truth that had been evolving since the sun set on the Pleistocene: breasts are really important. Consider this: in our mammalian ascent, being breastfed allowed us a youthful pass from gathering, chewing, digesting, and purifying food found in nature. Other animals such as reptiles had to live near spe- cialized, high-fat food sources. Mammals just had to be near their moms, who do all that work for them. Mammals had more flexibility during times of climate change and food scarcity. After lactation evolved (from sweat glands) in the Mesozoic, mammals gained ascendancy over dinosaurs. The world became a different place. Breasts have helped advance our own species’s evolution in ways both self-evid- ent and unexpected. With their rich stores of milk, they allowed our newborns to be born smaller and our brains to grow bigger. Having smaller babies meant our hips could be smaller, assisting our ascent into bipedalism. Breast-feeding may well have enabled the development of gesture, intimacy, communication, and socialization. Our nipples helped develop and prepare the human palate for speech and gave us a reason to have lips. So, in addition to greasing the way to our global domination, breasts begat the fine art of kissing. It was a tall order, but breasts were up to it. Millions of years of evolution and environmental pressure created an organ that was pretty darn fabulous, or so we thought. MINE LOOKED FABULOUS FOR ABOUT NINE MONTHS, WHILE I WAS pregnant with my first child. After he was born, my breasts became wondrously utilitarian for the first time. But for a piece of finely tuned evolutionary machinery, mine often malfunctioned. They became objects of betrayal, frustration, self-doubt, and excruciating pain. Meta- phors of aeronautics were now applied with disturbing frequency. I didn’t employ the correct “latch-on” or “suction disengagement,” and my nipples paid the price. A week after my son was born, I came down with my first case of mastitis, a practically me- dieval systemic infection that starts in a clogged milk duct. I would endure three more cases before the first year was out. Although I grew to love breast-feeding, I am not a dewy-eyed sprite about it. Breasts are virtually the only organ the body has to learn how to use. The process isn’t for everyone. I was certainly swayed by visions of the purity and goodness of breast milk. While baby formula is derived from either cow’s milk or soy protein, human breast milk is perfectly suited to the human baby, as we are often told in the mommy literature. It contains hundreds of substances—including ones that fight germs—many of which cannot or have not been synthesized in formula. Breast milk is always the right temperature; it has the correct balance of lipids, proteins, and sugars. It is medi- cinal, nutritious, and, to a baby, delicious. It was designed to be the perfect food, and I, new mother, was sold. I was happily nursing my second child, blithely backstroking through that magic bubble known as the mother-infant pair-bond, when I stumbled upon a news report that would forever alter my perception of breasts. I read that scientists were finding industrial chemicals in the tissues of land and marine mammals as well as in human breast milk. So much for the blissful insularity of early motherhood. Along with their more exalted roles, breasts, I learned, are also the catchment for our environmental trespasses. I realized my breasts connected me not just to my children, but me (and by extension, my children) to my neighboring ecosystem. Breastfeeding, it turns out, is a very efficient way to transfer our society’s industrial flotsam to the next generation. I released my breast from my daughter’s airlock and searched for answers. What toxic load had I already bequeathed my children by nursing them? What did it mean to their health, and to mine? Was it still okay to breast-feed? How did these chemicals interfere with our bodies? Could we ever make our milk pure again? I did what journalists do and wrote about it. For a piece published in the New York Times Magazine, I sent my breast milk off to Germany to have it tested for flame-re- tardants, a common class of chemicals known to accumulate in fat and cause health problems in lab animals. My levels came back higher than I expected and ten to a hundred times higher than those found in European women. My exposure came from electronics, furnishings, and food. I also had my breast milk tested for other chemic- als, including perchlorate, a jet-fuel ingredient, which certainly is not what baby has in mind for dinner. My results kept coming back positive, with levels about “average” for Americans. It was a discouraging revelation of how thoroughly polluted we’ve become in the early twenty-first century. “Well, at least your breasts won’t spontaneously ignite!” quipped my husband, trying to make the best of a situation over which we were virtually helpless. But I was reeling. The chemical cocktail in my chest collided with the journalist in my head. I wanted to find out how this elixir of evolution had come to meet such a diminished fate. Beyond that, I had to wonder how modern life was changing our breasts in other ways, and changing our health. The answers weren’t always easily forthcoming. PERHAPS NOT SURPRISINGLY, BREASTS HAVE OFTEN ELUDED clearheaded thinking. Every set of eyes sees them a little bit differently. Rather than naming us all mammals, Linnaeus could have classified us by our shared ear-bone construction or four- chambered heart, but in singling out our unique mammae, he appears to have had a political motive as well as a scientific one. Linnaeus was the father of seven children. One of the conventions he abhorred was the practice of wet-nursing, in which the in- fants of the European middle and upper classes were literally farmed out to be breast- fed by surrogates. As a result, many babies died of malnutrition and disease. In 1752, a few years before Linnaeus introduced the term Mammalia into his tenth edition of Sys- tema Naturae, he wrote a treatise on “Mercenary Wet-Nurses.” The science historian Londa Schiebinger argues that while Linnaeus cared about infant health, he was also deeply perturbed by the possibility of greater equality between the sexes during the En- lightenment. To Linnaeus, a woman’s rightful place was in the home, acting as nature intended. To prove it, we would now be called mammals. Then again, maybe Linnaeus just liked breasts. He was hardly the only man of science to conscript this body part into ideological service. The breast has always been