My friends with daughters are comparing notes on what's happening on the puberty front in each of our houses. All the discussions proceed in the most genteel, discreet, kids-might-overhear, suburban mom code:
Mom 1: "Anything? You guys got anything at your house?"
Mom 2: "Nah."
Mom 3: "Well," significant pause, "we've got buds -- maybe even a Tanner II."
Mom 4: "Buds?" Choking snort of coffee, "we're way beyond buds. Tanner III or IV at least."
See, for moms of adolescent girls, "Tanner" is a useful code for covertly talking about breasts. Named after a pediatrician, Tanner refers to the stages of breast development. Breast growth starts with something called breast buds; then, based on a timeline, breast growth expands (pardon the pun) to several stages of development (I-V). The cynical among us might say that Dr. Tanner is famous for describing the obvious: Breasts start small, get bigger.
The British Medical Journal recently published a fierce debate about whether doctors should be able to "claim" a disease with their name (as in Hodgkin's disease). I instantly thought of Dr. Tanner. I mean, why is the growth of breasts named after a man? And what the heck happened to the stages of breast regression? My friends and I want to talk about all the stuff happening to our own bodies as we cruise toward menopause, but we don't have anything like the Tanner stages to use as code. I'm guessing guys have been more interested in describing breast expansion than regression. What male doctor would want his name stuck on breast loss for all eternity?
The most we have to work with is that old joke phrase, Cooper's droop, a term used for droopy breasts, named after a man who described the "ligaments" of the breast. He probably thought he'd be forever credited with identifying the cause of breast perkiness, but, because of his name's unfortunate rhyme with droop, he got stuck with the opposite.
Whether men study it or not, women know that breast regression is like growth in reverse -- things go away in stages. It's not like you're a Tanner V one day and wake up with Cooper's droop the next. So, as a female physician, I am claiming the stages of breast regression. And I think I've got the perfect name for it -- mine.
The Gurley Stages of Breast Regression
(Reference ages are general descriptions, assuming some variation in estrogen production over time)
Gurley Stage I: Cup Wrinkle (also known, among those with more support, as air cups)
Description -- This stage sneaks up on women in their late 30s, and is often laughed off with one of the following excuses:
a) I need to buy new bras -- these gray, stretched-out ones from my nursing days don't fit anymore.
b) I'm getting more premenstrual -- see, my breasts change cup sizes all the time now. Big. Little. Big. Well, mostly little.
c) I've lost weight. OK, maybe just in my breasts, but still, it's good to lose weight, isn't it?
Gurley Stage II: Loss Recognition
Description -- Occurs during women's early to late 40s, coinciding with the onset of random chin hair. Breast loss is like watching a helium balloon deflate -- Tanner 5 is tight and perky. Gurley I has a bit of give. By Gurley II, we're talking obvious softening and a bit of drifting down. It is usually marked by emotional outbursts, provoked by occasions such as --
a) None of the Victoria's Secret staff will wait on you, even though you obviously have money to spend. Perhaps it is because you've been back four times in the past week, each time asking for another fitting. You're sure that if you can just find the right person to measure you, you'll still be a C. Who is making all these broken tape measures, anyway? After another fruitless shopping trip, you write an irate complaint to the State Department of Weights and Measures, which files your letter under "menopause" and ignores it.
b) Your sisters, aunts and mother begin sending you anonymous bra packages. Even though the bras are lovely, and bizarrely seem to fit, you check the label and toss them, because someone got the size wrong. It's kind of sad, really, how, after all this time, your family still doesn't know you.
c) Finally, your girlfriends stage an intervention. Let's just say that wine, self-defense class maneuvers and popping elastic bra straps are involved, and leave it at that.
Gurley Stage III: The Folds
Description -- Sets in around the late 40s, early 50s, occurring in the two years prior to the loss of all periods, during the perimenopausal stage of hot flashes. Your helium balloons can now wrinkle. Having made it through the denial phase, you are obsessed with how much breast time you have left. You realize that men will think you're drooping, but you know, more accurately, that your breasts are shrinking, until soon there will be only a fold of skin lying on your chest. When you're at the gym, in front of the big wall mirrors, you see that all the women in their late 40s and early 50s around you look the same:
a) Breast shape is now like two crescent moons lying on their curved sides, as though the breasts are evaporating from the top down.
b) No bounce. There is, instead, a "swing."
c) Even for women with small breasts, the nipples point down.
d) If you had cleavage before, you now have crepe cleavage. Gurley Stage III is classically accompanied by a frantic splurge on "supporting" bras, proving that you can, in fact, buy breasts without having to undergo plastic surgery.
Gurley Stage IV: The Pressed Flower
Description -- Post-menopause. Your breasts began with a stage known as a bud, but they now resemble a pressed flower. You've made your peace with the changes, and more important, you know the pressed-flower version fits with the rest of you -- a more focused and distilled version of your younger self.
So what, in the long run, does my all this mean to the future of medicine? Well, not to be too arrogant, but just as Dr. Tanner "invented" breast development, I, Dr. Gurley, have just "invented" breast regression. Now, as you sip your latte in a cafe and people-watch with a friend, you can lean forward and say, "What do you think: Gurley III or IV?"
And your friend can answer, "Not sure -- but she carries it well, doesn't she?"