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The part of the month that you chose to do your monthly breast self examination is important, and is more important if you are pre-menopausal. Breasts can be very sensitive at certain times, due to your menstrual cycle, and you are the one that can best determine when you are least tender. Most women have the least amount of discomfort if they wait until seven to ten days following the first day of menstrual flow. That is likely when the fluid retention (bloating) from your period is lowest. If you are comfortable doing it any time during the month, then choose a day in relation to the beginning of your period, and do it on that day every time. That way you will have a built-in reminder. Your breasts change a lot during the month (cyclical changes), and you will feel different things inside your breasts at different times of your menstrual cycle. If you are postmenopausal, just pick an important day of the month and do the exam on that day every month. VISUAL: To start the exam, remove any clothing that is above your waist (or perform this when you step from the shower and have toweled off) and stand facing a mirror with your arms hanging down to your side. A triple mirror, similar to what you might find in a clothing store would be excellent, if you can acquire one. The area should be well lighted, so plan to do this when the light from the window is best or be sure to have a good lighting fixture near the mirror(s). Look for any change in the surface of your breasts, such as dimpling, puckering, scaliness or any other changes in the surface of your skin from what you observed the last time (last month, right?). Slowly turn to each side to allow a full view of both sides of both breasts. Look for any changes in the shape or size or profile of your breasts. Examine your areola and your nipple for any changes, such a change in the color or shape of your areola , scaly skin or a newly inverted nipple (lactating ladies may see a little encrusted material on the nipple itself), or anything that is not what you are used to seeing. Continue to stand facing the mirror and lift your arms up over your head (like "its a hold up... stick 'em up). Hold them there and look for the same symptoms listed above. Continue while slowly turning to each side. Don't be in a rush… move slow enough to see everything. While still facing the mirrors, place your hands on your hips, and push inward and downward, flexing the chest muscles under your breasts. Again, look for the same symptoms listed above. Look for any bulges in your breasts that show up when you press in and down onto your hips. Keep your hands on your hips and lean forward, allowing your breasts to hang freely away from the chest wall. Watch the breast surfaces as they move. You are looking for the same symptoms listed above. POSITION: Lie on your back, on a bed or other flat surface. Elevate your shoulder (the side you are examining) with a folded towel. If too much breast tissue falls to the side and under your arm, and your nipple is not pointing directly up toward the ceiling, you may need to assume the side-lying position. (To do that, lie on your right side to examine your left breast, and pull your left shoulder down onto the folded towel.) Reverse these instructions when you examine your right breast. Using one of your fingers, trace the perimeter of the breast tissue area that is to be examined. Place your finger in the center of your armpit and trace straight down to the bra line. Follow along the bra line to the middle of your sternum (breastbone). Now move upward, between your breasts, to your collarbone. Follow your collarbone back to the starting point in the armpit. This entire area needs your attention. PALPATION: To examine your left breast, hold your right hand in the bowed-hand position (fingers lifted back as far as possible), and use the pads of only your three middle fingers (not the tips… the pads...where the finger prints come from). Press onto the surface of your breast with a very light pressure and move your fingers in a small, dime-sized circle, several times. (Imagine that you are trying to locate a sesame seed just under the surface of the skin.) Press to mid-depth of your breast and a couple more circles. Press to the fullest depth and make a third pair of circles. Each time you make a circle you are feeling for any palpable feature. Do not be in a hurry. Extra circles and a little extra time will only lead to a more thorough knowledge of your breasts and their internal construction. By doing this each month, these features will become familiar to you in time, and you will be able to detect any NEW features that have come into your breasts. Those new features should be brought to your specialist's attention. That is, after all, the purpose of BSE. Start making those circles under the arm, moving down toward the bra line. As you make your way down to the bra line (we can call this our first "pass") move (slide) forward about 1/2 inch each time. Do not lift your fingers from the skin as you move them over the breast …lighten the pressure and slide them. This will allow you to not only keep track of where you are located, but will also assist in detecting any small bumps just under the surface of the skin. Body lotion, baby powder or a body massaging oil may make the sliding easier. Resist grabbing and squeezing your breasts... you need the sensitivity of your finger pads to find what is inside your breasts. When you reach the bra line, move about 3/4 inch toward the breastbone, and continue to make the circles at three different depths, in a line straight up to your collarbone. Move 1/2 inch and repeat the circles at three depths into the breast. When you reach the collarbone, move another 3/4 inch toward the breastbone and start another pass, down to the bra line. You need to make about ten to sixteen vertical passes (10 for A cup, 12 for B cup, 14 for C, etc.). Continue making a new pass every 3/4 inch until you reach the breastbone. If you squeeze the nipple very lightly, you may likely see a drop or two of fluid come from the nipple. This is not unusual, and may be almost any color, from white to black, but if it is pink or red, or it has changed since you last checked, it should be brought to a specialist's attention. Check carefully around any surgical incision on the breast. Tumors can flare up around an incisional scar from previous breast cancer surgery. If you had a mastectomy and have no reconstruction done, be sure to check the scare every month. REMEMBER: You are only becoming aware of your breasts. As you can see in our Anatomy images, there are many individual pieces in the breast, and it is difficult to know what should be there and what should not be there. All you want to do is become familiar with what is there now. Familiarity will allow you to notice any future CHANGES, which is what should be checked by your medical provider. If you find any irregularities in your breasts, use a pen and circle where the area of concern is. It will was off over the next few days. Reposition yourself and readjust to check the other breast. Using the other hand, repeat the examination, starting with tracing out the perimeter (line that surrounds the breast tissue to be examined). RECOMMENDATIONS: Maintain a self-care plan for early breast cancer detection, including:
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his procedure
for performing a Breast Self-Examination each and every month is based on the AMERICAN CANCER
SOCIETY'S "Seven P's Checklist". Now, before you say "But there's a lot
of junk in my breasts... how would I know what belongs there and what
doesn't?", understand that your purpose is not to determine what is in
your breast. Your purpose is to get used to your breasts' construction
by regularly checking it, and then you will be merely looking for
ANYTHING that is DIFFERENT from the last few time you checked your
breasts. If you find anything about your breasts that is of any concern
to you, of if you see any changes in their surface or internally, please have your health practitioner check it out.
He or she is the expert. You are the sentinal.