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How To Do A Breast Self Examination (BSE) By Ken L. Smith, Breast Health Facilitator for ACS
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 less tender. Most women have the least amount of discomfort if they wait until seven to ten days following the first day of menstrual flow. 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. Your breasts change a lot during the month, and you will feel different things inside your breasts at different times of your cycle. If you are postmenopausal, just pick an important day of the month and do the exam on that day every month. To start the exam, remove any clothing that is above your waist 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. 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. Examine your Areola and your nipple for any changes, such as scaly skin or a newly inverted nipple (lactating mothers may see a little encrusted material on the nipple itself). Continue to stand facing the mirror and lift your arms up over your head (straight 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. 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. 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. 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). Press 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 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 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, move (slide) forward about 1/2 inch each time. Do not lift your fingers from the skin as you move them over your breast …slide them. This will allow you to not only keep track of where you are, but will also assist in detecting any small bumps just under the surface of the skin. Body lotion, baby powder or a body oil may make the sliding easier. When you reach the bra line, move about 3/4 inch toward the breastbone and, continue to make the circles at three different depths. Proceed upward, toward the collarbone. You need to make about ten to sixteen vertical strips (10 for A cup, 12 for B cup, 14 for C, etc.). Continue until you reach the breastbone. Squeeze very lightly to see if any unusual liquid comes from your nipple. Some emission would not be unusual, but any change should be brought to a specialist's attention. Check carefully around any surgical incision. Tumors can flare up around an incisional scar from previous breast cancer surgery. 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. 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). Maintain a self-care plan for early breast cancer detection, including:
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his procedure
for performing a Breast Self-Examination is based on the AMERICAN CANCER
SOCIETY'S "Seven P's Checklist". If you find anything that is of any concern
to you, please have your health practitioner check it out.
