How to Perform a Breast Self-Exam
Breast self-exam (BSE) is one method by which a woman can track any abnormal changes in her breasts, and adult women may choose to perform monthly breast self-examinations. Even though breast self-examination is not recommended as a screening tool for breast cancer (routine mammography is recommended for breast cancer detection), every woman should become familiar with how her breasts look and feel so she can more easily identify changes she feels or sees in her breasts. Any changes in your breasts (nipple discharge, change in size, color, lumps, etc.) should be discussed with your health-care professional as soon as possible. It is important to understand that if you find changes in your breast, they are not necessarily indicative of cancer.
If you are still menstruating the examination should be performed several days after your period has ended. During this time, your breasts are less tender and lumpy. If you are no longer menstruating (after menopause), breast self-examination should be performed on the same day each month.
Breast Cancer Symptoms and Signs
If you notice any of the following changes in your breasts, notify your doctor as soon as possible. Possible signs and symptoms of breast cancer include:
Changes in the nipple:
- Change in appearance
- Nipple that is slightly depressed inward (retracted)
Changes in the appearance of the breast:
- A new mass or masses in the breast (not all masses are indicitive of cancer)
- Unexplained change in the size or shape of the breast
- Dimpling or puckering on the skin of the breast
- Unexplained swelling or shrinking of the breast
- Unexplained pain in one area that is persistent and does not change position
- Redness, warmth, or scaly skin on the breast
- A hard mass, knot, or thickening inside the breast or underarm
- Itching on the surface of the breast
Facing a Mirror
Use the following techniques if you wish to perform breast self-examination. Choose the method that is best for you. Stand before a mirror and compare the breasts for differences in size, nipple inversion (turning in), bulging, or dimpling. Note any skin or nipple changes, such as a hard knot or nipple discharge.
Inspect your breasts in the following four steps:
- With your arms at your sides
- With your arms overhead
- With your hands on hips - press firmly to flex your chest muscles.
- Bend forward - inspect your breasts.
In these positions, your pectoral muscles are contracted, and a subtle dimpling of the skin may appear if a growing tumor has affected a ligament.
- Place a pillow under your right shoulder.
- Put your right hand under your head.
- Check the entire breast area with the finger pads of your left hand.
- Use small circles and follow an up-and-down pattern.
- Use light, medium, and firm pressure over each area of the breast.
- Feel the breast with the surfaces of the second, third, and fourth fingers, moving systematically and using small, circular motions from the nipple to the outer margins.
- Gently squeeze the nipple for any evidence of discharge.
- Repeat these steps on your left breast employing your right hand.
In the Shower
Breast self-examination can easily be performed while you're in the bath or shower. It may be easier to identify breast masses when the skin is moist.
- Raise your right arm.
- With soapy hands and fingers pressing on the breast tissue, check your right breast with your left hand.
- Use the same small circles and up-and-down pattern described earlier.
- Repeat on the left breast with your right hand.
If you have breast implants, it may be useful to have your surgeon or doctor assist you in identifying the edges of the implants so any changes in the contour of the breast can be easily appreciated.
Partner with Your Healthcare Professional
Your health-care professional can instruct you in the proper technique for breast self-examination during your annual breast examination. This should be discussed during your general check-up or women's wellness check-up if you are menopausal or postmenopausal. Routine breast self-examination has not been proven to reduce breast cancer deaths, nor has it been as helpful as routine screening using mammography. However, breast self-exams are very cost effective and have no side effects. Masses that may represent breast cancer, when discovered using this technique, are more likely to be an early stage, may have a better outcome, and may likely have higher cure rates (i.e. long-term survival).
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National Breast Cancer Foundation. Symptoms and Signs of Breast Cancer.
National Breast Cancer Foundation. Breast Self-Exam.
Susan G. Komen. Breast Self-Exam.
Susan G. Komen. Warning Signs of Breast Cancer.
UpToDate. Patient information: Breast cancer screening (Beyond the Basics).