How To Do a Self Breast Exam

How to do a Self Breast Exam

Along with many other health care providers, I believe self breast exams (SBE)s are an important part of breast health.

Self breast exams, along with mammography, are often the reason women are able to find and treat breast cancers.

Most women only get clinical breast exams done by their health care providers once a year with their annual exam. So it's important for women to be checking their own breasts on a regular basis in between breast exams done by your health care provider.

I notice in my practice that many women don't know how to do self breast exams and/or don't know what to look for when doing them.

First of all, getting in the habit of doing SBE, to look for differences, is the most important thing. Because it's easy to forget about doing your self breast exams, it helps to link your exam to a certain time of the month and put it on your calendar. For women who are still having their periods (i.e. not menopausal or post-menopausal), the best time to do a self breast exam is 7 days after the first day of your period. 

In lieu of doing your SBE 7 days after the first day of your period, plan on doing yours the first day of every month. This strategy also works for women who don't have their periods regularly, including menopausal and post-menopausal women. The most important thing is consistency. Setting a recurring alarm or "appointment" in your phone or on your calendar is a helpful way to keep you on schedule.

A good SBE (self breast exam) has two parts: inspection and palpation.

First, do your Inspection:

Stand naked in front of the mirror. This can easily be done just before you are about to get in the shower. Put your hands on your hips and push down. This action contracts the pectoralis major muscle (the big muscle behind the breast). While doing this, compare your breasts for symmetry. Is the contour the same? Is there any skin dimpling or puckering? It is completely normal for women to have one breast that is slightly larger than the other. However, the contour (shape) should be the same.

Secondly, raise your hands above your head and check for symmetry again. If the contour of your breasts is not symmetrical or there is puckering or dimpling of the skin, you need to contact your health care provider. These can be signs of a benign growth, a mass, or possibly even a cancer, and it needs to be evaluated by a licensed health care provider. Another important part of the breast inspection is to note if you have had any drainage from the nipple. If you are breastfeeding, of course breast milk is expected. However, if you are not breastfeeding, it's important to note if you are having any drainage from the nipple. This includes any kind of drainage: blood, milky drainage, or clear drainage. If you're having nipple drainage and you're not breastfeeding, please call and make an appointment with your health care provider.

Next, do your Palpation:

The second part of the SBE is the actual palpation (or touching/feeling) of the breasts. You can do this in the shower, but the best way is lying down. Raise the arm above your head of the side you are going to check first. With your other hand, reach across and feel your breast. You can palpate your breast in a circle, or in a zig-zag pattern, or whatever pattern works best for you. It just matters that you are taking time to feel the whole breast. WebMD instructs you to use the pads of your middle three fingers.

When I do clinical breast exams, I start on the outside of the breast and do a circular pattern, moving inward until I check the nipple and have checked the entire breast. Then I move to the other breast and do the same. It's important to feel superficially or with a light touch, as well as to palpate the breast more deeply. This allows for you to check the breast better and helps you catch a lump that can be closer to the skin (superficial) or deeper into the breast tissue. Pay attention to lumps, areas of thickness, or anything that feels new and/or different. (WebMd)

Take your time. When you first start doing SBE, they may seem overwhelming and may take some time to get the hang of. That's okay. Once you get to know your breasts, you will become more efficient at checking them thoroughly and it will become a natural part of your habits.

Your breasts are made up of breast tissue and fatty tissue.

The actual breast tissue is roughly in the shape of a doughnut. Fatty tissue then fills in around the "doughnut" of breast tissue. The breasts can feel very lumpy or dense. Some women have what are called "fibrocystic breasts." Fibrocystic breasts feel very lumpy, but fibrous lumps are usually benign. However, breast cancer can occur in anyone, so it's important for ALL women to do breast exams. The first 3-4 times you do a SBE, you may not know or understand what you are feeling.

I usually tell my patients that during the first few SBEs you do, you are simply getting to know your breasts.

Things will feel foreign to you for a few months but soon you will be able to say, "Oh yeah, I felt that denser area last month," etc. If you have any questions whatsoever about what you are feeling, it's a good idea to make an appointment with your OB/GYN provider to ask questions and get evaluated. It's better to be too cautious than to assume there is nothing wrong.

Another part of breast health is getting your annual mammogram, once you reach the age of 40.

If you do not want to do your own SBE, if you have a partner or a spouse, you can ask her (or him) to do it for you or with you. Of course, I like to recommend you getting to know your own breasts, but if the thought of it concerns you for some reason, you can get the help of your partner. Give her or him the instructions (it's even a good idea for your health care provider to show your partner how to do it) and help remind your partner every month to check your breasts. You will still need to be responsible for the inspection part, but your partner can do the palpation part of the exam. There have been many women who come to have a breast lump evaluated that their partner or spouse has identified.

For more information on breast cancer and to assess your own risk factors, you can check out Susan Komen for the Cure, or American Cancer Society. 

Or you can ask your health care provider what resources she or he recommends.

Some health care providers have posters or pictures you can hang in the shower to show you how and/or remind you to do self breast exams. Ask your provider if you'd like to have this visual reminder.

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