How to Perform a Breast Self-Examination (BSE)

What is a breast self-examination (BSE)?

Breast self-examination (BSE) is a procedure you do on your own to physically and visually check your breasts and underarm areas for any changes. It has not been shown that BSE alone can accurately determine if you have breast cancer.

Therefore, BSE should be used in addition to (not in place of) a clinical breast examination by your health care provider and mammography. Discuss the benefits and limitations of BSE with your health care professional.

When should a BSE be done?

By doing BSE regularly, you get to know how your breasts normally feel so that you are more apt to detect any change. You should begin doing breast self-examination by age 20 and keep doing it throughout your life, even during pregnancy and after menopause.

You should perform BSE every month. Get familiar with how your breasts usually look and feel so that you may notice any change from what is normal for you.

• If you still menstruate, the best time to do BSE is several days, or about a week, after your period ends. These are the days when your breasts are least likely to be tender or swollen
• If you no longer menstruate, pick a certain day, such as the first day of each month, to remind yourself to do BSE
• If you are taking hormones, talk with your doctor about when to do BSE

Pay Attention to Changes

Check with your doctor if you find any change in your breast(s) that causes you concern. Changes in your breasts may include: 

• Development of a lump
• A discharge other than breast milk 
• Swelling of your breast 
• Skin irritation or dimpling 
• Nipple abnormalities (such as pain, redness, scaliness, or turning inward)

How to Do a BSE

1. Stand in front of a mirror that is large enough for you to see your breasts clearly. Check each breast for anything unusual. Check the skin for puckering, dimpling, or scaliness. Look for a discharge from your nipples.

 

2. Watching closely in the mirror, clasp your hands behind your head and press your hands forward.

 

3. Next, press your hands firmly on your hips and bend slightly toward the mirror as you pull your shoulders and elbows forward.

 

Do steps 2 and 3 to check for any change in the shape or contour of your breasts. As you do these steps, you should feel your chest muscles tighten.

4. Gently squeeze each nipple and look for a discharge.

 

5. Raise one arm. Use the pads of the fingers of your other hand to check your breast and the surrounding area firmly, carefully, and thoroughly. Some women like to use lotion or powder to help their fingers glide easily over the skin. Feel for any unusual lump or mass under your skin. Feel the tissue by pressing your fingers in small, overlapping areas about the size of a dime. To be sure you cover your whole breast, take your time and follow a definite pattern: lines, circles, or wedges.

 

Some research suggests that many women do a BSE more thoroughly when they use a pattern of up-and-down lines or strips. Other women feel more comfortable with another pattern.

The important thing is to cover your whole breast and to pay special attention to the area between your breast and your underarm, including the underarm itself. Check the area above your breast, up to the collarbone and all the way over to your shoulder.

Lines - Start in the underarm area and move your fingers downward little by little until they are below your breast. Then move your fingers slightly toward the middle and slowly move back up. Go up and down until you cover the whole area.

Circles - Beginning at the outer edge of your breast, move your fingers slowly around the whole breast in a circle. Move around your breast in smaller and smaller circles, gradually working toward your nipple. Don't forget to check your underarm and upper chest areas, too.

Wedges - Starting at the outer edge of your breast, move your fingers toward the nipple and back to the edge. Check your whole breast, covering one small wedge-shaped section at a time. Be sure to check your underarm area and the upper chest.

6. It is important to repeat step 5 while you are lying down. Lie flat on your back, with one arm over your head and a pillow or folded towel under your shoulder. This position flattens your breast and makes it easier to check. Check each breast and the area around it very carefully using one of the patterns described above.

 

7. Some women repeat step 5 in the shower. Your fingers will glide easily over soapy skin, so you can concentrate on feeling for changes underneath.

What do you do if you find a lump?

One of the most frightening moments for a woman is if she finds an unusual or new lump during a breast self-examination. One of the most important reasons to perform regular breast self-examination is so that you know what is normal for your breasts. If you find a lump, it is important not to panic.

If you find a lump in one breast or feel something "different" in the tissue, examine the same spot in the opposite breast. Usually, if the same area in the opposite breast feels the same, there is little need for worry. But if they feel different, or you feel a definite lump, there may be good reason for concern.

It is important to contact your health care provider right away. Sometimes the lumpiness may be due to menstrual changes. But if you have nipple discharge or skin changes, such as dimpling or puckering, your doctor may want to see you right away.

It is natural to be frightened when you find a lump. But do not let the prospect of cancer delay you from taking action. Remember that 80 percent of all breast lumps are benign (noncancerous).