For women who choose to do monthly breast self-examinations (BSEs) but have not been trained in the technique, it is highly recommended that they receive the proper instruction from a nurse, physician or trained healthcare professional. Having the technique can help ensure that the woman’s method is correct and effective.

A BSE should be performed on each breast in a routine fashion to be sure no area is missed. To perform a breast self-examination, a woman should lie down and place her right arm behind her head to begin examining her right breast. It is not recommended to perform a BSE standing up because the position does not allow the breast tissue to spread evenly over the chest wall. By lying down, the tissue is spread thinner and thus makes it easier to detect any possible changes.

Next, using her finger pads of the middle three fingers (index, middle and ring fingers) of her opposite (left) hand, the woman uses tiny circular motions over the entire breast area. These dime-sized circular motions should overlap so that no area is missed.

During the breast self-examination, the breast area is examined with three different levels of pressure. The first is a light pressure, allowing the woman to check the tissue closest to the skin. A medium amount of pressure helps the woman to feel a little deeper; while a firm pressure will allow the woman to feel the tissue of the chest and ribs. The light, medium and firm pressure should be done at each spot before moving to the next. The process is then repeated on the left breast using the right hand and placing the left arm behind the neck or back.

The American Cancer Society (ACS) recommends the examination of the breast be performed using a vertical pattern, which helps ensure that no area is missed. In the vertical pattern, the exam involves an up and down motion (from the neck and collar bone to the ribs). After the breast has been examined, it is important for a woman to also examine each underarm for any lumps or signs of enlarged lymph nodes. This part of the exam can be done while sitting or standing. Each arm should be raised only slightly so that the tissue is not tightened.

Women who have breast implants should consult with their physicians about the most effective way to conduct a BSE. These women need to learn how to distinguish breast tissue from the implant device. Physicians can instruct women on ways to apply pressure to check for changes without causing leakage or damage to the implants.

For women who choose to perform monthly breast self-examinations, it is important to do the exam regularly and become familiar with their breasts. A woman (or man) who detects a change or lump in the breast should first check the other breast. It is normal to find some lumpiness, especially if both breasts feel the same. However, a patient should contact their physician if any of the following signs or symptoms develop:

• Development of a lump in the breast or underarm area
• Irregular thickening of breast tissue
• Swelling
• Skin irritation
• Dimpling or puckering
• Nipple pain
• Nipple retraction (turning inward)
• Redness or scaliness of the nipple or breast
• Discharge from the nipple (other than breast milk)

Some changes in the breast are normal. There are many explanations for these changes, including aging, the menstrual cycle, pregnancy, menopause, taking birth control pills or taking other hormones, such as estrogen or progesterone. It is important for women to know that, more often than not, these changes are not cancer. In fact, one of the most common causes of breast lumps are fibrocystic changes, sometimes referred to as fibrocystic disease. This condition, which is technically not a disease, is not cancerous. Generally found in both breasts, these changes form as a result of repeated exposure to hormones, which in turn increase the firmness of the breast tissues leading to the creation of fluid-filled cysts. More than 60 percent of women in their childbearing years have fibrocystic changes or “lumpy” breasts. However, only a physician is qualified to make that determination.

Some women who have breast implants question their ability to perform monthly breast self-examinations, or even the value of mammography. BSEs and clinical breast exams, however, are the same for women with breast implants as they are for those without them. These women should inform their physicians and mammography technicians of the implants prior to their examinations.