How to Effectively Perform a Breast Self-Exam

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The breast self-exam: many of us have heard of it, but how many of us make it a regular part of our monthly routine?

While it can be intimidating to think about the possibility of breast cancer, becoming familiar with your breasts and aware of any changes that may occur is important for every woman

Keep in mind, however, that a breast self-exam should in no way replace a doctor’s evaluation but can be used as an additional tool towards your overall health practices.

According to a 2003 National Health Interview Survey (NHIS), out of 361 breast cancer survivors, 25% first detected an abnormality by self-examination and another 18% discovered an abnormality themselves by accident. A total of 57% of survey participants used a detection method other than a mammogram on the path towards diagnosis.

With the importance of the breast self-exam in mind, let’s demystify the process so you can easily make this a new part of your monthly routine.

The Anatomy of the Breasts

Most of us are familiar with the external parts of the breast, the nipple and areola being at the center, but there is a lot more going on underneath the surface. 

Each breast has 15 to 20 lobes branching from and surrounding the nipple. Ducts run from the nipple to the lobes which are made up of smaller lobules that have hollow sacs called alveoli.

The ducts from the nipple are thicker by the nipple and thin out as they branch off to each lobe, similar to branches on a tree. Normal changes in the lobes occur due to fluctuations in hormones during hormonal cycles and as a result of pregnancy and breastfeeding. By doing a regular breast self-exam, you are able to detect if anything seems to be changing.

Surrounding the ducts and lobes is fat, ligaments, and connective tissue. This is the part of the breast most readily felt with a light touch. The amount of fat in the breasts is what determines their size and will fluctuate with weight changes and aging. 

The breasts are fed nutrients and oxygen by capillaries and arteries, some of which run up through the armpit. The lymph nodes to the breast follow a similar path through the armpit but also connect to above the collar bone and through the chest. Lymph nodes work to drain harmful substances from the body through the lymphatic system and help the body fight infection.

Monthly Breast Self-Exam Methods

According to the Mayo Clinic, the best time to perform a breast self-exam is when your breasts are least tender. The governmental medical site, MedlinePlus, recommends 3 to 5 days after your period begins, or if you are post-menopausal, on a consistent day each month. Whatever time you choose for a breast self-exam, make sure it is consistent to minimize the chance of detecting differences that are due to regular hormonal shifts.

One of the goals of the breast self-exam is to become more familiar with your breasts so that you can readily detect any changes in size, shape, symmetry, or anything else unusual such as nipple discharge when you are not pregnant or nursing.

Follow these steps consistently each month during your breast self-exam:

Do a visual inspection.

The first part of a breast self-exam is a visual inspection. Without any clothing on that may cover your breasts, use a mirror to look for any visual changes. This could mean checking for nipples becoming inverted, any puckering or dimpling in the breasts, and changes in the breasts’ overall size and shape. Also look out for any signs of rashes, swelling, or redness. You will also want to raise your hands above your head and by lifting the breast to check visually from other perspectives.

Do a standing manual inspection.

This can come just after your visual inspection while you are still standing in the mirror or can be done sitting up in bed, or in the shower using soap to help the movements glide freely. Use the pads of your fingers on each hand to the opposite side and vary pressure levels as you slowly feel under your armpit.

With your arm above your head on the same side as the breast you are examining, make small circular movements with the pads of your fingers and follow a path from around the nipple and circling outward until you have felt every part of the breast.

You can also use an up and down pattern to cover all areas of the breast, or start at the outside and work inward

Pressure variations will help you feel multiple layers beneath the skin. Lighter pressure can be used around the nipple and use more pressure as you move towards the edges of the breast area.

Do a manual inspection lying down.

Move to a lying down position and use the same method and process as the standing inspection. You will want to follow a similar pattern each breast exam you do to be sure you cover all areas of the breast. This will ensure that you have completed a thorough breast self-exam.

Common Breast Symptoms That May Require a Trip to the Doctor

If you find irregularities during your breast self-exam, there is no reason to panic. Many breast irregularities can be attributed to benign causes, such as fibrocystic breast changes, but some findings might signal the need to go in for a breast exam with a doctor for further investigation and diagnosis.

You may need to see a doctor if you detect changes in the breast such as:

  • Breast pain outside of normal hormonal tenderness
  • Asymmetrical breast changes
  • Lumps that are new, unusual, or found in one breast but not the other, especially those found near the armpit
  • Cysts
  • Nipple Discharge that is sticky or bloody
  • Any other changes outlined above in the breast exam section such as dimpling, puckering, rash, etc.

What Are Fibrocystic Breast Changes?

Fibrocystic breasts occur when the lobes or lobules become more lumpy than usual, sometimes described as nodular or glandular. According to the Mayo Clinic, more than half of all women will have fibrocystic breast changes at some point in their lives, usually between the ages of 20 and 50. These changes, while they may be uncomfortable, are not a disease (hence updating the term from fibrocystic breast disease to fibrocystic breast changes) or at all harmful in and of themselves. 

Signs of fibrocystic breast changes include lumps that fluctuate in size and tenderness that fluctuates in intensity because of menstrual cycle changes and dark brown or green nipple discharge that is not bloody. Noticing these changes during a breast self-exam is critical to your health. Here are a couple of other important considerations while dealing with FCBD:

  1. Although FCBD is considered non-pathological, it’s a sign of estrogen dominance. 
  2. Implies an imbalance between estrogen and progesterone
    1. Symptoms: breast tenderness, irregular menstrual cycles, painful periods, PMS
    2. Stress can cause or worsen this imbalance
    3. Can be genetic: there’s a pathway that helps your body use estrogen efficiently and if it’s not genetically set up to work that way then you may have a tendency to make a more aggressive estrogen which causes these symptoms

If these types of changes persist after your period, a new lump occurs, or if there are areas with consistent and worsening breast pain, then it may be time to suspect other causes and seek a further diagnosis. There is no connection between fibrocystic changes and a higher risk of breast cancer, however, it may be good to see a Naturopathic Doctor in order to get to the root cause of your symptoms.

Woman talking to doctor about breast concerns, breast self-exam

Dr. Karen Threlkel

Dr. Karen Threlkel is a naturopathic physician that helps women with hormonal issues as part of her practice, as well as helping patients feel more healthy overall by helping them strengthen their mind-body connection. If you suspect you may be experiencing fibrocystic breast changes and live in the Washington, DC area, contact our office to find out more about what Dr. Threlkel can do to support your health needs.

About The Author:

Picture of Dr. Karen Threlkel, Naturopathic Physician, Washington DC

Dr. Karen Threlkel, Naturopathic Physician, Washington DC

Dr. Threlkel received her degree of Doctor of Naturopathic Medicine from The National College for Naturopathic Medicine (now called The National University of Natural Medicine) in Portland, Oregon. She also holds a Bachelor Degree in Kinesiology from The University of Maryland. She is licensed in Naturopathic Medicine by the Government of the District of Columbia Department of Health. Dr. Threlkel is a member of the American Association of Naturopathic Physicians, past president & current member of the Washington DC Association of Naturopathic Physicians.

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