Tips for performing Breast Self Examination

Few women really want to do a breast self-exam, or BSE, and for many the experience is frustrating — you may feel things but not know what they mean. However, the more you examine your breasts, the more you will learn about them and the easier it will become for you to tell if something unusual has occurred. Breastcancer.org believes that BSE is an essential part of taking care of yourself and lowering your risk of breast cancer.

Some tips for BSE:

• Try to get in the habit of doing a breast self-examination once a month to familiarize yourself with how your breasts normally look and feel. Examine yourself several days after your period ends, when your breasts are least likely to be swollen and tender. If you are no longer having periods, choose a day that's easy to remember, such as the first or last day of the month.
• Don’t panic if you think you feel a lump. Most women have some lumps or lumpy areas in their breasts all the time. In the United States, only 20% of women who have a suspicious lump biopsied turn out to have breast cancer.
• Breasts tend to have different “neighborhoods.” The upper, outer area — near your armpit — tends to have the most prominent lumps and bumps. The lower half of your breast can feel like a sandy or pebbly beach. The area under the nipple can feel like a collection of large grains. Another part might feel like a lumpy bowl of oatmeal.
What’s important is that you get to know the look and feel of YOUR breasts' various neighborhoods. Does something stand out as different from the rest (like a rock on a sandy beach)? Has anything changed? Bring to the attention of your doctor any changes in your breasts that last over a full month's cycle OR seem to get worse or more obvious over time.
• You may want to start a journal where you record the findings of your breast self-exams. This can be like a small map of your breasts, with notes about where you feel lumps or irregularities. Especially in the beginning, this may help you remember, from month to month, what is “normal” for your breasts. It is not unusual for lumps to appear at certain times of the month, but then disappear, as your body changes with the menstrual cycle (if you are still menstruating). Only changes that last beyond one full cycle, or seem to get bigger or more prominent in some way, need your doctor's attention.

Learn the Five Steps of a Breast Self-Exam.

How to Perform a Breast Self-Exam

Women older than 20 years should perform monthly breast self-examinations (BSE). If you still have menstrual periods, you should perform the examination a few days after your period has ended. During this time, your breasts are not tender. If you are not menstruating (such as in menopause), BSE should be performed on the same day each month.
Use the following techniques to perform a BSE. Choose the method that is best for you.

Facing a mirror

Stand before a mirror and compare both 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 4 steps:
• With your arms at your sides.
• With your arms overhead.
• With your hands on hips - Press firmly to flex your chest muscles.
• Bent 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.

Step 1:

bse step 1

Begin by looking at your breasts in the mirror with your shoulders straight and your arms on your hips.
Here's what you should look for:
• Breasts that are their usual size, shape, and color.
• Breasts that are evenly shaped without visible distortion or swelling.

If you see any of the following changes, bring them to your doctor's attention:
• Dimpling, puckering, or bulging of the skin.
• A nipple that has changed position or an inverted nipple (pushed inward instead of sticking out).
• Redness, soreness, rash, or swelling.

Step 2:

bse step 2

Now, raise your arms and look for the same changes.

Step 3:

bse step 3

While you're at the mirror, look for any signs of fluid coming out of one or both nipples (this could be a watery, milky, or yellow fluid or blood).

Step 4:

bse step 4

Next, feel your breasts while lying down, using your right hand to feel your left breast and then your left hand to feel your right breast. Use a firm, smooth touch with the first few finger pads of your hand, keeping the fingers flat and together. Use a circular motion, about the size of a quarter.
Cover the entire breast from top to bottom, side to side — from your collarbone to the top of your abdomen, and from your armpit to your cleavage.
Follow a pattern to be sure that you cover the whole breast. You can begin at the nipple, moving in larger and larger circles until you reach the outer edge of the breast. You can also move your fingers up and down vertically, in rows, as if you were mowing a lawn. This up-and-down approach seems to work best for most women. Be sure to feel all the tissue from the front to the back of your breasts: for the skin and tissue just beneath, use light pressure; use medium pressure for tissue in the middle of your breasts; use firm pressure for the deep tissue in the back. When you've reached the deep tissue, you should be able to feel down to your ribcage.

Step 5:

bse step 5

Finally, feel your breasts while you are standing or sitting. Many women find that the easiest way to feel their breasts is when their skin is wet and slippery, so they like to do this step in the shower. Cover your entire breast, using the same hand movements described in Step 4.

Breast Self-Exam - Step 5 Larger Version

Lying down


Right breast

• 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 discharge.

Left breast

Repeat these steps on your left breast using your right hand. In the shower.
A BSE can easily be performed while you're in the bath or shower. Some women discover breast masses when their skin is moist.
• Raise your right arm.
• With soapy hands and fingers flat, check your right breast.
• Use the same small circles and up-and-down pattern described earlier.
Some research suggests that many women do 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 the whole breast and to pay special attention to the area between the breast and the underarm, including the underarm itself. Check the area above the 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 the 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 the breast in smaller and smaller circles, gradually working toward the nipple. Don't forget to check the underarm and upper chest areas, too.
Wedges: Starting at the outer edge of the 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 the underarm area and the upper chest.

The American Cancer Society recommends using three different levels of pressure to examine your breasts:
• Light pressure - to examine the tissue closest to the skin.
• Medium pressure - to feel a little deeper.
• Firm pressure - to feel deeper tissue closer to the chest wall.

Partner With Your Health Care Provider

Your health care provider can show you the proper technique for a breast self-examination during your annual breast examination. This should be brought up during your general check up.
You should perform this exam monthly and immediately report any suspicious breast lumps or conditions to your doctor.
Routine breast self-examination has not been proven to reduce breast cancer deaths, nor has it been as helpful as routine screening by mammography. However, breast self-exams are very cost effective and have no side effects. Tumors that may be breast cancer, when found with this technique, can be in an early stage, may have a better outcome, and may possibly have higher cure rates (long-term survival).

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Document partialy by: breastcancer.org