Self Breast Examination 2.0

Over the years there has been debate about the benefit of self breast examination. Healthcare providers  feel that it is important for patients to know what is normal for themselves as it can happen that a cancer or mass is not seen on a mammogram. While there are diagrams on self-breast examination, feeling the breast tissue in a circular manner, this article describes self  breast  examination in a way that makes the breast exam more of a mental image. 

Think of the breast as a tree. The trunk is at the nipple and the branches spread out from there. At the end of every “branch” there is the glandular breast tissue which can be thought of as “grape clusters”. The thickness of your breast tissue is very different from anyone else, so it’s important to know what your tissue feels like. 

Starting in the lower inner part of your breast you can feel your “trees” coming out from the nipple area like spokes on a tire. If you pay attention, and press firmly, you can feel the rubbery texture of the glands. Some people have smooth textures, others are very pebbly, while others have smooth rubbery densities that are more bunched together. What is important is that this is the building block for other denser areas in the breast, like the area in the upper outer quadrant of the breast. In feeling the lower inner breast, notice how the gland goes all the way to the very lower area along the mammary fold, where the breast tissue ends and the abdominal wall tissue begins. 

With this feeling in mind, the upper outer part of the breast has the largest volume of breast tissue and is therefore “denser”. Patients frequently state that they have masses, “fibrocystic breasts” or other changes, when it is really normal glandular tissue. To really feel this area, pull the breast downward toward the nipple so that you can feel the “valleys” between the breast tissue. For the most part, the glands are compressible and you can feel between the “valleys”. The breast tissue is rubbery, smooth and everything feels the same as what is next to it. Sometimes the tissue does not compress all of the way and it is important to compare the both breasts at the same time if you are not sure an area is normal. Breasts feel equal to each other for the most part and, if they do not, you need to bring this to the attention of your doctor. 

The nipple is no longer compressed as the breast is a gland and discharge may be normal for you. If you notice staining on your bra or fluid that comes out in its own, bring this to the attention of your doctor. Most of the time discharge is normal, but spontaneous clear and bloody discharge is abnormal. If there is skin breakdown, bleeding or ulcers of the nipple, this is abnormal and you doctor needs to know about it.

However you perform your self breast exam, knowing what your “normal” is will help you find potential changes which could be the sign of an early breast cancer.