How To Do A Monthly Breast Self Exam

It has come to my attention that many women are not doing monthly breast self exams to check on the health of their breasts.  Ladies (and men – because men get breast cancer too), doing a monthly breast self exam is truly necessary. Don’t wait for your yearly check-up at the doctor’s office.  Get to know the look, feel and texture of your own breasts and nipples because self-monitoring may just save your life. Doing this definitely saved mine.

Why People Are Not Doing Monthly Breast Self Exams

Upon inquiring why people have not been doing monthly breast self exams (let’s call them BSEs for brevity), some say they just don’t know how to do them and would rather leave it up to their doctor to do.  Some are nervous because if they find lumps and bumps they spend a lot of time and energy worrying about them (and hey – we all do that, but the ostrich head-in-the-sand attitude will not help you!).  Some say they just do self exams occasionally when they think of it.  Regardless of your breast cancer status, regardless of your pre- or peri- or post-menopause status, you simply must do a monthly breast self-exam.  Yes, even if you’ve had a single or double mastectomy and I’ll tell you why later.

So let’s get started.  There are many different scenarios to be encountered these days, so I will try to cover them all.

The Pre- and Peri-Menopausal BSE

Women should start doing BSEs in their early 20’s.  Mothers, teach your daughters how to do them. Timing is the thing, it’s best to do the BSE toward the end of the menstrual period because that is the time when hormonal changes have the least influence on breast tissue, and the breasts are the least tender.  See video below for instructions on how to do a thorough self exam.

The Post-Menopausal BSE

This group of women is generally not as prone to breast tenderness so they can choose an easy day to remember – for instance if your birthday falls on the 18th of the month, do your BSE consistently on the 18th of each and every month.  See the video below for instructions on how to do a thorough self exam.

BSE After Breast Implants

Checking out your breasts when you have breast implants is imperative. You are checking not only the health of the breast but the viability of the implant.  Implants tend to push the breast tissue forward so it is easier to feel any abnormal changes in the breast. Choose your timing depending upon whether you are pre- or post-menopausal (see above).

If you do encounter any hardness in the breast area, it can sometimes be the result of capsular contracture, which can occur when a hard tissue capsule forms around the implant. It can feel small and barely noticeable, or it can become very painful and distort the shape of the breast. Let your doctor know if you see or feel any of these symptoms. For more information about capsular contracture, click here.

BSE After Lumpectomy and Flap Reconstruction Surgery

If you had a lumpectomy followed by a flap reconstruction, it is definitely necessary to do a monthly self exam.  Choose your timing depending on your menopausal status (see above) and do a thorough BSE as shown in the video below. The breast(s) with the flap reconstruction is/are definitely going to feel different but get to know those changes.

Should you feel a lump or hard tissue soon after the surgery, this can be a case of benign fat necrosis, the result of fat cells dying after breast reconstruction surgery. These cells calcify and form lumps soon after the surgery, and unlike cancer, they generally stay the same size or shrink over time.

BSE After Mastectomy and Reconstruction

If you have had a single or double mastectomy with reconstruction, you will still want to perform a monthly BSE, both on the normal breast (if you still have one), as well as along the surgical lines of the reconstructed breast. Look for any changes in the area where your breast was removed, such as lumps, bumps, persistent rashes, skin thickening, skin color changes.  I recommend this because even though the breast tissue has been removed, I personally know of two women who had breast cancer recur along the surgical lines of their mastectomy scars.  They felt odd lumps/bumps along the surgical lines, which biopsies revealed were cancerous.  I don’t share this to frighten you, merely to make you aware that it is possible and to be vigilant.

If You Feel Something During Your BSE

The breast is constructed rather like an orange or a grapefruit – you will probably feel segments, or nodules or glands and while that can be scary, it’s usually normal.  Get to know how your breasts normally feel.  If you feel something lumpy or hard, doctors normally advise that you wait two weeks and then do another BSE. Chances are what you felt will be gone because breast tissue often changes throughout the menstrual cycle in the pre-menopausal breast. But if the abnormality persists, you should definitely see your doctor for a clinical examination.

Excellent Breast Self Exam Video

Thank you to Michele Martineau, a fellow Coloradan who had the BRCA1/2 gene mutation, for the provision of her YouTube video demonstrating a very thorough (and discreet) breast self exam (she has done a much better job of making this video than I possibly could have done!):

Michele has an excellent website ( detailing her journey of choosing to have bilateral prophylactic mastectomy followed by several reconstruction surgeries and a detailed account of the troubles she encountered with those surgeries. If you are considering mastectomy and reconstruction surgery, this is a don’t-miss-it website.

What To Look For During The BSE

As you perform your BSE as described by the informational video above, you are looking for abnormalities in each breast such as dimpling, puckering or skin bulges, skin redness, soreness, rashes or swelling, lumps, and bumps. You also need to look at the health of the nipples. Do they look normal or are they inverted? Are they oddly puckered? Is there any discharge or crustiness?  Anything out of the ordinary that you are not comfortable with should be checked out by your doctor.

Don’t Forget Your Armpits, Collarbone

Make sure to check the soft tissue in the armpit as well as above and below both sides of the collarbone, because that’s where lymph nodes are located. Using your fingerpads, press gently into the soft tissue of the armpit and above and below the collarbone.  You are searching for any lumps, soft or hard.  Again – anything out of the ordinary with which you are not comfortable should be checked out by your doctor.

If You Have A Hot Painful Breast But No Lumps

If you have a hot, painful breast but no lumps are present, you may have what is known as inflammatory breast cancer.  See my article You Woke With A Red, Hot, Swollen Breast? for more information.

Please be vigilant, people.  I hope this information makes a difference to someone.

References:  View “How To Do Breast Self Exam” video

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