Becoming Breast Aware

What you should look for when performing this lifesaving monthly ritual.

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No body part worries women more then her breasts: Are they sexually appealing? Will they be adequate to nourish my baby? Is that a lump? Throughout a woman's life, the breast goes through more changes than a teenager dressing for a date. The question on the top of your mind is, "Is that normal?" But the better question might be, "Is that normal for you?"

Becoming acquainted with the topography of your breast can help you and your health practitioner plot a course of action if necessary.

Breastscapes

Underneath the skin and nipple there is fibrous, glandular and fatty tissue, lobes and a network of milk ducts that give the breast its size, shape and density. Changes in the breast can be temporary, benign (non-cancerous) or cancerous.

Here is what you should be paying attention to:

  • Size and Symmetry - Breasts come in all shapes and sizes; from AA to DD and beyond. As weight is lost or gained, particularly during pregnancy, the breast will vary in size. Normal breasts can be unequal in size and shape. What you are looking for is an unusual increase in the size of one breast and if one is more pendulous than the other.
  • Nipples - When examining the nipple you are looking for changes in appearance, direction (pushed inward) and if there is any discharge other than breast milk. You are also looking for skin peeling around the nipple.
  • Skin - Here you want to see if there is any dimpling, puckering, ridges, redness, rash and/or scaling on the skin, areola or nipple. Note any prominent vein patterns.
  • Nodularity - This is the part that gets tricky. Monthly hormonal changes during menstruation can cause the tissue to become tender and nodular. What you are looking for is a new lump or thickened area, which may or may not be painful or tender. You want to note the shape (round, oval or irregular), margins (defined or irregular), texture (rubbery, soft, firm, hard) and if it is movable or fixed.


Taking in the Scenery

A breast self-exam is one way to get the lay of the land. Performing this test at the same time every month will help you learn what is normal for you. 

There are 2steps to breast self-examination (BSE); first you look, then you touch. Follow these instructions for both breasts.

  • Stand in front of a mirror with breasts exposed. With hands on hips positioned slightly forward, note the size, shape, color, contour and symmetry.
  • While standing, take the pads of your three middle fingertips and slide or walk fingers up and down in rows as if you were mowing the lawn. Start under the armpit and move across the whole breast systematically; first, with a light touch to examine tissue nearer to the skin, then heavier to reach tissue in the middle, then more deeply to reach tissue nearer to the bone. This is to assure that no portion of the breast is left unexamined. Extend the search under the arm and in the armpit. Give the nipple a little squeeze to see if there is any discharge.
  • Repeat the process while lying down with knees flexed, arm overhead at a 90-degree angle slightly raised with a pillow underneath the shoulder of the breast being examined.

Gaining Perspective

When it comes to diagnosing diseases of the breast, patients and their healthcare practitioners are at a disadvantage. Certain characteristics are suggestive of cancer but there is never any certainty. You may feel the lump or not. Your practitioner may feel the lump or not. Doctors may see the lump on X-ray mammography or not. Technicians may detect it on a breast ultrasound or not. An MRI (magnetic resonance imaging) may reveal a lump or not. If lumps are detected they may be benign or not. There is no perfect test. You can only tell if a lump or change in breast tissue is cancer by testing the cells under the microscope.

Still, there are some red flags that require a closer look: Lumps that are new, have changed over time, are firm, non-movable, do not vary with menstrual cycle, or are associated with overlying skin changes or nipple discharge.

If You Aren't Sure, Explore Some More

If you discover something, don't panic. Be proactive. Note the location, size, shape and consistency of the lump, and if it is mobile or tender. If you are still menstruating, note where you are in your cycle.

If you find something suspicious, it makes sense to get it checked by a professional.

For routine preventive breast care, the American Cancer Society suggests that yearly mammograms begin at age 40 and a clinical breast exam (CBE) be performed by a qualified health practitioner every 3 years for women in their 20s and 30s and every year for women 40 and over. Women who are at higher than average risk of breast cancer should talk with their doctors about when and how often to have a screening mammogram.

The most common causes of a single breast lump are:

  • Fibroadenoma - A benign solid tumor formed by glandular and fibrous tissue
  • Fibrocystic changes - benign breast changes
  • Cysts - Benign, smooth discrete fluid-filled sacs
  • Non-invasive cancers - Ductal carcinoma in situ (DCIS)
  • Atypical hyperplasia - Fast-growing abnormal cells

To find a certified Food and Drug Administration mammography center near you, click here.