What are the steps for a self-breast examination (SBE)?

Steps for Self-Breast Examination (SBE)

Self-breast examination should be performed systematically using a specific technique that includes visual inspection and palpation of all breast tissue to detect any abnormalities that warrant further evaluation. 1, 2

Preparation

• Women should become familiar with their breasts to promptly report any changes, though formal BSE instruction is not required as part of a specific program 1
• The best time to perform SBE is a few days after your period ends when breasts are least likely to be tender or swollen 2
• Women who choose to do SBE should receive proper instruction and have their technique reviewed during periodic health examinations 1

Visual Inspection

1. Stand before a mirror with arms at sides

   • Look for any changes in breast shape, size, contour, or symmetry 1, 2
   • Check for skin changes including redness, dimpling, puckering, or nipple changes 1

2. Place hands firmly on hips and press down

   • This contracts the pectoralis major muscles and enhances identification of asymmetries 1, 2
   • Look for the same changes as in the previous position 1

3. Raise arms overhead

   • Continue looking for changes in contour, swelling, dimpling of the skin, or changes in the nipple 1, 2

Palpation

1. Lying down position

   • Lie down with a small pillow under the shoulder/back on the side being examined 1, 2
   • Place the arm behind your head to flatten breast tissue on the chest wall 1, 2

2. Use proper finger technique

   • Use the pads (not tips) of your middle three fingers 1, 2
   • Make small circular motions, about the size of a dime 1

3. Cover the entire breast area systematically

   • Follow a vertical strip pattern from top to bottom covering the entire breast 1
   • Cover the pentagon-shaped area with these boundaries: 1, 2
     • Down the midaxillary line
     • Across the inframammary ridge at the fifth/sixth rib
     • Up the lateral edge of the sternum
     • Across the clavicle
     • Back to the midaxilla

4. Apply three levels of pressure

   • Light pressure to feel tissue closest to the skin 1
   • Medium pressure to feel a little deeper 1
   • Deep pressure to feel tissue closest to the chest wall 1

5. Pay special attention to key areas

   • Examine the upper outer quadrant and area under the areola/nipple thoroughly, as these are the most common sites for cancer 1, 3
   • Include the armpit (axillary) area 1, 2

6. Examine the nipple area

   • Gently feel the nipple and areola 1
   • Note any discharge, pulling or changes in the nipple 1

Follow-up Actions

• Report any changes promptly to a healthcare provider 1
• Changes to report include: new lumps, skin changes, nipple discharge, pain that doesn't fluctuate with menstrual cycle, or any other breast changes 1, 2

Important Considerations

• BSE alone has not been shown to reduce breast cancer mortality, but can help women become familiar with their breasts 1, 4
• Women should be aware that most breast changes are not cancer, but should still be evaluated 1
• The goal is to detect changes from your normal breast tissue, not to diagnose breast conditions 5
• Women with breast implants can perform SBE using the same technique, as implants are placed behind breast tissue 1

Remember that SBE is just one component of breast health monitoring and should be combined with clinical breast examinations and appropriate imaging studies as recommended by your healthcare provider 1.