Breast self-exams — along with clinical breast exams and mammography — raise your awareness of your breast health. Find out what breast familiarity entails and review self-exam techniques.

About 2% of all breast cancer is diagnosed during pregnancy. Breast examination should be part of the prenatal visit and appropriate diagnostic tests should be performed if any abnormality is found. This includes fine needle aspiration, ultrasound, open biopsy under local anesthesia and, in selected cases, mammography with proper shielding of the fetus. No single diagnostic x-ray procedure results in radiation exposure to the extent that it is a threat to the well-being of the developing pre-embryo, embryo or fetus. Therefore, exposure to x-ray during pregnancy is “not an indication for therapeutic abortion.” However, because a woman’s breasts during pregnancy are so dense, it is almost impossible to screen the breasts visually, making diagnostic imaging an unreliable method of finding or evaluating breast cancer during pregnancy. Prompt diagnosis and appropriate treatment are as essential in the pregnant woman as in the non-pregnant woman.

It is very important that you continue doing breast self examination every month throughout pregnancy, nursing and thereafter.

How to perform a breast self-exam

Start by looking closely at your breasts. Disrobe and stand in front of a mirror with your arms at your sides. While facing forward and turning from side to side, look for puckering, dimpling or changes in size, shape or symmetry. Check to see if your nipples are turned in (inverted). Inspect your breasts with your arms in two other positions: hands on your hips and hands raised overhead, palms pressed together.

Perform the manual part of the exam in the shower or lying down with no shirt or bra on.

If you choose the shower, lather your fingers and breasts with soap to help your fingers glide more smoothly over your wet skin. If you do the exam lying down, choose a bed or other flat surface to lie on.

Move your hand over your breast using one of three techniques: the clock pattern, the wedge pattern or the sweeping technique. No matter which method you choose, be sure to check your nipple for any discharge. Do this by gently pinching the nipple with your fingers positioned at 12 o'clock and 6 o'clock and again with your fingers at 3 o'clock and 9 o'clock.

Touching or gently pressing a breast lump may cause some discomfort. If you do detect any changes, such as a lump, thickening, asymmetry, dimpling, redness, nipple discharge or nipple inversion, see your doctor promptly.

Breast self-exam using a clock pattern

• Visualize your breast as the face of a clock.
• Place your left hand behind your head and examine your left breast with your right hand.
• Place your right hand at 12 o'clock — at the very top of your breast.
• Press the pads of your three middle fingers firmly on your breast in a slight circling, massaging motion.
• Move your hand down to 1 o'clock, then 2 o'clock, continuing until you return to 12 o'clock.
• Continue in the same pattern, moving your hand in smaller circles toward your nipple.
• Check the tissue under the nipple and look for discharge.
• Check the tissue under your armpit and surrounding your breast.
• Place your right hand behind your head and repeat the examination on your right breast using your left hand.

Breast self-exam using a wedge pattern

• Visualize your breast as a circle divided into wedges, like pieces of a pie.
• Place your left hand behind your head and examine your left breast with your right hand.
• Press the pads of your three middle fingers firmly on your breast in a slight circling, massaging motion.
• Start at the top of your breast about a half-inch below your collarbone and slide your fingers in toward your nipple as you massage.
• Examine the breast tissue in the entire wedge — or piece of pie.
• Move your fingers clockwise to the next wedge in the circle.
• Continue examining your breast in this manner until you've completely examined your breast and underarm.
• Place your right hand behind your head and repeat the examination on your right breast using your left hand.

Breast self-exam using a sweeping technique

• Place your left hand behind your head and examine your left breast with your right hand.
• Instead of a circling, massaging motion, sweep your three middle fingers from your collarbone down to your nipple.
• Work clockwise around your breast.
• Sweep your fingers from the outside of your breast in toward your nipple.
• To feel deeper breast tissue, repeat the process using a walking motion with your fingers.
• Continue examining your breast in this manner until you've completely examined your breast and underarm.
• Place your right hand behind your head and repeat the examination on your right breast using your left hand.

When should you start breast self-exams?

Also mothers should inform their daughters about the benefits and limitations of breast self-exams when they reach age 20. That's the age you should begin breast self-exams. Whether or not you perform breast self-exams, you should have a clinical breast exam by a health professional every three years until you're 40. After age 40, schedule a clinical breast exam and a mammogram every year.

What's the best time for breast self-exams?

The best time to perform a breast self-exam is about a week after the start of your period. That's when your breasts are least likely to be tender or swollen. Your breast tissue undergoes changes each month during your menstrual cycle. Changes in hormone levels associated with menstruation cause your breasts to swell. Once your period starts, the swelling subsides and your breasts return to normal.

During pregnancy and nursing, your breasts may feel more lumpy than usual. If you have any questions about how your breasts look or feel, don't hesitate to ask your doctor about them.

Pros and cons of breast self-exams

One benefit of breast self-exams is the potential to identify and treat a cancerous breast lump while it's still small and in an early stage of development. On the flip side, however, you might need a biopsy to evaluate an area of concern. If the biopsy results are noncancerous (benign), you might feel that you've undergone an invasive procedure unnecessarily. Breast self-exams may also be challenging if you have normally lumpy (fibrocystic) breasts.

Breast self-exams alone don't reduce the number of deaths from breast cancer. Breast self-exams can miss tumors, as can other methods of screening. That's why it's important to rely on more than one method to screen for breast cancer. A combined approach to breast cancer screening — including breast self-exams, clinical breast exams, mammography and magnetic resonance imaging (MRI) for certain high risk women — increases your chances of finding breast cancer at an early, treatable stage.