Most breast abnormalities that are brought to a doctor’s attention are found by the woman herself. But a systematic examination can be difficult to master, because there are no hard-fast rules to tell you what is normal and what isn’t.  Each woman becomes her own expert by learning what is normal for her and checking her breasts each month for any changes. This can be a challenging experience in the beginning because the breast is not even-textured. Instead, it is made up of several different types of tissues including the milk-producing lobes and ducts that lead to the nipple, as well as fatty and connective tissue, and structures of the lymph system.

• Perform the breast self-exam (BSE) at the same time each month. If you have regular periods, the best time is usually a few days after the period, when breasts are less likely to be tender or extra “lumpy.” If you are no longer having periods, pick a day of the month you will remember, such as the first day of every month.

 
• Start in front of a mirror. Get to know what your breasts look like – their size, general shape, symmetry, the appearance of the nipples (remember to see if they point in a particular direction, are inverted, or have any unusual characteristic), and the contour from the front and from the side. Look at your breasts first with your arms relaxed at your sides. Next, place your hands on your hips and push against your sides. Finally, raise your arms over your head. See if there is any change in contour or nipple direction, especially if one breast yields a change and the other doesn’t.

 
• Draw a simple map of what you see. Doctors often do this in a patient’s record. Later, after you have felt the tissues beneath the skin, add specific findings to your drawing. For example, draw circles where you feel “lumps” or other structures. 

 
• Assess your breast either standing or lying down on your back. Some women feel it is beneficial to do this in the shower when the skin is slippery and the fingertips slide more easily over the skin. 

 
• Always follow the same technique, whether it is to start from the nipple outward in a “spoke” pattern or circular pattern or to begin under the armpit and work down to one side of the breast, then the other. 

 
• About ¾ of all breast tumors are found in the upper outer region of the breast, in the area under the armpit, or behind the nipple, so you should be extra careful checking these areas.

 
• Include the nipple in your BSE. Gently squeeze the nipple and note if there is any discharge. Some women have a normal clear or straw-colored discharge, but a change – as with all aspects of the exam – can be important.

 
• Tell your doctor if there is a change. Remember that about 90% of all breast abnormalities are benign, but also keep in mind that most of the changes that are cancerous are detected because a woman has brought the problem to the attention of her doctor.

The University of Pennsylvania Health System provides a page of diagrams that can help you in learning how to do a monthly Breast Self Exam.