By M. Ellen Mahoney, M.D., F.A.C.S.

Keeping breasts healthy requires three complementary methods: breast imaging (usually a screening mammogram), clinical breast exams, and breast awareness or self-examination.  Each of these can detect cancers that may be missed by the other methods.

Bubble Wrap, Gravel, or Rocks? How Does Each Breast Feel?

If you’re a caregiver needing to give breast exams, the first thing you should be aware of is that breasts change all the time.  They change within the month for premenopausal women, and they change over the stages of a woman’s life.  The most important observation for you to make is to determine the background texture of the breast. When you press your breasts, or the breasts of your loved one, does the tissue under your breasts feel like butter, bubble wrap, gravel, or rocks?  Whatever the texture, it should feel the same everywhere.  If you notice a difference in the texture, it usually is not subtle.  It will be different from anything you have felt in those breasts—ever.  But if you don’t perform regular breast exams, you won’t be able to tell what is different

Be aware of the normal range of tissue changes for your loved one, familiarize yourself with the background tissue, and realize that significant breast lumps are not subtle if you press hard enough and examine closely enough.

When to Give Breast Exams

Don’t time breast exams precisely.  In fact, it’s better to do them randomly, so you can be aware of normal changes in the breasts during the month.  After a few months of breast exams, you’ll begin to get a sense of natural changes and differences. You can also do the exam at various times during the day, rather than all at once.  For example, breasts can be examined before showering or bathing. This may be a good time to make sure that the usual differences in breast size remains stable (for example, if one breast is always larger, be sure that is still the case), that there are no changes in the nipples, and that there are no changes in the skin. Breasts should be viewed with the arms above the head, as well as while the hands are on the hips. 

When examining the breasts, be sure to carefully examine the full extent of the breast tissue. You’ll want to examine from the clavicle (the long bone that connects the arm to the body)to the upper abdomen and from latissimus to latissimus (under the arm, from back to front) across the midline of the body.

While your loved one is upright (possibly in the shower), take your bare hands (soapy hands often work well in the shower) and place your fingers on their breasts. Press and move over the whole area of breast tissue, taking at least 10 to 20 seconds per side.  Later in the day, or on a different day, while your loved one is in bed lying flat, massage the whole extent of the breast.  Fingers should be kept together and the flat portion of the fingers used in a rolling circular motion to cover all of the area.  The goal is to imprint the breast texture on your mind.  If there is something to be found, it will usually make itself known. Of course, if you are a woman, you should examine your own breasts too.

Different, Dense, Dominant yet Discrete

If you do find something that stops your fingers, use your finger tips to be sure the lump has edges all around it and that it is “different, dense, dominant, yet discrete.”  In other words, if you are looking hard enough, and covering the extent of the breast, a problem should make itself known. But if you are not thoroughly checking, any problems may remain hidden.

When Something Feels Different

If you find something you feel is different, check the other breast to see if there is anything like it.  If your loved one is premenopausal, and especially if she is premenstrual, wait until a few days after her period to see if the area blends into the background.  Check again. Do you still feel something different? It’s time for medical attention. Be sure to contact your loved one’s doctor and tell him or her that you have been performing monthly breast exams for your loved one, and that you have noticed something different.

Clinical Breast Exams

I should emphasize that the most common finding for any home exam will be finding nothing at all.  That’s why it is most important to schedule your loved one’s clinical breast exam and mammogram, since your exams should be considered supplementary. 

Breast Imaging (Screening)

Mammography has been proven to reduce mortality in women over 40. This screening should be done yearly for women with average risk of breast cancer and continue annually.  Annual mammograms are now even recommended for women under age 40.  A clinical breast exam should be done yearly during the gynecological exam. 

Remember, the keys to healthy breasts include screening, clinical exam, and self-breast exam.