This document provides information on breast self-examination, including its purposes, timing, components, guidelines, procedure, results, indications, precautions, advantages, and the role of nurses. Breast self-examination involves inspecting and feeling the breasts for lumps or abnormalities. It is recommended for both men and women beginning at age 20 to help detect breast cancer early. The procedure involves different examination positions and techniques like circular motions to thoroughly check the breast tissue. Finding a new lump or change should be reported to a healthcare provider for further evaluation. Regular breast self-exams can improve early cancer detection but may also produce false positives, so women should be educated on the proper technique by nurses.

1. Breast self examination
Presented by: Nabina Bhasima
Bsc.Nursing 4th year

2. Overview:
• Introduction
• Purposes
• Timing
• Components
• Guidelines
• Procedure

3. Contd…
• Results
• Indications
• Precautions
• Contraindication
• Advantages
• Disadvantages
• Role of nurses
• Research article

4. Introduction
• A breast self examination is a technique which
allows an individual to examine his/her breast
tissue for any physical or visual changes.
• It is often used as an early detection method for
breast cancer.
• Both men and women should perform a BSE at
least once each month beginning at age 20.

5. Contd..
• A breast self-exam is a way anyone can check
own breasts for any changes such as lumps or
thickenings that could be symptomatic of breast
cancer.
• This process includes looking and feeling each
breast, and reporting anything unusual to the
doctor.

6. Contd..
• When breast cancer is detected in its early stages,
chances of surviving the disease are greatly
improved.
• In fact, women who perform regular breast self
exam find 90% of all breast masses.

7. Definition
• A procedure in which women examine her
breasts and their accessory structure for
evidence of change that could indicate a
benign or malignant process.

8. Purposes
• To find any changes that may occur.
• To detect breast lumps.
• To improve quality of life.
• To cost benefit.

9. Timing of BSE
• Beginning at the age of 20years or after onset
of menarche.
• The BSE is usually performed within 7-10
days after the first day of the menstrual cycle,
when the breasts are smallest and cyclic
nodularity is least apparent.

10. Contd…
• If her periods arenot regular, a BSE should be
done on the same day every month.
• BSE should be regularly performed by every
woman such as pregnant, breast feeding and
menopausal woman, or have breast implants.

11. Components
1. Position
• One important component during breast
examination is position.
• Depending on whether looking at or feeling the
breast, women should select different options.

12. Contd…
• Use of mirror and a proper light system
facilitate detection of abnormalities.
• BSE can be done either in the sitting or lying
down position (dusting the hand with powder
or using cream).

14. 2. Hand movements
• Use the pads of three middle fingers to examine
every inch of breast tissue.
• Move fingers in small circular and regular
movement to cover the entire breast, part by part.
• Donot lift the fingers from breast between
palpations.

15. Contd…
• Use powder, lotion or soap to help fingers
glide from one spot to the next.
• If any difficulty using or feeling with the
finger pads of one of both hands, try using
the thumb, the palm of hand.

16. 3. Palpation perimeter
• The examination area is bound by the line which
extends down from the middle of the armpit to
just beneath the breast, continues across the
underside of the breast to the middle of the breast
bone, then moves up and along the collar bone
and back to the middle of the armpit.

17. Contd..
• Most breast cancers occur in the upper outer
area of the breast.

18. 4. Pressure level
• For each small circle, change the amount of
pressure, so one can feel the different levels
of breast tissue.
• Light pressure to feel the tissue closest to the
skin.

19. Contd..
• Make each small circle three times: once
light, once medium and once deep-before
moving on the next area.
• Firm pressure to feel the tissue closet to the
chest and ribs. A firm ridge in the lower curve
of each breast is normal.

20. 5.Breast palpation
• Be sure to palpate carefully beneath the nipple.
• Women who have had any breast surgery should
still examine the entire area and the scar.
• Any scar should also be carefully examined from
end to end.

21. Contd…
a. Wedge method
• Start in the armpit, proceed downward to
the lower boundary.
• Move a fingers width toward the middle
and continues palpating at upward until to
the collarbone.

22. Contd..
• Repeat until all the breast tissue are covered.
Make atleast 6 strokes before the nipple and
4 strokes after the nipple.
• One may need between 10 and 16 stroked to
cover all the breast tissue.

23. Contd...
b. Circular form
• Think of the breast as a force on a clock,
• Start at 12’o clock and move toward 1o’clock in
small circular motions.
• Continue around the entire circle until reach 12
o’clock again.
• Keep fingers flat and in constant contact with
breast.

24. Contd…
c. Breast palpation in triangle pattern.
• Palpation is begun at the medial portion of
the chest wall below the clavicle and
progresses down and up in a vertical strips
pattern.

25. Contd…
• The examiner should slide from palpation
position to examiner should slide from
palpation position to position rather than
lifting his or her hand.

26. 6. Axillary examination
• Examination of the armpits. The arm should
be lower because when the hand is behind
head, the axillary skin is tight and difficult to
palpate.

27. Contd…
• Gently move the arm 20-30 cm away, so can
gain access to axillary region.
• Direct the fingers tips of examining hand
toward the top of axilla. Then push the
palmar aspect of hand towards chest wall.

28. 7. Check for nipple discharge on
nipple
• Squeeze nipples to check for discharge.
• Many women have a normal discharge.
• Nipple discharge can also be a sign of breast
problem.
• Look for discharge in bra or clothing.
• Report any discharge to physician.

29. 8. Breast abnormalities
• Lumps, bumps or thickening: feel for a lump,
bump or thickening that has not been there
before.
• Pain (only when it is a new and persistent
pain report o doctor)
• Change in skin colour or texture
i. Peau d’orange
ii. Redness/ eczema

30. Contd…

31. Contd…

32. Contd…

33. Contd…

34. Contd..

35. Contd..

36. Guidelines for Breast self
Examination
• The national comprehensive cancer network
screening guidelines suggest that women
between 25 and 40 years old who are
asymptomatic and have no special risk
factors for breast cancer undergo a clinical
breast exam every 1 to 3 years.

37. Contd….
• Women older than age 50, women with
increased risk factors for breast cancer,
history of breast cancer, and/or symptomatic
patients are recommended to receive more
frequently clinical breast exams.

38. Procedure
• Explain procedure to the patient. Ask her to put on
a gown with the opening in the front.
• Provide privacy and assist the patient to sitting
position facing and expose chest and breasts.

39. Contd…
• Explain and teach breast self examination.
For inspection: ask the patient to stand in
front of the mirror and check both breasts for
anything unusual with patients.

40. Contd..
• For palpation method.
- Teach the patient to use the right hand to palpate
the left breast and vice versa.
• Before beginning a monthly BSE, woman’s
breast should be completely exposes, stand
undressed from the waist up in front of the
large mirror.

41. Step 1
a. Begin by looking at breasts in the mirror with
shoulders straight and arms on the hips.
b. Look for:
- Breasts: size, shape and color
- Breasts : evenly shaped without visible
distortion or swelling.

42. Contd…
- Dimpling, puckering or bulging of the skin,
- A nipple that has changes position or become
inverted (pushed inward instead of sticking
out)
- Redness, soreness, rash or swelling
- If any changes, consult doctor.

43. Contd..
Step 2:
Place the hand at the back of the head.
• Look for any changes in size, shape, position or
any changes to the skin of the breasts.
• Check for any skin puckering, dimpling, sores or
discoloration.

44. Contd…
• Inspect nipples and look for any sores,
peeling or change in the direction of the
nipples and other unusual changes.

45. Contd…
Step 3:
• Next, place hands on hips and press down
firmly to tighten the chest muscles beneath
the breast.
• Turn from side to side so, inspection of outer
part of breast can be done.

46. Contd…
Step 4:
• Bend forward toward the mirror.
• Roll shoulders and elbows forward to tighten
the chest muscles.
• Breasts will fall forward.

47. Contd…
•Look for any changes in the shape or contour
of breast.
Step 1 to Step 4 involves inspection of
breast.

48. Contd..
Step 5: Palpation of the breast.
• Palpate the breasts with pads of the fingers to feel
for lumps or soreness.
•Several common patterns, which are designed to
ensure complete coverage.
•The vertical strip pattern involves moving the
fingers up and down over breast.

49. Contd…
•The pie-wedge pattern starts at the nipple and
moves outward.
•The circular pattern involves moving the
fingers in concentric circles from the nipple
outward.

50. Contd..
Step 6: Palpation of nipple
• Check nipples for discharge (fluid). Place
thumb and forefinger on the tissue surrounding
the nipple and put outward toward the end of
the nipple. Look for any discharge. Repeat on
other breasts.

51. Contd…
Step 7: Palpation of breast while lying down.
• Lie down and place a small pillow or folded
towel under right shoulder.
•Put right hand behind head.
•Place left hand on the upper portion of right
breast with finger together.

52. Contd..
•Do the circular motions.
•When the circle is complete, move in one inch
toward the nipple and complete another circle.
Continue in this pattern until felt the entire breast.
Make sure to feel the upper outer areas that extend
into armpits.

53. Contd…
After examination if find a lump
• See the health care provider if discover any
new changes.

55. Normal and abnormal results
• Many women find lumps or changes in their
breasts, since some of these are normal
changes that occur at various points in the
menstrual cycles.
• Finding a change or lump in breast is not a
reason to panic.

56. Contd…
• Breasts often feel different in different places.
• A firm ridge along the bottom of each breast
is normal, for instances.
• The look and feel of breasts will change as
age increases.

57. When to contact
• A hard lump or knot near underarm.
• Changes in the way breasts look or feel,
including thickening or prominent fullness that
is different from the surrounding tissue.
• Dimples, puckers, bulges or ridges on the skin
of breast.

58. Contd…
• A recent change in a nipple to become
ouched in (inverted) instead of sticking out.
• Redness, warmth, swelling or pain.
• Itching, scales, sores or rashes.
• Bloody nipple discharge.

59. Indications of BSE
1. Complaints of breast pain
2. Skin changes
3. Nipple discharge
4. Lumps
5. Gross changes in size or shape
6. Breast lump developing during pregnancy
or lactation

60. Precautions for BSE
• When examining the breast, some general tips to
keep in mind include:
1. Use the pads of fingers:
• Use of the pads, not the very tips of three middle
fingers for exam.
• If any difficulty feeling with finger pads, use
another part of hand that is more sensitive, such as
palm or the backs of the fingers.

61. 2. Use different pressure levels:
• The goal is to feel different depths of breast
by using different levels of pressure to feel all
the breast tissue.
• Use light pressure to feel the tissue closet to
the skin, medium pressure to feel a little
deeper, and firm pressure to feel the tissue
closet to the chest and ribs.

62. Contd…
• Be sure to use each pressure level before
moving onto the next spot.
• If not sure how hard to press, talk with doctor
or nurse.

63. 3. Take time:
• Donot rush.
• It may take several minutes to carefully
examine breasts.

64. 4. Follow a pattern:
• Use a methodical technique to ensure the
examination of entire breast.
• For instance, imagine the face of a clock over the
breast.
• Begin near collarbone and examine that section,
moving finger toward nipple.

65. Contraindications
• If a woman is excessively anxious about the
breast examination.
• Prior history of venous thrombosis.

66. Advantages:
1. Women can use BSE to assess their breasts.
2. When they perform BSE properly and
regularly, they can notice any changes in
their breasts and seek further evaluation.
3. Reduces the risk of breast cancer by early
detection and treatment.

67. Contd…
4. Allows women to know the health of their
breasts.
5. Provides each woman knowledge of what
their own breast tissue feels like.

68. Contd…
6. Is a non invasive, simple procedure.
7. Can detect breast cancer at an earlier stage
than if a woman does not perform BSE.
8. Awareness of breast anatomy.

69. Disadvantages
1. Fear and anxiety about what may be found
during the exam.
2. False-positive (False alarm) finding, which
is a result that indicates that a condition is
present (i.e. breast lump or possible cancer)
when it is not (i.e. non-cancerous breast
tissue)

70. Role of Nurse in BSE
• Assessing a patient’s compliance of
performing self-breast examinations should
entail not only if she merely does the
examination, but when she is doing them and
how she is doing them.

71. Contd…
• As the primary nurse, if we are not educated
on proper techniques of a self-breast
examination, it is our responsibility to
provide a resource to the patient that can
properly demonstrate this.

72. Contd..
• Women should be educated on the proper
way to do a self-breast examination.
• Women should be told about the ideal time of
month to perform examination. This will
allow women to know what is normal breast
tissue and what is abnormal to aide in early
detection of breast cancer.

73. References
Book References
Prasai S. Durga. Gynaecology Nursing. 2nd
Edition. Jamal,kathmandu: Medhavi Publication;
2018:105-110
Brunner and Suddarth’s. Textbook of Medical-
Surgical Nursing. 13th edition. New Delhi: Wolters
Kluwer;2016:359-373
• Sharma Sarojini. Oncology Nursing Manual. 4th
Edition. Bharatpur, Chitwan:BP Koirala
Memorial Cancer Hospital, Dec 2014: 15-18

74. Net References
• Henderson JA, Ferquson T. Breast Examination
Techniques. Available from
(https://www.ncbi.nlm.nih.gov/books/NBK459179)
Accessed Date: 30th Edition, 2019
•Myoclinic. Breast Self examination for breast
awareness. Available from
(https://www.mayoclinic.org/tests.procedure/breastexa
minationabout/pac.20393237) Accessed Date: 30th Nov
2019
• Breast 360. Breast Self Examination. Available from
(https://Breast360.org/topics/2015/02/03/BreastSelfExa
mination_bsel) Accessed Date : 30th Nov 2019

75. Thank you