Definition
Breast self-examination is a procedure in which women examine their own breast and underarm (axilla) areas of the body physically (feel) and visually (look) to identify any changes to detect breast carcinomas at the earliest.
Purposes
- To rule out breast cancer.
- To identify any breast disorder (lump, masses, distortion. swelling, etc.).
Indications
- Nipple abnormalities (nipple discharge, pain, redness scaliness, turning inward).
- Routine screening after the age of 20 years.
- Any lump or swelling in the breast.
- Axillary lymph node enlargement.
- Family history of breast cancer.
Ideal Age and Time for BSE
- Women after the age of 20 years should perform BSE monthly once and continue throughout their lives ever during pregnancy and after menopause.
- The best time is a specific day, or about a week, after the menstruation ends. These are the days when the breasts are least likely to be tender or swollen.
What to Look For
- Lumps or thickened areas that feel different from surrounding tissue.
- Changes in breast shape, size, or skin texture (dimpling, redness, or swelling).
- Nipple discharge or inversion that wasn’t present before.
Articles
| Articles | Purpose |
| Mirror | To inspect the breast. |
| Screen | To maintain privacy. |
| Rolled towel/small pillow | To provide support and comfort. |
Procedure
| Nursing action | Rationale | |
| 1. | Explain the procedure to the patient. Ask her to disrobe up to waist and put on the gown with the front opening. | Facilitates easy access while maintaining privacy. |
| 2. | Wash hands. | Prevents transfer of microorganisms. |
| 3. | Place screen around the patient. | To provide privacy. |
| 4. | Instruct the patient to sit or stand facing mirror and expose the chest and breast. | Allows comparison of breast bilaterally. |
| Inspection | ||
| 5. | Stand in front of a mirror to check each breast for anything unusual such as discharge from the nipple, puckering, dimpling, or scaliness. | Normal breast: Color same as the body color, round in shape, smooth surface with no discharge. Abnormal breast: Redness, blue hue, retraction, dimpling, enlarged pores, edema, lumps, lesions, rashes, ulcer, and discharge |
| 6. | Clasp hands behind the head and press your hands forward and look for any abnormalities. Note any change in contour (shape or size) of the breast. | Change in shape or size indicates lump in the breast. |
| 7. | Press hands firmly on hips and bend slightly toward the mirror as you pull your shoulders and elbows forward. Note any change in contour (shape or size) of the breast. | Change in shape or size indicates lump in the breast. |
| Palpation | ||
| 8. | This technique can be done in standing and lying-down position with the shoulder supported with the towel or small pillow. | It aids to identify any lumps or masses in the breast Inflammation, discharge, nodules and fissuring, and lesions are abnormal findings. |
| The breasts are best examined while lying down as it spreads the breast tissue evenly. | ||
| Raise your left arm over your head. Using three or four fingers of the right hand and examine the left breast by compressing the mammary tissues against the chest wall. Palpate breast, areola, and nipple from the periphery to nipple, in concentric circular motion/wedge section/vertical strips until you have examined every part of the breast. | ||
| Pay special attention to subareolar part and gently press the nipple between the fingers. | ||
| Palpate the axilla starting at the anterior axillary line and continuing at an angle to the midaxillary line and up into the axilla. Identify the posterior, anterior, central, and lateral axillar node enlargement. | Normal lymph node should be nonpalpable, less than 1 cm, and nontender. | |
| Squeezing | ||
| 9. | Gently squeeze the nipple and look for any discharge. If there is any discharge, report to the physician. | Normally no discharge on squeezing except while lactating. |
| 10. | Repeat steps 8 and 9 in the other breast. | To identify abnormalities in the other breast. |
| Aftercare | ||
| 11. | Allow the patient to dress. | Provides comfort to the patient. |
| 12. | Wash hands. | Reduces the transmission of the microorganisms. |
| 13. | Instruct to report or visit the doctor in case of identifying any abnormalities. | Facilitates early initiation of treatment regimen. |
| Documentation | ||
| 14. | Document the procedure with date, time, steps followed, findings of abnormalities, and response of the patient. | Serves as a legal document and prevents duplication of work. |
Special Considerations
- Perform BSE monthly, preferably a few days after your menstrual cycle ends.
- Postmenopausal individuals should choose a consistent day each month for examination.
- Use the pads of your fingers, not fingertips, for better sensitivity.
- Apply light, medium, and firm pressure to examine different tissue depths.
- Follow a systematic pattern (circular, vertical, or wedge-shaped) to ensure full coverage.
- One breast may be slightly larger or positioned differently.
- Look for lumps, skin dimpling, nipple discharge, or persistent pain.
- Hormonal changes may alter breast texture; consult a healthcare provider for guidance.
- Those with a family history of breast cancer should combine BSE with regular clinical exams.
- BSE does not replace mammograms or clinical breast exams but serves as an additional tool.
- If abnormalities are detected, seek medical evaluation promptly.
REFERENCES
- Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
- Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
- Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwers, ISBN-13:978-9388313285
- Adrianne Dill Linton, Medical-Surgical Nursing, 8th Edition, 2023, Elsevier Publications, ISBN: 978-0323826716
- Donna Ignatavicius, Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care, 11th Edition ,2024, Elsevier Publications, ISBN: 978-0323878265
- Lewis’s Medical-Surgical Nursing, 12th Edition,2024, Elsevier Publications, ISBN: 978-0323789615
- AACN Essentials of Critical Care Nursing, 5th Ed. Sarah. Delgado, 2023, Published by American Association of Critical-Care Nurses ISBN: 978-1264269884
- Ernstmeyer K, Christman E, editors. Nursing Fundamentals [Internet]. 2nd edition. Eau Claire (WI): Chippewa Valley Technical College; 2024. PART IV, NURSING PROCESS. Available from: https://www.ncbi.nlm.nih.gov/books/NBK610818/
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