Additions to level 1 are in RED

1. Visual Exam4 positions
Look in a large mirror in a well lighted room.
Light should be placed off to one side.

1st Position


Arms relaxed by your side.
Observe your breasts first directly facing the mirror.

What to look for
General: any change in size, shape or contour.

Skin Changes:  texture, dimpling, retraction, or scaling of the skin.  soreness, rash, swelling, or flattening.

Nipple Changes:
A nipple that has changed position.
An inverted nipple – pushed inward instead of sticking out.
Redness, swelling or other irregularities.

Repeat the visual inspection as you turn slowly from side to side.  Carefully observe all sides of your breasts.

Lift each breast to check the areas underneath.

2nd Position
Raise your arms over your
Raise as high as you can.

Repeat the visual exam above.

3rd Position
Rest your palms on your
Shoulders straight.
Thumbs facing forward.
Press down on your hips firmly.
Roll your shoulders and elbows forward.

Repeat the visual exam.

4th Position
Bend forward from the hips with your arms relaxed.
Breasts should hang straight forward.
Make sure to see the area of the back side of the breast.
Use a mirror.

Again repeat the visual exam.

Very Important
Your visual exam has to include all the positions and maneuvers mentioned.

2. Nipple Check
Squeeze each nipple between your finger and thumb.  Check for any discharge.  This could be milky, yellow, green, dark, clear & sticky or blood.
Note the color and whether the discharge occurs spontaneously or by squeezing.
Report any nipple discharge to your doctor

Push the nipple deep into the hallow beneath it.  Note any unusual resistance, hardness or lump beneath the nipple.

3. Feeling = Palpation

Area to check
Entire breast area.

From armpit to the middle of the chest bone.
From the collar bone to ribs.

Position – Laying Down
Lie flat on your back.
Pillow or folded towel under your right shoulder.
Right arm at a right angle.
Breast should be center on top of your chest.
The breast tissue spreads evenly over the chest wall.
Breast tissue is as thin as possible
It is the best position to feel all the breast tissue.

Right Breast
Use the left hand for the right breast.
Moisten the pads of your three middle fingertips with body lotion.
Do not use fingertips! They are less sensitive.
Long fingernails will impede your examination.
Never compress your breast between thumb and fingers.
This may cause you to feel a “lump” that doesn’t exist.

Feeling patter – strip or vertical or linear
Move your hand in overlapping small (dime-sized) circular motions, in and up and down pattern.

Never remove your hands from your breast during the examination.
You are feeling for something that varies in size greatly.
It could be from a size of a small pea all the way to much larger size.

Starting place
Start in the underarm area and move your fingers downward little by little, until you reach the ribs below the breast.  Then move your fingers slightly toward the middle, and slowly move back up to the neck or collar bone (clavicle).
Go up and down strip by strip until you cover the entire area.
(10-16 vertical strips are recommended).

Very Important

Pay special attention to the area between the breast and the underarm, including the underarm itself.

Make sure you include the area beneath the nipple.

Pressure levels
Go over each area using 3 different levels of pressure to feel all the breast tissue. down to the rib cage.

Light pressure – to feel the tissue closest to the skin.
Soft touch barely move the top layer of the skin.

Medium pressure – feel the middle part of the breast tissue.

Firm pressure – feel the base of the breast tissue closest to the ribs.

Use each pressure level to the feel the breast tissue before moving on to the next spot.

Report any abnormality, lump or thickening found during a breast exam to your physician right away.

Left Breast
Repeat the procedure on your left breast.
Pillow under your left shoulder.
Left hand at the right angle.

Repeat the exam using the finger pads of the right hand.

Congratulations for taking charge of your health.
Remembering to do the exam is the most difficult part of it.
Put a reminder in your phone for next month.