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Old 08-01-2007, 09:26 AM   #1
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Default What is a BSE?

Okay, so I resorted to a bit of thread-title trickery to get you to open the post. It's an important topic, and I want people to read this. If trickery gets that done, I'm okay with it. This post is long and involved. I don't expect everyone to read it through, but I hope you try to take it in bits and pieces. Print it out. Show it to friends and family.

A number of years ago, I was sitting on the bed getting ready to go to sleep. I don't remember what caused me to find the lump in my right breast since I never did monthly self-exams. Always meant to... just never got around to it. But there it was. A lump. In my breast. Frantically, I felt around to see if it was possibly just... god, what could it be?? Is there one in the other breast too? (like that would make it *not* a lump). No, it's just there. And it's BIG. About the size of a quarter. SHIT. That's huge. Wait, this is craziness. It must just be the position I'm sitting in. I'll lie down and check. Damn. Still there. What the hell do I do now? It's... so big. That's bad!! That must be bad, right? It's nighttime... I can't call my doctor. Should I go to a hospital.. that seems silly. It doesn't hurt, maybe that means it's okay? My doctor said I have cysts - but never there. Can they move? Maybe they can. But... that doesn't feel like the others do. Oh, christ. I'm in big trouble. I never thought this would happen to me. It's cancer. That's it, I have cancer. Wait, my friend Lora has lumps, and none of hers were cancer, right? CANCER. God, that word. Fuck! I can't have cancer!

BSE = Breast Self Exam. Why are they important?
"There is a 1 in 10 chance that a woman will have breast cancer during her lifetime. Over 1,000,000 women find lumps in their breasts every year some of which are cancerous but most are benign. A simple Breast Self-Examination (BSE) can be the key to finding any abnormality early."
What are your risks for breast cancer?

Primary risk factors:
  • Age: It is rare for women younger than 35 to have breast cancer. The risk increases with age. Most breast cancers occur in women older than 50 years.
  • Family history: If your mother, sister, or daughter has developed breast cancer before menopause, you are three times more likely to develop the disease.
  • Personal history: If you've had breast cancer, you have an increased risk of getting it again. Also, if you've had benign breast disease (e.g., fibrocystic breast disease), you are at an increased risk. Women with a family history of two first-degree relatives (mother or sisters) should seek consultation with a geneticist to see if they may possess an inherited gene that would significantly increase their risk of cancer. Family history of a second-degree relative (grandmother or aunt) increases risk by approximately 10%.
  • Lifestyle: There is a lower incidence of breast cancer among women who exercise regularly and a higher proportion of breast cancer among obese women. There is also evidence that there is increased risk of breast cancer with increased alcohol use (i.e., 3 or more drinks per week).
Factors placing you at greater risk:
  • If you began menstruating early (before age 12)
  • If you take birth control pills (though evidence is not conclusive)
  • If you never have children
  • If you have children when you are 30 or older
  • If you have menopause at 55 or older
  • If you take Hormone Replacement Therapy (HRT)
  • Obesity
  • History of benign breast conditions

What are the most common symptoms of breast cancer?
  • Painless breast mass - 66%
  • Painful breast mass - 11%
  • Nipple discharge - 9%

Okay. So the risks are daunting. If you're like me, you try to ignore most of the health horror stories we hear about being fat women. I listen, hear the multitude of things I'm going to die from, then I put it away. La, la la. Me? I'm fine!

But, sometimes we're not fine. I wasn't fine when I found the quarter sized lump in my breast. Had I done BSEs regularly, I would have found it earlier.

How to do BSE?
There are two basic steps to conducting a BSE:
  1. Visual Examination
  2. Tactile Examination

Visual Examination
During the first part of the BSE, the visual examination, you look for changes in each breast. What is important in visual BSE is not the normal difference between your two breasts, but any change in one breast without a similar change in the other. The changes you have to look for include:
  • Shape
  • Size
  • Contour or symmetry (is there a difference in the level between your nipples? Do both breasts look symmetrical?)
  • Skin discoloration or dimpling
  • Bumps/lumps NOTE: normal lumpiness, like in the week before and of your menstrual cycle, will appear as very small and separate lumps like the texture of an orange.
  • Sores or scaly skin
  • Discharge or puckering of the nipple
  • Dimple
  • Ulceration

Stand in front of a mirror and look for the above changes in your breasts (from both a frontal and profile view) in 5 different positions:
  1. With your arms raised
  2. With your arms down at your sides
    (she looks happy, huh? Perhaps the Cruella deVille hairdo causes her sour expression)
  3. Bending forward
  4. with your hands on your hips and shoulders turned in
  5. with your arms relaxed hanging in front of you
Tactile Examination
This is the part of the examination when you need to feel your breasts for any changes. It is important to check the surrounding areas because breast cancer may be found in the lymph node tissue around the breast and underarm. Begin by lying in bed. Place a small pillow or folded towel under your left shoulder and your left hand behind your head. Your shoulder should be raised high enough for your left breast to be center on top of your chest, falling neither to the center nor toward the armpit; this arrangement distributes the breast tissue as evenly as possible across the chest wall. If a breast is not properly flattened against the chest, it is difficult to feel a lump particularly in the outer upper quadrant, where tissue is thickest (and where most cancers occur).Feel your breasts and surrounding areas, which include:
  • the breast
  • between the breast and underarm
  • the underarm
  • the area above the breast up to the collarbone and across to your shoulder
Use the pads of your three middle fingers on your right hand pressed together flat to check your left breast, and do the opposite for the right breast. You should press on your breast with varying degrees of pressure:
  1. light (move the skin without moving the tissue underneath)
  2. medium (midway into the tissue)
  3. hard (down to the ribs "on the verge of pain") When using any of the 3 patterns, you should always be using a circular rubbing motion without lifting your fingers.

Patterns of breast examination
Spiral: Begin with a large circle around the perimeter of your breast and make smaller and smaller circles as you work your way toward the nipple.

Wedges: Pretend your breast is divided into sections like triangular pieces of a cake, begin in the nipple area and feel your breast in a small circular motion within one section, then move on to the next wedge starting in the nipple area again.

Vertical or linear: Pretend your breast is divided into vertical stripes. Begin on the underarm area on one side and feel your breast in a small circular motion up and down in a zig zag pattern till the whole breast is covered. Then repeat the process for the right breast with your left hand.


What to feel for?
Carefully notice the "feel" of your normal breast structure, so that you can note at once any changes from what is usual for you. Many women have a normal thickening or ridge of firm tissue under the lower curve of the breast, at its attachment to the chest wall; also the large milk ducts can be felt as a ring of bumps at the outer edge of the areola. In very slender women, the bony prominences of the chest wall may be mistaken for chest tumours, as may enlarged milk glands, fat tumours, lymph nodes, or benign cysts. All such thickenings should be felt carefully during each monthly BSE, in order to distinguish normal conditions from potentially dangerous changes. Any lump or other change found in one breast only (especially in the upper outer quadrant) is more likely to be serious. If in doubt about ANY development, consult your doctor.

In the shower
Many lumps are more easily felt when the breast and fingers are wet and slippery with soap lather, which reduces the friction. If your breasts are small, place one hand on your head and examine the breast on the side with your opposite had in an up-and-down pattern, as you do lying in bed. If your breasts are large or pendulous, you will be better able to feel them if you immobilize a breast with one hand (first supporting from below, then pressing down from above) and examine it with the other hand (first from above, and then from below).
If you find that you exhibit any of the characteristics as described above, do not delay. Go see your physician immediately for a clinical breast examination and other tests for a definite diagnosis.

Examining the fat breast
We're lumpy and bumpy, and often blessed with extra-large breasts. Standing in the shower isn't always comfortable for a very large person... so how to do an adequate exam? Here's what I recommend:

Take a large Ziploc freezer bag (they're thicker and sturdier), and put 1 tablespoon of oil inside the bag. Any oil will do. Remove as much air as possible while keeping the oil inside the bag (if it leaks out, start over), and SEAL THE BAG WELL. This step cannot be more important, lol. Also: If not Ziploc, use a good quality freezer bag.

Place the bag on your breast, and perform the 'shower' exam as described. The oil-filled ziploc will give you the frictionless touch that you need to feel breast tissue.





If you've read this far, you are to be commended!

As for the rest of my story, I went to my gynecologist who immediately sent me for a mammogram. Several of them. There was a large lump. The technician asked me if I had been hit by a baseball, or was something hard thrown at my chest? Hmm. I was sent to a surgeon. The surgeon examined me and said that the lump would have to come out and be tested. He said there was a 20% chance it was cancer... I don't know how he figured the odds.

After more mammograms where a wire was inserted in my breast (gross, and funny looking - but not painful... turns out there aren't many pain receptors in breast tissue) I had the lumpectomy under local anesthetic. The only thing that bothered me was the blood running down my armpit, and the smell of burning flesh as they cauterized the wound.

A few days later, the pathology report was in on my breast tissue. It was necrotic. That means it was "dead" tissue that had no blood supply. How the hell does dead tissue get in my breast? I thought back to the technician asking if I was hit. I wasn't hit, but years earlier, I did have a huge and horrible bruise across my chest when an ill-fitting seatbelt protected me during a violent car crash. That injury to my breast was so deep, the tissue had died.

I now have a 3 inch scar, but it's faded almost completely away. Since my story ended relatively well, I'm kind of glad to have that scar.

Take care of yourselves.



P.S. - Undoubtedly, there's more information out there on this topic. I gathered what I felt was good information, but I welcome additions, corrections, stories, comments.... whatever any of you wish to share. I only ask that we consider the importance of this topic, and give it the proper respect.




Sources:
So You Wanna
McKinley Health Center
DrNDTV
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Old 08-01-2007, 11:12 AM   #2
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Thank you for posting this, Sammie! BSE is one of the best things women (and men!) can do to safeguard their health. We're the best sleuths when it comes to finding lumps and we do it with no radiation. We may not be able to see our cervix to catch early cervical cancer -- we have to rely on medicos to do that. But we, more than anyone else, can catch early breast changes.

Get to know your breasts, folks. That way you'll know how they respond to hormonal changes, what's normal for you, etc. It may save your life someday!
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Old 08-01-2007, 11:16 AM   #3
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Originally Posted by Miss Vickie View Post
(and men!)
So important to include this! Thanks, Vick - many don't realize or believe that men DO get breast cancer too.
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Old 08-01-2007, 08:31 PM   #4
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This is very good information to have here. Thanks for posting all of this, Samantha.

What I learned last year is that there's a type of breast cancer called Inflammatory Breast Cancer (IBC) which doesn't necessarily manifest itself as a lump within the breast. It can be diffuse throughout the breast with no discernible mass. IBC is an advanced and accelerated form of breast cancer usually not detected by mammograms or ultrasounds.

http://www.ibcresearch.org/

Link to story with movie clips

YOU DON'T HAVE TO HAVE A LUMP TO HAVE BREAST CANCER

Some symptoms of IBC are:

- Rapid, unusual increase in breast size (such as a cup size in a few days)

- Redness, rash, blotchiness on breast

- What appears to be a bruise that won't go away

- Change in color/texture of the areola

- Nipple discharge

- Persistent itching of breast or nipple

- Lump or thickening of breast tissue

- Stabbing pain and/or soreness of breast

- Feverish breast

- Swelling of lymph nodes under the arm or above the collarbone

- Dimpling or ridging of the breast

- Flattening or retracting of nipple
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Old 08-02-2007, 06:40 AM   #5
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Great info, Frankie! I've seen reports on IBC lately, so I'm glad that's now included on this thread.
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Old 08-02-2007, 07:06 AM   #6
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I'm hoping this thread will become a resource for breast health, and anyone that might be facing a health challenge. In that light, I think this article is particularly useful:

MRIs Spot Breast Cancers in High-Risk Women
But the technology won't replace mammography, experts stress


TUESDAY, July 31 (HealthDay News) -- MRIs caught more breast cancers in women at high risk for the disease than either mammography or ultrasound, according to a new study that compared the three screening methods. "This particular study supports what prior studies have shown and what the American Cancer Society recommends: that women at high risk benefit from adding MRI to mammography to screen for breast cancer," said lead researcher Dr. Constance D. Lehman, professor of radiology at the University of Washington Medical Center in Seattle. The study "also shows that ultrasound does not have added benefit compared to MRI," added Lehman. MRIs found all six of the breast cancers detected, while mammography spotted only two, and ultrasound found just one, among the study's sample of 171 women at high risk but without symptoms of breast cancer. A larger, earlier study of women already diagnosed with breast cancer found that MRIs also detected more cancers in the opposite breast than mammography did.

In March, the American Cancer Society published new guidelines recommending both mammography and MRI screening for women at high risk for breast cancer.

The current study, published in the August issue of Radiology, does not break new ground but does add evidence on the advantages of adding MRIs to the screening process, as well as the disadvantages of adding ultrasound, according to Dr. Daniel C. Sullivan, associate director of Duke University's Comprehensive Cancer Center in Durham, N.C. "There has been conflicting data from other small studies about ultrasound. Some found it is effective, and some have not. This [study adds] a little more information that it is not," said Sullivan, an expert on biomedical imaging. To be more conclusive, scientists are awaiting a larger study on ultrasound that is currently under way, he said. Based on earlier studies and supported by the current study, the "data are pretty clear" about the usefulness of adding MRI to mammography screening for premenopausal women at high risk for breast cancer, Sullivan added. Only about 1 percent to 2 percent of all women fall into the high risk category, noted Debbie Saslow, director of breast and gynecologic cancer for the American Cancer Society. The current study included 171 women averaging about 46 years of age. About 46 percent of the women were premenopausal. The researchers defined high risk in women 25 and older as a woman who carries one of the breast cancer genes BRCA1 or BRCA2 or a 20 percent probability of carrying a mutation, or a strong family history of breast and ovarian cancer. Further research is needed to determine whether MRI should be added to screenings for older women or a broader group of women, Sullivan said. So far, using MRIs along with mammography can be justified only with high risk women because of the higher cost of MRIs, the risk involved in injecting contrast material needed to display very small lesions, and the biopsies required to rule out false-positives, he added. In the current study, the MRIs did detect eight false-positives. (5% - disturbingly high, imo) For technological reasons, MRIs are often able to detect cancers that mammography misses, Sullivan explained. However, MRIs should not be seen as a replacement for mammograms, he added. In a previous study, mammography detected a few cases that were actually missed by MRI, the expert said.

The development of a viable replacement for mammography is still some years off, according to both Saslow and Sullivan. Saslow said some work is being done with blood and saliva tests, but no conclusions about their usefulness are expected soon. Optical imaging -- which uses lasers -- and a type of mammography that doesn't use breast compression also are being explored, Sullivan added. "Those are still quite a few years away before they could really replace mammography," he said. For women who find mammography uncomfortable, "the bad news is that for the foreseeable future, about five to 10 years, there is no likely replacement for mammography," according to Sullivan.

As someone who is obese and has had a previous lump - I'm considered to be at high risk, so I'll be talking to my doctor about an MRI this year.
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Old 08-02-2007, 09:24 AM   #7
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Whew! I thought you were about to warn us of an outbreak of Bovine Spongiform Encephalitis ("Mad Cow Disease") -- and what with the pet food recalls and botulism incidents lately, it wouldn't have surprised me.
Valuable public service announcement, here. Thanks!
-Rusty
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Old 08-03-2007, 01:38 AM   #8
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Some extra notes:

There are some concerns that women who get more mammograms have a greater risk of the cancer--mainly due to the exposure to X-rays, the form of radiation which has been shown to greatly increase the chance of cancer. If you're high-risk (you have a genetic predisposition towards it) then you REALLY SHOULD NOT GET A MAMMOGRAM and opt instead for a MRI.
http://www.newstarget.com/010886.html

However newer mammogram techniques use lower radiation frequencies so there's less likelihood of a problem (possibly. We're still waitin' fer the data on that one). That said, most breast cancers are found through BSE, not by mammograms.

If you're under 55, being obese actually makes you a lower risk for breast cancer. If you're 55 and obese and taking hormone tablets etc for menopause, then you have the same risk for breast cancer as normal weight women. The reason it seems like most people with breast cancer are fat is because most cases occur after 55, and most women don't use the hormone tablets.
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Old 08-06-2007, 10:59 PM   #9
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Quote:
Originally Posted by CleverBomb View Post
Whew! I thought you were about to warn us of an outbreak of Bovine Spongiform Encephalitis ("Mad Cow Disease") -- and what with the pet food recalls and botulism incidents lately, it wouldn't have surprised me.
Valuable public service announcement, here. Thanks!
-Rusty
That's the first thing I thought also!!! That's what a degree in Agriculture will do to you.
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Old 08-07-2007, 06:55 AM   #10
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Samantha, thank you for posting this. It's extremely important and cannot be stressed enough, IMO.

My mother recently had a lumpectomy and is undergoing radiation therapy. She is a larger woman with very dense breasts, and she did not detect any changes in her breasts. A routine mammogram caught a very small lump, very deep within her tissue. Had she waited until she could feel a lump, it probably would have been too late. Certainly, she would have been dealing with much more than a lumpectomy & radiation treatments.

We are fortunate in that her margins were clear, and there was no evidence of spread to her lymph nodes.

This is why I was so touched that you took the time & made the effort to post this information.
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Old 08-07-2007, 11:18 PM   #11
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I went in for my annual today (actually a little late, I usually get these things around my birthday in Feb) and my PCP found a lump in my left breast.
She said to me, "Do you realize you have a lump in your left breast?" I told her yes, I had discovered it the beginning of this year, but it seemed to come and go.

She has set me up for a mammogram on the 11th of September. She assured me that it was probably nothing to concern myself with, but the mammogram was a precautionary test. (better safe than sorry)

I'm a little concerned, but am not showing it terribly much, because I don't want to freak DH out.

I'm thinking it's just those fatty cyst one gets around cycle time. It's that time of the month for me, so I'm sure this could be what it is. The doc agreed this could indeed be a cycle cyst.

I'm rambling here...I think my point is BSE is important, do not to let anything suspicious go by without being checked out. I'm glad my PCP reminded me of that.

Great post Sammie!
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Old 08-07-2007, 11:19 PM   #12
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Sending positive healing vibes to your mom Traci!




Quote:
Originally Posted by TraciJo67 View Post
Samantha, thank you for posting this. It's extremely important and cannot be stressed enough, IMO.

My mother recently had a lumpectomy and is undergoing radiation therapy. She is a larger woman with very dense breasts, and she did not detect any changes in her breasts. A routine mammogram caught a very small lump, very deep within her tissue. Had she waited until she could feel a lump, it probably would have been too late. Certainly, she would have been dealing with much more than a lumpectomy & radiation treatments.

We are fortunate in that her margins were clear, and there was no evidence of spread to her lymph nodes.

This is why I was so touched that you took the time & made the effort to post this information.
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Old 10-04-2007, 05:59 AM   #13
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Old 10-07-2008, 03:34 PM   #14
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This being October, and all....

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Originally Posted by SamanthaNY View Post
Examining the fat breast
We're lumpy and bumpy, and often blessed with extra-large breasts. Standing in the shower isn't always comfortable for a very large person... so how to do an adequate exam? Here's what I recommend:

Take a large Ziploc freezer bag (they're thicker and sturdier), and put 1 tablespoon of oil inside the bag. Any oil will do. Remove as much air as possible while keeping the oil inside the bag (if it leaks out, start over), and SEAL THE BAG WELL. This step cannot be more important, lol. Also: If not Ziploc, use a good quality freezer bag.

Place the bag on your breast, and perform the 'shower' exam as described. The oil-filled ziploc will give you the frictionless touch that you need to feel breast tissue.
Good news and bad news prompt the resurrection of this post.

The good news is that there are now products on the market which offer a frictionless 'bag' (such as I described last year) to aid women in breast self exams.

Olivia Newton John is promoting the Liv Self Breast Exam kit:

" The Liv Aid is a revolutionary breast self-exam aid that enhances your ability to feel changes easily. It's for every woman. Designed to help you do a convenient breast self-exam

Recommended across the medical community, the Liv Aid is made of soft, latex-free polyurethane and filled with a non-toxic lubricant. It allows breast tissue to stay in place during an exam and lets your fingers glide smoothly across your breast. By reducing friction between fingers and skin, it makes for greatly increased sensitivity.

This remarkable touch-enhancing tool is like a magnifying glass for your fingers! The Liv Aid Kit is easy to use, conveniently reusable, and latex free. It is FDA registered as a breast self exam device and recommeneded by doctors, nurses, and breast centers nationwide."

And, there's something called Aware:

"The Aware breast self exam kit is designed to educate and raise awareness on breast health. The Aware breast self-exam kit contains the Aware reusable breast self-examination pad, step-by-step directions, & an instructional video. The Aware-BSE pad reduces friction to allow your fingers to glide more smoothly across your breast and enhance your sense of touch, while providing an easier and more comfortable exam. The Aware BSE Aid was designed to help women perform their monthly breast self-examination with more confidence to help detect changes in their breasts. "

And now the bad news: TRY TO FRIGGIN' FIND A RESOURCE TO BUY THESE!! There aren't a lot of resources, but I did find an Amazon listing - not sure I trust it since there outside link went nowhere.

Anyway - at least you know about them now.

P.S. - just found another one called Sensa Touch. Same type of thing.

Last edited by SamanthaNY; 10-07-2008 at 03:47 PM.
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Old 10-07-2008, 03:56 PM   #15
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I, too, was terrified this would be about the latest mad cow scare...but thankfully the info you've provided is much more beneficial.
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Old 10-07-2008, 05:54 PM   #16
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Thanks for bumping this thread, Sam. It's a very timely topic and reminds me that I'm due for my mammo sometime in the next couple of months.
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Old 10-07-2008, 07:16 PM   #17
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I am really bad because I rarely check my breasts. I have never been sure that I have done it correctly either.

This reminds me that I also need to have a pap smear.

Thanks.
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Old 10-07-2008, 08:06 PM   #18
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It might sound strange, but I have kind of a phobia about checking my breasts. The tissue is not dense so every gland and bump stands out when I press in and feel around. It sort of freaks me out. My boobs have always felt kind of lumpy to me and I don't know what's a normal lump and what's not. So it scares me out of checking them.

Oh -- Before you start calling me ol' lumpy boobs, they look and feel perfectly normal until you really massage them deeply, of course.
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Old 10-07-2008, 09:09 PM   #19
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Thanks for bumping up the thread! I have to schedule my mam this month as it is my birthday soon and I always do this as a present to myself!
Thanks again, Kara
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Old 10-07-2008, 09:29 PM   #20
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My breast tissue might be similar to yours, lala. I didn't check for a long time simply because I didn't know what was normal/me and what was something to worry about. After a gyn visit confirming my breasts felt normal, I spent time touching them to get a better feel for the "landscape" of them while laying down and sitting up with my arm up. Just check regularly, jot a few notes down in a journal if you need to, then compare next time you check.
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Old 10-08-2008, 04:21 AM   #21
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Quote:
Originally Posted by LalaCity View Post
It might sound strange, but I have kind of a phobia about checking my breasts. The tissue is not dense so every gland and bump stands out when I press in and feel around. It sort of freaks me out. My boobs have always felt kind of lumpy to me and I don't know what's a normal lump and what's not. So it scares me out of checking them.

Oh -- Before you start calling me ol' lumpy boobs, they look and feel perfectly normal until you really massage them deeply, of course.
Quote:
Originally Posted by ThatFatGirl View Post
My breast tissue might be similar to yours, lala. I didn't check for a long time simply because I didn't know what was normal/me and what was something to worry about. After a gyn visit confirming my breasts felt normal, I spent time touching them to get a better feel for the "landscape" of them while laying down and sitting up with my arm up. Just check regularly, jot a few notes down in a journal if you need to, then compare next time you check.
Don't feel bad, Lala - I hear that a lot, and think it's a safe guess that almost all fat women have sorta lumpy breasts. By far the important thing is just to check them, so you get some sort of baseline idea of what they're like (or even better after a doc's exam like TFG mentioned). At first you might be like "wait, what's that... oh, what's that?" - but that's okay. You will know very quickly when something isn't supposed to be there. Here is some info about what breast lumps can feel like - they're different from breast tissue, so I'm quite sure that if there's something there of any size, you'll feel the difference. It won't be like the normal bumpies in your breasts, it (generally) will feel more like a foreign object. And if you have any questions at all, don't hesitate to check with your doctor. NO doctor will look at you sideways or hesitate a second if you suspect a breast lump. In fact, many doctors will teach you how to do a self breast exam right there in their office, so you can ask questions about what you're feeling.

The important thing is just to check. Even if you're winging it... just cop a feel!
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Old 10-08-2008, 06:18 AM   #22
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Thanks Samantha for doing this post, like many others im not one for doing this very often but will do it regular now.
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