BREAST SELF-EXAMINATION TECHNIQUE

BREAST SELF-EXAMINATION TECHNIQUE

Breast self-examination is a simple and useful tool to help screen for breast diseases (such as cancer) in addition to a regular physical examination by your doctor with a mammogram and/or ultrasound. This is because approximately 1 in 19 women may get breast cancer.

Summary

  • Self-examination is recommended on a monthly basis once the breast is developed at adulthood
  • Choose same date and same time (ideally a few days after your period has ended so that the breast is not swollen or tender to touch)
  • Get to know the feel of your breast so that you can recognise any changes early
  • A mammogram is recommended every 2 years from the age of 50 years to 74 years but may be indicated earlier at 40 if you have risk factors such as a family history or BRCA gene positive

Click below to learn on “How to examine your breast by yourself”

Steps

Step 1: Stand in front of a mirror with your shoulders straight and arms at your side. Make sure the breast size and shape are similar. Look for any unusual superficial skin changes like dimple, pucker, skin thickening, redness or scaly rash. Make sure the nipple has no pain, redness, scales, itching, thickening, nipple inversion or discharge. Raise your arms and look for similar changes.

Step 2: While lying down or sitting comfortably, use your right hand to feel your left breast and vice versa. Use from a smooth touch with the first 3 fingers of your hand in a circular manner to feel for abnormal changes. Look for lumps (especially new or hard irregular ones) in breast and armpits.

Step 3: Visit your doctor for a yearly breast examination, a mammogram and/or ultrasound every 2 years.

Reference: breastcancer.org

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BREAST MAMMOGRAM: WHAT TO EXPECT

BREAST MAMMOGRAM: WHAT TO EXPECT

A mammogram uses a low-dose X-ray to see inside the breasts to help doctors detect and diagnose breast diseases. It is recommended that mammogram should be performed every 2 years on women from the age of 50 to 74 years or earlier and more frequently if you have high risk factors for developing breast cancer like family history or BRCA gene positive. You should also see a doctor and have a mammogram if you detect an unusual lump in your breast during your routine monthly breast self-examination (also read Breast Self-Examination”).

Click below to watch a video on “What to expect during a mammogram”

How to prepare for a mammogram

  • The best time for a mammogram is one week after your period. This is because your breast may be tender just before your period
  • Inform the doctor or technician if there is any possibility that you are pregnant
  • Do NOT wear deodorant, talcum powder or lotion under your arms or on your breasts on the day of the mammogram because it may appear as white spots on the X-ray
  • Wear a separate top from your skirt or trousers to make it easy to do the mammogram

Reference: drugs.com, cdc.gov

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NURSING BRAS FOR PREGNANT AND NURSING MOTHERS

NURSING BRAS FOR PREGNANT AND NURSING MOTHERS

Click below to watch a video on nursing bra

Most normal bras do not allow changes in breast cup size during pregnancy. Normal bras have underwire which is NOT recommended for milk engorged breasts because they can cause uneven pressure on the breast and predispose you to blocked milk ducts or mastitis.  If you do insist on wearing bras with underwire, it is important they fit well.

Nursing bras should have softer and larger cups with wider straps to support the breasts comfortably. They should have breathable fabric such as cotton to prevent excessive sweating which can cause fungal infection. The fabric should be soft with concealed seams to prevent chafing or causing irritation. It should also be stretchy to adjust with the change in breast size as you breast feed throughout the day. Some nursing bras have adjustable hooks to allow for changes in breast size.

Why do I need a nursing bra?

  • They are designed to be stretchy to allow the bra to accommodate the changing size of a nursing breast
  • They have flaps to allow you to be able to unfasten easily with one hand. Most of the time, you will be holding the baby with the other hand
  • They are designed to have breast pads or be able to hold removable breast pads
  • They are made with breathable fabric to reduce sweating
  • They are either seamless or have concealed seams to prevent cutting into your breast

Image Source: Alleghany Trees

Can I sleep in a maternity bra?

Good sleep nursing bras should be seamless with double layered cups so you can wear it with nursing pads while you sleep to prevent leakages.

How to buy my nursing bra?

During the later part of your pregnancy, buy 1 numerical size and 1 cup size larger than what you wearing. This allows for the sudden breast enlargement when milk is produced after the birth of your baby. Once your breast size settles down around 1-2 weeks postpartum, you can buy more nursing bras.

Refer to this conversion chart based on your pre-pregnant bra size.

How to measure a nursing bra

Size Chart
Purchase a nursing bra by Lunavie
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GENERAL BREAST CARE DURING BREASTFEEDING PERIOD

GENERAL BREAST CARE DURING BREASTFEEDING PERIOD

Your breast will change during pregnancy and during the postpartum period. Hormones released by your body during pregnancy will make your breasts grow and produce breast milk.  After the birth of your child, your breasts will start to fill up with breast milk in anticipation of feeding your hungry baby. You breast will be larger and feel tender due to milk engorgement which may leak through the nipples.

It is important to take good care of your breasts to prevent problems during breastfeeding. Here are some tips for breast care during breast feeding period.

1) Practice good hygiene by washing your breast and nipples with warm water while having your bath or shower. Do not use too much soap as it may dry your nipples causing them to crack.

 

Image Source: Smart Parents

2) Wear a supportive nursing bra which is not too tight and preferably made of cotton so that it does not sweat too much. Use breast pads to prevent milk leakage wetting the bra. This prevents fungus (thrush) growth and also makes it comfortable for you.

Purchase a nursing bra by Lunavie

3) Get your baby to latch correctly from the first breastfeed and breastfeed regularly (at least every 2 to 3 hours) to prevent the development of painful breast engorgement, plugged milk ducts and mastitis. If your baby does not want to feed, pump the breast milk to release the milk and encourage the breast to produce a healthy supply of milk.

4) Moisturize your nipples with your breast milk after breastfeeding and then let the nipples air dry naturally.

5) Remove your child from your breast correctly. When you’re ready to take your baby off the breast, do not pull him/her off but instead, place your finger in the corner of her mouth to break the suction between the mouth and your breast.

Latching

Latching is the most important part of successful breast feeding. Always get into a good comfortable position to breastfeed. Use a support pillow and a comfortable chair which you can lean back to relax. Hold your breast (using a C or U hold) and guide the nipple to your baby’s mouth. Aim the nipple to the baby’s upper lip (not middle of the mouth) with the head slightly tilted back. Try to get as much of the lower portion of the areola in the baby’s mouth.

Image Source: Multi-Mam

A good latch will result in breast feeding which is not painful. You will know when you have a good latch when:

  • Tongue is seen when the bottom lip is pulled down
  • There is a circular movement of the jaw rather than rapid chin movement
  • There is no clicking or smacking noises and you only hear swallowing
  • The baby’s chin is touching your breast
  • At the end of the feed, your nipple is not flattened or misshaped
  • There is no pain during feeding

Blocked milk ducts

Blocked milk ducts occur when you are making milk faster than it is used or there is incomplete emptying. Other causes include pressure from an ill-fitting bra, stress, previous breast surgery scar and incomplete latch. The blockage feels hard and tender to touch.

Image Source: Mayo Clinic

Treatment options include:

  • Warm compress and gentle massage towards the nipple to help express the blocked milk
  • Position your baby to suck at the blocked duct area
  • Have more rest to reduce stress and stay hydrated

Sore or cracked nipples

Cracked nipples are common and give rise to pain during breastfeeding. It typically arises 3-7 days postpartum and can increase the risk of nipple infection and mastitis. Cracked nipples can be treated with 100% lanolin or glycerin/hydrogel nipple pads placed over the nipples to help soothe and heal cracked or painful nipples.

Mastitis

Mastitis is breast inflammation (usually due to infection) and is common during the first 6 months of breastfeeding. Failing to empty the breast milk or going for long periods between feeds causes the breast to be engorged with milk. Infection happens when bacteria enters the breast through the nipple and is more common when the mother has a cracked or sore nipple.

The symptoms are redness, tenderness or pain which may be accompanied by fever.

Seek treatment immediately to prevent abscess formation. Mastitis is treated with antibiotics which will not harm the baby and acetaminophen (Tylenol) for the pain and fever. In the meantime, get more rest, drink more fluids and you can place a warm wet pack on your painful breast or massage the breast gently to increase the milk flow.

Feed your baby with your healthy breast. If your nipple of the affected breast is too painful to breastfeed, use a breast pump to empty the breast of milk. This will help the mastitis get better faster.

Guide to breast milk pumping

Image Source: Mother Nature Network

There are many reasons to pump breast milk to store and be fed to the baby at a later time.

  • You have a premature baby in ICU who cannot be breastfed
  • You have to return to work or unable to breastfeed during certain periods
  • Your baby does not want to feed but your breast is engorged with milk
  • Your nipples are too sore to breastfeed
  • You have twins or triplets

Try to pump round 15-20 minutes on each side. It may take a few minutes before the milk starts to emerge so be patient. Divide the milk into the amount your baby will drink each time before freezing. This makes it easier for you to calculate the amount your baby drinks each time. Try to pump frequently and equally on both breasts as this allows the breasts to maintain a steady supply of milk and reduce the risk of blocked milk ducts.

If you have any concerns about your breasts or how to care for them during breast feeding, do contact your gynaecologist or a lactation consultant.

How to increase milk production

Have healthy well balanced diet, keep hydrated and feed (or pump) regularly (around every 2-3 hours) is the secret to maintaining a good milk supply. Foods which encourage milk production are called lactogenic foods. Some of the examples of lactogenic foods are oatmeal, barley, green leafy vegetables, garlic, almonds and etc.

Medications which encourage milk production are Metoclopramide and Motilium which can be used to increase milk production as a last resort.

Download Teleme’s mobile app and consult a health practitioner below

Dr. Aqmar Suraya

Dr. Aqmar Suraya

Obstetrician & Gynaecologist (general OBGYN)

Dr. Azlina Firzah

Dr. Azlina Firzah

Breast Surgeon

Dr. Saladina Jaszle

Dr. Saladina Jaszle

Breast Surgeon

Ms. Lactation Nurse

Ms. Lactation Nurse

Breast Lactation Consultant

EVERYTHING YOU WANTED TO KNOW ABOUT BREAST CANCER BUT AFRAID TO ASK

EVERYTHING YOU WANTED TO KNOW ABOUT BREAST CANCER BUT AFRAID TO ASK

Click below to watch a video on breast cancer

Statistics of breast cancer

In the USA 1 in 8 women will get breast cancer.  In Malaysia, the incidence has been discovered to be 1 in 19 women and accounts for around 30% of all new cancers. Around 5,000 Malaysian women are diagnosed with breast cancer every year, most of them aged between 30 and 60 years, where nearly half of those affected are under 50-years of age. Malaysian patients have poor survival rate due to lack of awareness of the signs and symptoms fear of screening and delay in medical treatment when traditional alternative is preferred.

High risk factors

  • Family history of breast or ovarian cancers
  • BRCA gene positive (more than 50% chance of getting breast cancer)

Lifestyle Risk Factors

  • Smoking
  • Alcohol consumption
  • Overweight (BMI more than 25)
  • Lack of exercise
  • Early menarche or 1st pregnancy at a late age in life.

Breast cancer

Breast cancer either begins in the cells of the lobules (known as the milk-producing glands) or the ducts (known as milk passages) and rarely from fatty and fibrous tissue of the breast.  It can spread via the lymph nodes into other parts of the body. The breast cancer’s stage refers to how far the cancer has spread beyond the original tumour.

 

Symptoms or signs of breast cancer

There may be no symptoms at all.  Usually there is a breast lump, breast pain, skin dimpling, changes at the nipple such as in-turning, discharge, rash or redness.

Breast screening

  • Mammogram is recommended every 2 years for women age 50 to 74 years
  • Should not be denied in women between 40-49 even if they are low or intermediate risk,
    Malaysian Clinical Practice Guidelines (2010)

Treatment of breast cancer

Breast cancer is treated with a combination of surgery, chemotherapy or radiation and the choice depends on the cell type and stage of cancer.  Surgery aims to remove the entire cancer with a some surrounding normal tissue and lymph nodes where necessary.

What are the risks for recurrence?

  • Stage of cancer at the time of diagnosis (more advanced stage has worse prognosis)
  • Grade of cancer (higher grade with more undifferentiated cells have worse prognosis)
  • Cancer cell type (invasive cells have worse prognosis)
  • ER / PR hormone receptor positive (amenable to hormone therapy)
  • HER2 gene positive (worse prognosis)

Follow up schedule after breast cancer treatment

  • After initial surgery/chemotherapy/radiotherapy, you are recommended to see the doctor Every 3 months for the first 2 years
  • After that, every 6 months for 3 years
  • After that, every year for 5 years
  • After that, as advised by the doctor

For more references:
www.moh.gov.my | www.acadmed.org.my | www.cancer.org.my |
http://www.cancerresearch.my/research/breast-cancer/ |
http://www.nationalbreastcancer.org/early-detection-of-breast-cancer 

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