During a breast exam, you’re looking for anything that’s new or different from your normal baseline: changes in skin texture, nipple appearance, lumps that weren’t there before, or swelling in the underarm area. The goal isn’t to diagnose anything yourself. It’s to know what’s normal for you so you notice when something changes. The American Cancer Society recommends that women be familiar with how their breasts normally look and feel and report any changes to a health care provider right away.
Visual Changes to Watch For
Start by looking at your breasts in a mirror with your arms at your sides, then raised overhead, then pressed against your hips (which contracts the chest muscles and makes subtle changes more visible). You’re scanning for asymmetry, skin changes, or anything that looks different from last time.
Dimpling is one of the most important visual signs. It looks like small indentations in the skin, sometimes resembling the surface of an orange peel. This texture change can be caused by a tumor pulling on the tissue beneath the skin. Dimpling has several possible causes, some benign: fat tissue that has died after surgery or injury, fibrocystic breast changes, or mastitis in women who are breastfeeding. But it’s also a symptom of invasive ductal carcinoma, lobular breast cancer, and inflammatory breast cancer, so any new dimpling should be evaluated.
Skin discoloration matters too. Patches of redness, pink, or purple on the breast, especially if warm to the touch or accompanied by swelling, can signal inflammatory breast cancer. This is a rare but aggressive form that often doesn’t produce a distinct lump, making visual signs particularly important. Scaly or flaking skin on or around the nipple is another change worth reporting.
Nipple Changes That Matter
A nipple that has recently turned inward is different from one that’s been inverted since puberty. Congenital nipple inversion is common and typically harmless. Acquired inversion, where a previously protruding nipple starts pulling inward, is more concerning because a growing mass behind the nipple can pull it backward. New inversion accompanied by discharge, erosion, or a lump beneath the areola warrants prompt evaluation.
Nipple discharge outside of breastfeeding deserves attention, especially if it happens spontaneously (without squeezing) and comes from only one breast. The color matters. Discharge that is brown, bloody, pink, or watery carries a higher association with breast cancer than milky, green, or yellow discharge. Clear or watery discharge also appears on the higher-risk end of the spectrum. That said, most nipple discharge turns out to be benign, but the combination of spontaneous, single-sided, and red or brown fluid is the pattern that needs investigation.
What a Concerning Lump Feels Like
Most breast tissue is naturally lumpy, and what you’re feeling for is something that stands out from everything around it. A lump associated with breast cancer tends to be hard, painless, and have irregular edges. It often feels fixed in place rather than sliding easily under your fingers. A new lump that feels firm or doesn’t move when you push on it is the kind that needs medical attention.
Not all concerning lumps fit that description exactly. Some feel round, smooth, and firm. Some move freely under the skin but are still worth checking. The key distinction isn’t one specific texture but whether the lump is new, persistent (doesn’t come and go with your menstrual cycle), or feels distinctly different from the surrounding tissue. Benign lumps from fibrocystic changes tend to fluctuate with your cycle, feeling more prominent and tender before your period and then settling down afterward. A lump that stays the same size regardless of where you are in your cycle is more likely to need further workup.
Don’t Skip the Underarm Area
Breast tissue extends into the armpit, and the lymph nodes there are often the first place breast cancer spreads. When examining yourself, use the pads of your second, third, and fourth fingers to feel into the hollow of each armpit. You’re checking for firm, swollen, or tender nodes that feel like small marbles or peas beneath the skin. Also run your fingers along the area just above and below your collarbone, where additional lymph nodes sit. A swollen node doesn’t automatically mean cancer (infections and immune responses cause swelling too), but a persistently enlarged, hard, or painless node in the armpit is significant.
How to Do a Thorough Exam
There are three common patterns for covering all the breast tissue. The vertical strip method moves your fingers up and down in parallel lines across the breast, like mowing a lawn. The concentric circle method starts at the nipple and spirals outward in widening rings. The spoke method moves from the nipple outward in lines like wheel spokes. Any of these works as long as you cover the entire breast from collarbone to the bottom of the bra line and from the breastbone to the armpit.
Use the flat pads of your three middle fingers, not the tips. Apply three levels of pressure at each spot: light pressure to feel tissue just under the skin, medium pressure for the middle layers, and firm pressure to feel tissue close to the chest wall and ribs. Doing part of your exam lying down (with a pillow under the shoulder of the side you’re examining) spreads the tissue thinner and makes deeper lumps easier to detect. Standing in the shower works well too, since wet skin lets your fingers glide more smoothly.
When to Examine and What’s Normal
If you menstruate, the best time to check is 7 to 10 days after your period starts. Hormone levels are at their lowest point then, so breasts are the least tender and swollen, making it easier to feel actual changes rather than normal cyclical lumpiness. If you no longer have a period, pick the same day each month to create a consistent habit.
It’s worth knowing that breasts are rarely symmetrical, and many women have naturally lumpy or dense tissue. The tissue may feel grainy, ropy, or nodular, and that’s often just the normal architecture of glands, ducts, and fat. Monthly estrogen and progesterone fluctuations cause the tissue to swell and become tender in the days before a period, then return to baseline afterward. What you’re building over time is a mental map of your own normal so that a real change stands out.
What Happens If You Find Something
Finding a lump or change doesn’t mean you have cancer. Most breast lumps are benign. But any new, persistent, or unusual finding should be evaluated through what clinicians call a triple assessment: a physical exam, breast imaging, and sometimes a biopsy.
For women under 35, ultrasound is typically the first imaging step because younger breast tissue is denser and harder to read on a mammogram. After 35, a mammogram is usually the primary tool, often supplemented by ultrasound. If imaging shows something suspicious, the standard next step is a core needle biopsy, where a small sample of tissue is taken for analysis. A normal mammogram alone isn’t enough to rule out a problem if you can feel a lump, so expect your provider to complete all three steps of the assessment before offering reassurance. For solid lumps that aren’t removed, follow-up imaging every six months for at least two years is standard to confirm the finding stays stable.