Latest / Rebellious Aging Podcast / Rebellious Aging: Breast Exam
Transcript
- speaker-0: Hi, this is Dr. Robert Peterson with Rebellious Aging Podcast. speaker-1: And I'm Ken. speaker-0: And this is Breast Cancer Awareness Month. So today we're going to be talking about breast self-examination. We're going to be covering a few topics. First of all, a simple way of doing it that only takes a few seconds and will not interfere with your regular life. The second is how to do breast self-exam if you have breast implants. And then the third thing is that we need to emphasize that breast self-exam is a supplement to and not instead of. Regular mammography. speaker-1: So let's get started. Doctor Peterson, what prompted you to develop this technique? speaker-0: that's a great question. So over the course of my career I've had thousands of patients that have come in to talk about breast augmentation. And in the course of discussing this with the women, I discovered that very few women actually perform breast self-examination. And there's a variety of reasons for that, speaker-1: I even can relate to that. I'm guilty of, you know, not wanting to do the self exam just 'cause I'm busy or I just forget to do it. And even my girl cousins, you know, they don't they don't know what to do or how to do it, so they just kinda put it off. Yeah. Yeah. speaker-0: That's been my experience as well. That women are afraid that they don't know how to do it right. Yes. They don't know when they're supposed to do it. Should you do it in the shower? Should you run circles? They don't know what they're looking for. They don't know if they find something, whether it's something they're supposed to find or not supposed to find. and there's also an element, a little bit of fear that they're afraid that they might find something and they kind of don't want to. Yeah. So that's part of it as well. speaker-1: Yeah. Well that's true, yeah. So Doctor P what changed? speaker-0: I realized that the way that we taught women how to do breast self-exam was very different than the way we as physicians do the exam. When we do the exam, we have women lie down, put their arm up, so that the breast is flattened out. So they're comfortable, the shower's not running, and they're dry, it's a much more comfortable environment. The other thing is that I realized that we as physicians, we use our whole hand and we check the whole breast quickly that way. So we will do a breast exam on a patient in just a few seconds. But doing it yourself the way it was taught with going around in circles and in the shower and stuff was too complicated. And I thought, well, if we do it this way with the women lying down with their hand above their head at their head and with the whole hand, why shouldn't we teach the patients to do it the same way and then they can do it quickly just like we do. and I and I thought, okay, well let's start doing that. speaker-1: Exactly. Yeah. And that's so much easier. I don't even think about it and I just put it off this way it's so much easier. You can do it right before you go to sleep or you can just like w when you wake up, yeah, to go get your day started. So much easier. speaker-0: That's exactly right. And after you've done it for a while, you can do this and you can feel and you can be thinking about breakfast or something that somebody said at work. And you don't even have to think about what you're doing. Your fingers will let you know if there's a lump. And and it just takes a few seconds. speaker-1: That's correct. Totally agree. Can you show us? speaker-0: Sure. So here we have these model implants that are the shape of a breast and kind of seem like a breast. So we teach the women to do exactly what we do as physicians. We use the whole hand, we press against the breast, and we rub back and forth. Now if you do that, if there's a lump inside, then it'll rub against the ribs and you'll feel it moving against the ribs. And so even if you just pressed and you didn't necessarily feel it. With movement you'll feel it bumping over the ribs. Then you can do one whole hand, you move up, you do the whole another whole hand, and you move up and then finally do the other whole hand. And as you can see, this only takes a few seconds. I always ask women after they do it, and we demonstrate this to them, I say, Okay, now, did you miss any place? Is there any place in the breast that you didn't palpate? And they'll say, No, or they'll say, maybe there's a spot up here I didn't get but I'll say, can you say with a high degree of confidence that you've just checked your entire breast in just a few seconds? And they say, Yeah, they can. And so that's what we want. We want you to examine the whole breast and not leave any part out. Whereas if you go in circles, and did I miss a spot in between the circles? where was I? and so women are much more comfortable that they've examined the whole breast if we do it that way. speaker-1: Yeah, yeah. So exactly what are we looking for? What are we trying to feel for? speaker-0: great question. If a lump in the breast is feelable, It has to be something you can feel. So a small breast cancer would be one centimeter or a little bit smaller, which is still not that early. It's still gonna have a billion cells or so. but that would be a small breast cancer, and that's something that you might be able to feel. Now there's stuff you can't feel. if the If the cancer is spread out like a spider web or it's teeny tiny, can be detected by mammography, you won't be able to feel it. But the things that you can feel have to be palpable, they have to be feelable. So the analogy that I always tell people, I say, look for a something like a peanut in the breast, something about that size and something firm. And so after they felt the breast, I say, okay, are there any peanuts in there? And Can you tell me with a high degree of confidence that there's no peanuts? They say, Yeah, there's no peanuts. I say, okay, good. Now you're good for another month. Okay. Now, conversely, if you find a peanut, get it checked on and make sure it's nothing serious. So speaker-1: Exactly, yeah. speaker-0: let me show you. So here's our little breast lump, which is like a peanut. And if it's in the breast and you're pressing against the ribs. You'll feel like this. And then when you get to here, as you go back and forth, you feel maybe a little thing bumping back and forth. maybe you won't feel it when it's this big, maybe you have to wait till it's a little bit bigger. But if you check every month, if something shows up, you'll hopefully find it when it's smallish. And the most important part to check is the top and outside part of the breast. This is called the upper outer quadrant. And I'll just kind of show you here. this part above the nipple and towards the armpit here. And that's important because fifty percent, fifty percent half of all breast cancers are in this upper outer quadrant. And the good news there is that this part is often the thinnest, flattest part. And it's the easiest to examine. The thicker part where the breast is, you know, much, much thicker and denser is has relatively fewer breast cancers. So you really want to make sure that you don't miss this part. And I tell people if they if they really want to just do the quick quickest, easiest thing, if you just put your hand like this, like this, and then like this, you'll have found 50% of any place that could have a breast cancer. And so you'll get ninety-eight percent of the benefit. with only putting your hand just in one spot. Just a few seconds. And so literally in a few seconds before you go to sleep or before you get up, you've got it covered. speaker-1: Especially doing it just that one section and just trying to feel for it. That's great, yeah. speaker-0: Yeah. if you then want to expand and do the other parts too, that's great. but if you just do that one part and then actually if you do the next part over, that's another twenty, thirty percent of the breast cancers. So you've gotten most of the breast cancers just doing the top part of the breast. speaker-1: That's great. That's awesome. of course, some women won't get their mammograms just for a few different reasons. you know, as a woman, you're probably scared. or if you have family history, when fear takes over, that's definitely something that you don't want to put yourself into, so you just put it off. so Pain is another one. I remember my mom telling me when she did her mammogram, she said, my god, it was so painful. I don't want to do that again. But and expenses. Expenses is another thing. Sometimes maybe insurance doesn't cover, so people just don't want to do it. Put it off again. or if it's like not ordered by a doctor, people will think like, my doctor didn't say anything, I don't need it, you know. do it another time. Yeah. Yeah. speaker-0: Yeah, so mammography is extremely important. Yeah. Mammography can detect cancers when they're, that this big, just a little teeny tiny thing. Yeah. and if you get mammograms regularly every year, then the mammogram is probably gonna pick up something before it becomes palpable. but if you don't get mammograms regularly for the v reasons that you told you know, they they're sore, they they're uncomfortable, you have to schedule it, time out of your busy life and then And then sometimes you have to go back and do another view and get an ultrasound. And then all that time you're worried about, you know, is there is this cancer? And so those are valid concerns for not getting mammography, but mammography is really important. The breast off exam is meant to supplement that and not not to take it over. as a plastic surgeon, what do you recommend relative to self exam and implants? speaker-1: Well, another great question because a lot of women think that if they have implants it's gonna be impossible to do self-exam and that the implants are gonna mess up the being able to feel the breast and so forth. But that's actually not true. That with an implant sometimes we put the implant in front of the muscle, sometimes you put it under the muscle, sometimes you put it partially under the muscle, sometimes you put it under another cover, things like that. But no matter where we put the implant. We always put all of the implant and all of the accoutrements of it, everything that surrounds and all of the mesh or whatever, is always behind the breast tissue. So all of the breast tissue is always in front of all of that stuff. So if you're going to examine the breast, if you feel the breast, anything that's inside the breast tissue, you'll be able to feel in a similar way by pressing the breast tissue against The implant. And then if you rock back and forth, if there's a if there's a mass in there, then you'll feel it perhaps rubbing back and forth over the implant. Now, if you only press down, you may not feel it because it may press into the implant, because the implant is much softer than the ribs, of course. but if you go back and forth, frequently you'll be able to feel something, and you can examine the breast that way. That's what we do as doctors. And again, we're just telling you to do the same thing at home that we're doing for you in the office. So we press against the implant, rock back and forth. And again, the top part of the breast, the upper outer quadrant is going to have 50% of potential breast cancers. And that's also an area that's frequently kind of above where the implant is. So you're actually able to examine the breast there, similar to the way you would do it, even if person didn't have implants. Okay. and then again, mammography is really important. And even if you have breast implants, then it's a good idea to get mammography on the recommended schedule. And with mammography they have to with implants they have to do a couple of extra views. so there are extra, you know, extra extras that they take. They and they and what they generally do is they squeeze the breast up in front of the implant and then take the mammogram that way. Okay. Awesome. speaker-0: And I know this could be a little scary for people who may have implants because you said, y they'll have to take more views or probably have to squeeze it a little bit more. But, like what Dr. Peterson said, mammograms are very important and you know, don't let that be a f scare you from doing it, which is you know, it's really important. speaker-1: Yeah. And then the other question we always get is is the mammogram gonna break the implant? And speaker-0: yeah. speaker-1: people are always very worried about that. It's a it's a legitimate concern. The implants are quite sturdy. So, you know, the implants will tolerate a lot. Okay. But if the implant is worn or old and you squeeze the implant, it could be that it would squeeze and cause a tear in the capsule and break the implant. With saline implants, of course, if you break the implant, all of the saline leaks out. With the silicone, the silicone leaks out of the shell, out of the capsule, but it doesn't go anywhere. The saline gets absorbed by your body, you pee it out, and your implant deflates. So it's a legitimate concern, but it's a very uncommon thing. the mammographers try very hard not to break your implants. it I'm sure it does happen sometimes, but it's more likely to break from just wear and tear from running around and jumping and doing things like that. speaker-0: I see, yeah. So does it matter? I heard breast self exam are no longer recommended. speaker-1: Yeah, another great question. Because the thing is mammography and ultrasound and MRI are so good at detecting breast cancer that they can they can find it before usually it would get to the point where you'd be able to feel it. So breast self exams kind of taken a second position now. It was it was very strongly promoted for a long time by the American Cancer Society and other societies. but now that they have found that it's not of course as important as mammography. Of course, as we just discussed, some people don't get their mammograms or they're a long time between mammograms, so it's still important to do breast self-exam because you might detect something that hasn't shown up yet on mammography. And because it's been so long that you've had a since you've had a mammogram that you might still find it. If you get a mammogram every year, it's unlikely the breast cancer will grow that fast. and so if you're getting r really frequent mammography, then it's less important. and then the other thing is that there are some things, there are some breast cancers that you cannot see on mammograms, but you can feel you can feel a mess. So because it's so easy to do. Because the way that we physicians do it is so easy and the way that patients can do it themselves is so easy. I recommend that everybody do it. the the downside is very little, it doesn't take much time. You don't have to take time out of your schedule, it's easy to do. You might catch something in between mammog mammography. it's not an excuse to not do mammography. But if you're if your other excuses win and you end up putting mammograms off for too long a period of time, then at least do self exam as a second fallback physician. So it's not that they the scientist the CITES don't recommend that you avoid it. They just don't promote it as a primary means of deter of detecting breast cancer early that will change mortalities, in the long run. speaker-0: I agree, right. So we talked a lot about the women. What about the men? Great. speaker-1: Great question. Okay, so men don't get mammograms. So we just talked about the fact that on women, mammography can detect cancer early. And and so the breast self-exam may not be as important to women because they're supposed to be getting mammograms every year after 50. men don't get mammograms. Yeah. So for men, pretty much the only way that they're gonna find a cancer is by self exam. And again, early detection is important for survival and for you know making treatment easier and so forth. So although men don't get breast cancer nearly as often as women, only about one percent as much, one percent is still a lot of men. Yeah. So because self-exam is so easy, we recommend that men once in a while, same thing. And on a man, of course, it's much easier because generally they don't have nearly as much breast tissue. Right. and so an abnormality in the breast tissue would be much more noticeable. A lot of men have gynecomastia, which is you know, breast tissue on a man. That's what gynecomastia means. and so they will have a palpable firmness in the breast. And the difference is that frequently it's this. Same on both sides. Now sometimes it's only one side. When it's only one side, we worry about it a lot more. when it's both sides, you figure it's just from hormones or the breast being very sensitive to to growth. but still it's a good idea for a man, It's easy enough, you're lying in bed, What am I gonna have for breakfast? let's see. Okay, done. Let's try the other side. And and even with moderate gynecomastia, it's pretty easy to examine a breast. speaker-0: Awesome. Yeah, I know and it's something that partners can do together. You're and women. You're laying in bed, just do it together. speaker-1: That's right. That's right. Ratio. speaker-0: Exactly. That's awesome. Well, this was so informative. You know, I definitely now think that I can do it more just because it's so easy and fast and I have no excuse. So yeah, very informative, not only for the women but for the men as well. Yeah. So It was great, awesome. speaker-1: Yeah, so when you lie in bed once in a while, once a month or every other month or once in a while, just take a feel and see what's going on up there. Thank you and thanks for watching.