From awareness to action: a breast surgeon's guide to knowing your normal

Every October, the world turns a little pink. Ribbons on lapels, landmarks lit up at night, cakes in office kitchens. I love it. Breast Cancer Awareness Month has done a great deal of good.

But here's something I've come to believe after many years of seeing people in clinic. Awareness is not the same as action.

Most of us know what the pink ribbon stands for. Far fewer of us know what to actually do on an ordinary Tuesday morning, when our fingers find something that wasn't there before. Do you wait? Do you look it up? Do you mention it to someone, or quietly hope it goes away?

That gap, between knowing and doing, is what this article is about. Not to worry you.

Quite the opposite. I'd like you to finish reading feeling calmer, clearer, and knowing exactly what to do if you ever need to.

Let's talk surgery.

Your breasts have a weather forecast

If you've lived in one place for a while, you know its weather. You know a grey October morning isn't a storm. You know the difference between a passing shower and something that's genuinely changed.

Breasts are a bit like that. They have their own seasons. In the week or so before a period, many people find their breasts feel fuller, lumpier or more tender. Afterwards, they often settle and soften again. Pregnancy, breastfeeding, the menopause, hormone treatments and even changes in weight all shift the forecast too.

None of that is a warning sign. It's simply the local weather. And the better you know it, the easier it becomes to notice when something doesn't fit the usual pattern.

That's really all "breast awareness" means: knowing your normal, so you can spot a change.

In praise of the ordinary breast

Before we talk about changes, I'd like to say a word for the ordinary breast, because it worries people far more than it should.

In clinic, I often reassure people about things that are simply normal:

• One breast larger than the other. Very common. Most people's breasts aren't a perfect pair.

• A lumpy or bumpy texture all over. Breast tissue is naturally glandular, and for many people it has always felt this way.

• Tenderness in one breast, especially around the time of a period.

• A few hairs around the nipple, or small bumps on the darker skin around it. These are normal glands and hair follicles.

• Nipples that have always turned inwards. If they've always been that way, that's your normal.

The key word in all of these is always. What matters isn't whether your breasts look like anyone else's. It's whether they've changed from how they usually are.

There's no perfect technique

Here's a confession I hear surprisingly often: "I used to check, but I stopped because I wasn't sure I was doing it right."

I understand that completely. But breast awareness isn't an exam, and there's no pass mark. You don't need a special pattern of circles or a diagram on the bathroom wall.

Breast Cancer Now sums it up in three simple words: touch, look, check.

• Touch your breasts. Feel the whole area, including up to your collarbone and into your armpits. Use whatever way feels natural to you: in the shower, lying down, or while you put on moisturiser.

• Look for changes. Glance in the mirror with your arms by your sides, then raised. You're looking for anything new in shape, size or skin.

• Check anything unusual with your GP.

The secret isn't technique. It's habit. People are far more likely to keep doing something if they attach it to something they already do. So pick a moment that's already part of your week: the Sunday shower, the first of the month, the moment you put on your body lotion. If you still have periods, a few days after your period ends is a good time, as the weather tends to be calmest then.

If you forget for a while, that's fine. Just pick it up again. A habit you return to is far better than a perfect routine you gave up on.

When the weather really changes

So what counts as a genuine change? A lump is the one everyone knows. But it isn't the only one, and that's where awareness often falls short. These are the changes worth getting checked:

• a lump or thickening in the breast or armpit that feels different from the rest

• a change in the size or shape of a breast

• dimpling or puckering of the skin, a bit like orange peel

• a nipple that has newly turned inwards, or changed position

• a rash, crusting or redness on or around the nipple

• fluid coming from the nipple without squeezing, especially if it's bloodstained

• swelling in the armpit or around the collarbone

• pain in one area of the breast that doesn't go away

On breast pain: it's very common, and on its own it's rarely a sign of cancer. Most of the time it's linked to hormones, a bra that doesn't fit well, or a strained muscle in the chest wall. But pain that's new, stays in one spot, or comes with any other change deserves a proper look.

And one more thing, for the men reading this: men have breast tissue too, and can develop breast changes, including, rarely, breast cancer. Everything here applies to you as well.

From breast awareness to action: three steps

This is the part I most want you to remember. If you notice a change, here's what to do.

1. Note it. Write down what you noticed, where it is, and when. Notes help you remember the details on the day, and they help whoever examines you understand the story.

2. Book it. Contact your GP. Don't wait for your next screening appointment, and don't wait until it "gets worse". Breast screening is designed for people with no symptoms. A new change, at any age, deserves its own appointment.

3. Go. Keep the appointment, even if you've half-convinced yourself it's nothing. Take someone with you if it helps, and bring your notes and your questions.

What I'd gently ask you not to do is spend the evening searching online. You'll find the worst stories, not your story. Your story starts with a conversation.

And please hold on to this: most breast changes turn out not to be cancer. Acting quickly isn't about expecting bad news. It's about getting a clear answer, so you can stop wondering.

From the other side of the desk

I'd like to tell you what these appointments look like from my chair, because I think it takes some of the fear away.

People often begin with an apology. "I'm sure it's nothing." "I didn't want to waste your time." "My partner made me come." I understand every one of those. But I'd like you to know that nobody who comes in with a breast change is wasting my time. Checking things is exactly what I'm there for.

The appointment itself is a conversation first. I'll ask what you noticed, when, and whether it's changed. I'll ask what worries you most, because that's often the most important question in the room. Then I'll examine both breasts and the armpits, explaining as I go.

If it would help, I may suggest an ultrasound scan, which uses sound waves rather than radiation to look beneath the skin. Sometimes that's all that's needed to give a clear answer. Sometimes we'll need more information, and I'll explain exactly why and what happens next. Either way, you should leave knowing what I think, what we're doing about it, and when you'll hear more.

The moment I value most is often the last one: seeing someone's shoulders drop when the worry finally has a plan.

Getting a change checked at SML Surgical Care

Your GP is always a good first step. If you'd prefer to see a specialist privately, at SML Surgical Care in Ware we offer consultant-led breast assessment for lumps, breast pain, nipple discharge, nipple changes and other breast symptoms, with clinical ultrasound on the same day when it's helpful. We also offer second opinions.

You can book online, call us on 01920 455522, or email info@sml.surgery. We're open on weekdays and on Saturdays.

This October, let's make it action

So, by all means, wear the ribbon this month. But let's add something to it. Know your normal. Make checking a habit, not a test. And if the weather really does change, note it, book it, and go.

That's the difference between awareness and action. And it's the one that matters.

This article is general information, not a diagnosis. If you're worried about a breast change, please see your GP or a breast specialist.