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SMG Women’s Health obstetrici­an and gynaecolog­ist DR DHARSHINI GOPALAKRIS­HNAKONE from The Obstetrics & Gynaecolog­y Centre, Mount Elizabeth Novena shows us how to perform a breast self-examinatio­n.

#1

Check for any abnormalit­ies by standing in front of the mirror with arms hanging by your side. Then raise both hands and place them behind your head. Finally, place your arms on your waist and flex the breast muscles to look for any skin changes, nipple rashes, overt lumps, skin dimpling, orange peel appearance­s of the skin or abnormal nipple discharge.

#2

Divide the breast into two circles – one about an inch from the nipple and one two inches from the nipple. Using the flat pad of your three middle fingers, examine your breast tissue by tracing the invisible circles starting from the outer circle. Apply medium to firm pressure and, while pressing, make a small, circular movement. Keep moving along the circle until you have felt the entire outer area of breast tissue before moving on to the inner circle.

#3

To check the nipples, place your second and third fingers of both hands on opposite sides of the areola. Compress the area firmly from both sides to feel for lumps below the nipple. You can reposition your fingers 90 degrees and palpate the area under the nipple from above and below at the same time, too. Squeeze gently to check for any discharge.

#4

Your breast tissue extends to your armpits, so you’ll need to feel your underarms, too. Start from the outer area of your breast near your armpit and continue palpating the outer armpit in a circular motion until you get to the inner hollow of your armpit.

#5

Repeat steps 2, 3 and 4 lying down. Place a folded towel or pillow under your right shoulder, extend your right elbow outwards and place your right hand under your head. Use your left hand to feel for changes in your right breast. Then repeat the procedure for the left breast with your right hand. smgwomensh­ealth.sg For more on breast cancer, turn to page 244.

QHow can I tell if I should get my varicose veins looked at or treated? Varicose veins are tortuous and bulging veins in the legs caused by such factors as age, sex, family history, as well as lifestyle and occupation­al factors. Treatment should be considered when you start experienci­ng symptoms in the affected leg. Typically, early symptoms include heaviness in the leg, calf aches, ankle swelling, pain and night-time leg cramps. Symptoms generally worsen as the day goes on, with swelling, heaviness and aches felt mostly at night.

An uncommon but more serious complicati­on that occurs with varicose veins is thrombosis, or clot formation. These painful, hard lumps occur suddenly within the affected veins, and can also bleed sometimes. Both situations require early review and treatment by your doctor.

The main long-term complicati­on of varicose veins is Chronic Venous Insufficie­ncy (CVI). In this case, the skin around the ankles hardens and develops pigmentati­on. Unfortunat­ely, this leads to formation of ulcers in the legs, which can take months to heal. CVI must be treated early.

An assessment of varicose veins involves an inclinic ultrasound with the results discussed at the same appointmen­t. Luckily, these days, varicose vein treatment is very different to old-style stripping; it’s now minimally invasive without any general anaesthesi­a or overnight hospital stay required. The Vascular & General Surgery Centre #18-05 Paragon Medical Suites, 290 Orchard Road 6736 2302 | tvgsc.sg

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Dr Sujit Singh Gill, director and consultant surgeon

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