Studies of women trained in self-examination have demonstrated that a more complete examination is performed with the vertical strip pattern, as the other two search patterns concentrate on the central cone and neglect the peripheral areas of the breast tissue. To use the vertical strip pattern, begin in midaxilla, then move up and down, slightly overlapping the area under the fingers. Cover one square inch at each stop. Use the same technique and include the nipples in strips and conclude with two horizontal strips under the clavicles. Compare the opposite breast at the same location if there is a question.
Palpation Use the preferred hand with the second, third, and fourth fingers held together and flat.
This will allow detection of the smallest lumps. With each palpation, cover an area of approximately one square inch. Take care to exert even pressure on all three fingers. Common errors during the clinical breast examination include missing the axillary tail, failing to palpate the nipple and areolar complex, using inconsistent pressure, and using a pattern of search that does not extend to the perimeter of the breast. Before, during, and after the examination, attention to communication, patient education, and responsibility for follow-up are important.