The ultimate goal of the clinical breast examination is to cover the whole breast with fingers educated to differentiate normal from abnormal breast tissue. Positioning the patient To inspect the breasts, the patient is seated, relaxed, with her arms at her sides. Next, the patient is asked to lean forward so the practitioner can look for symmetry, retractions, dimpling, nipple retraction, and discharge and scaling. Practitioners look for the same abnormalities while the patient is seated with arms overhead, and seated with hands on hips, forcibly contracting the pectoral muscles. The axilla should be examined while the patient is seated, with her arms at her sides.
Many examiners prefer to inspect breasts and reexamine the axilla after palpation.
For palpation of the breast, the patient is supine. If room allows, examine each breast from the opposite side of the table. The vertical strip pattern is recommended. 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.