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| Positioning and Inspection
for Breast Examination
From Reichman BS: Textbook and atlas: clinical breast examination
and instruction of patients in breast self-examination. In
Wallis LA, editor: Textbook of women's health, Philadelphia
PA, 1998, Lippincott-Raven.
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Inspection begins with the woman sitting
on the examination table with both breasts exposed. The patient’s
breasts are inspected with her arms at her sides, then with
arms overhead, and then with hands pressing on hips to contract
the pectoralis major muscles. If the woman has pendulous breasts,
the examiner should ask her to lean forward to allow the breasts
to hang away from her chest wall so that skin changes or other
abnormalities may be seen.
With the patient in each position the examiner
assesses breast size, shape, and symmetry. Some asymmetry in
breast size is common and is usually normal, but changes in
contour such as masses, dimpling, retraction, or flattening
should be further evaluated. Contracting the pectoralis major
muscles may make subtle skin retraction or other contour changes
more evident. The skin color and texture of the breasts are
examined for edema, rash, ulceration, or redness. The appearance
of the nipple and areola should also be noted.
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