Basic Clinical Skills | Physical Exam Study Guides

Examination of the Breast



Equipment Needed

Inspection

  1. Give a brief overview of examination to patient. [1]
  2. Have the patient sit at end of exam table.
  3. Ask the patient to remove gown to her waist, assist only if needed.
  4. Have the patient relax arms to her side.
  5. Examine visually for following:
  6. Observe the movement of breast tissue during the following maneuvers:
  7. Have the patient replace the gown.
  8. Reassure the patient, if the exam is normal so far, say so.

Palpation

  1. Have the patient lie supine on the exam table.
  2. Ask the patient to remove the gown from one breast and place her hand behind her head on that side.
  3. Begin to palpate at junction of clavicle and sternum using the pads of the index, middle, and ring fingers. If open sores or discharge are visible, wear gloves.
  4. Press breast tissue against the chest wall in small circular motions. Use very light pressure to assess superficial layer, moderate pressure for middle layer and firm pressure for deep layers.
  5. Palpate the breast in overlapping vertical strips. Continue until you have covered the entire breast including the axillary "tail." [2]
  6. Palpate around the areola and the depression under the nipple. Press the nipple gently between thumb and index finger and make note of any discharge.
  7. Lower the patient's arm and palpate for axillary lymph nodes.
  8. Have the patient replace the gown and repeat on the other side.
  9. Reassure the patient, discuss the results of the exam.


Notes

  1. For more information refer to A Guide to Physical Examination and History Taking, Sixth Edition by Barbara Bates, published by Lippincott in 1995.
  2. Bates refers to circular or clock face patterns. These are considered to be inferior to the "lawn mower" pattern of vertical strips and should not be used.

   Author: Richard Rathe, MD / rrathe@dean.med.ufl.edu
Copyright: 1996 by the University of Florida
 Location: http://www.medinfo.ufl.edu/year1/bcs/clist/breast.html
  Created: May 1, 1996   Modified: December 19, 2000

Basic Clinical Skills | Physical Exam Study Guides