Basic Clinical Skills |
Physical Exam Study Guides
Examination of the Breast
- None
- The patient must be properly gowned for this examination. All upper body clothing should be removed.
- The patient must be properly gowned for this examination. All upper body clothing should be removed.
- Breast tissue changes with age, pregnancy, and menstral status.
- The procedure described here can also be used for self-examination using a mirror for inspection.
- Give a brief overview of examination to patient. [1]
- Have the patient sit at end of exam table.
- Ask the patient to remove gown to her waist, assist only if needed.
- Have the patient relax arms to her side.
- Examine visually for following:
- Approximate symmetry
- Dimpling or retraction of skin
- Swelling or discoloration
- Orange peel effect on skin
- Position of nipple
- Observe the movement of breast tissue during the following maneuvers:
- Shrug shoulders with hands on hips
- Slowly raise arms above head
- Lean forward with hands on knees (large breasts only)
- Have the patient replace the gown.
- Reassure the patient, if the exam is normal so far, say so.

- Have the patient lie supine on the exam table.
- Ask the patient to remove the gown from one breast and place her hand behind her head on that side.
- 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.
- 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.
- Palpate the breast in overlapping vertical strips. Continue until you have covered the entire breast including the axillary "tail." [2]
- 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.
- Lower the patient's arm and palpate for axillary lymph nodes.
- Have the patient replace the gown and repeat on the other side.
- Reassure the patient, discuss the results of the exam.
- For more information refer to A Guide to Physical Examination and History Taking, Sixth Edition by Barbara Bates, published by Lippincott in 1995.
- 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