A. Inspect the breasts
Inspect the breasts with the patient both in the upright and supine positions. With the patient in the upright position, examine with the patient’s arms relaxed and then raised, looking for shape asymmetry, deformity, and skin changes (erythema, edema, dimpling). With the patient in the supine position, examine the entire breast systematically with the patient’s ipsilateral arm raised above and behind the head.
- If a mass is found, determine its size, shape, texture, tenderness, location, fixation to skin or deep tissues, and relationship to the areola. Evaluate the nipples for retraction, discoloration, inversion, ulceration, and eczematous changes.
- For nipple discharge, note its color and quality, where pressure elicits discharge, and whether it is from a single duct or associated with a mass.
B. The axillary, supraclavicular, and infraclavicular lymph nodes
The axillary, supraclavicular, and infraclavicular lymph nodes should be palpated with the patient in the upright position, with arms relaxed. The size, number, and fixation of nodes should be noted.