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There are several good techniques used to evaluate the breast. This video illustrates one of these methods, using the Vertical Strip Technique.
Start with a visual examination of the breasts. Localized redness of the skin, or erythema, may indicate infection, injury or malignancy. This nursing patient has mastitis.
Skin changes resembling an orange peel are called “Peau d’Orange” and may signify an underlying malignancy.
Red crusting of the nipple can be seen with infection, trauma or malignancy. This is a case of Paget’s disease.
Dimpling or retraction of the breast can be a sign of malignancy. The same is true with changes in contour.
Sometimes these changes are best appreciated by watching the breasts as the patient raises her arms over her head. An alternative method is to have the patient squeeze her hips, flexing her pectoralis major muscles. As she flexes, observe each breast for any of these changes.
Most breasts are slightly asymmetrical. This patient’s left breast is considerably larger than her right.
Nipple papillae are normally everted like this. Inverted nipples have a different appearance.
This lactating patient has a nipple laceration. Seven months later it is completely healed.
Accessory nipples or accessory breasts may be seen anywhere along the milk line, from the axilla to the groin.
Montgomery glands within the areola are a normal finding.
Lymph nodes are located just above and just below the clavicle. With the patient sitting up, feel for these lymph nodes. Normal lymph nodes in this area will not be palpable. Palpable lymph nodes in this area suggest underlying infection, injury or malignancy. With her arm raised, palpate for axillary lymph nodes. These may be located in several areas within the axillary folds. Repeat your exam on the opposite side.
Examine the breast tissue within the area enclosed by the mid-axillary line, the inframammary ridge, the sternal border, the clavicle, and back to the axilla. Use this portion of the first three fingers.
Breast masses may have well-delineated borders, or the borders may be less distinct. This breast mass, at surgery, was found to be a hemartoma.
While pressing in gently, move your hand in a small circular motion. Start in the axilla and work your way down in the mid-axillary line. Move your hand medially and start working your way back up. This vertical strip technique allows you to systematically cover the entire chest wall. Continue using this overlapping circular pattern. Keep following the pattern of the vertical strips until the entire chest wall has been covered.
To detect abnormalities at all levels of the breast, you may need to apply light, moderate or deep pressure. Frequently, you will need to adapt your technique to differences in breast size, consistency, sensitivity, and other factors such as implants.
Repeat the exam on the opposite side. Remember to have the patient raise her arms. Use the balls of the first three fingers. Make overlapping small circles with your fingers. Start in the mid-axillary line and follow the vertical strip pattern to the sternum.