A systematic approach to the breast examination is essential. The breasts must be inspected for size and symmetry, although some degree of asymmetry is not uncommon and is usually normal. The contour of the breast must be inspected, with special attention to dimpling, masses, or flattening. In order to accentuate potential dimpling, have the patient raise her hands above her head. The color, venous pattern, and any edematous changes should be noted. Nipple inversion of long standing is common and usually normal. Areolar or nipple rashes or ulcerations should be noted. For palpation of the breast, the patient must be in a supine position. Placement of a pillow under the patient's shoulder on the examination side and her arm above her head helps to spread the breast tissue over the chest and make palpation of nodules easier. A patterned approach should be used to ensure that all breast tissue is palpated. The pads of the three middle fingers should be used with a rotatory motion. The consistency of the breast changes with age and the hormonal milieu. Nodules should be described according to their quadrant (upper and lower, outer and inner), shape, size, relationship to surrounding tissue, and tenderness. The nipple should be palpated and compressed for discharge.
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