<aside> 💡 “Any areas of concern?”

“Now I am going to examine the breasts and lymph nodes”

</aside>

1. Begin by examining the lymph nodes with the top/bra still on.

   • Palpate supra/infraclavicular, pectoral, subscapular, central and lateral lymph nodes, observe for enlargement, tenderness, mobility and texture

2. “I am now going to inspect your breasts and look for any changes in the skin, please lower your gown”

   • Look for scarring, lumps, traction on skin, pulling or inversion of nipples, Peau d’orange appearance
     • at rest
     • hands on hips
     • roll shoulders forward and back
     • arms above head

3. Now examine the breasts with the patient lying down

   1. Ask patient to lie down on exam table and place arm overhead. Assist with pillow placement, pillow under shoulder for large breasted women.

   2. Palpate the breast with light and deep pressure in linear fashion as demonstrated by CTAs. Pay special attention to the upper outer quadrant and tail of breast where 50% of the abnormalities are found.

   3. Check the nipple. Check for masses under the nipple by placing a finger on each side of the nipple and palpating with a rocking motion. Check for nipple discharge by placing 1-2 fingers each side of the nipple, pressing down and out

      

4. Communicate your findings.

   • “Everything appears healthy and normal” OR “I have identified changes/lump in breast that require(s) further evaluation”