Inspect the Breasts in Various Postures

Inspection is next performed while the woman assumes several postures that may bring out signs of retraction that were less evident previously. Ask the woman to press her arms against her hips. This maneuver tenses the pectoralis muscles, which may bring out dimpling caused by fixation of the breast to the underlying muscles. This technique is shown in Figure 16-14. If a malignancy is present, the abnormal attachment of the tumor to the fascia and pectoralis muscle pulls on the skin and may produce skin dimpling. Any bulging may also indicate an underlying mass.

Another maneuver, which is useful for a woman with pendulous breasts, involves her bending at the waist and allowing her breasts to hang free from the chest wall. This technique is demonstrated in Figure 16-15. A carcinoma causing fibrosis in one breast produces a change in the contour of that breast.

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