In palpation of the breast, the examiner should use both the flat of the hand and the fingertips, as demonstrated in Figure 16-17. Palpation should be performed by the ''spokes of a wheel,'' the concentric circle, or the vertical strip method. The ''spokes of a wheel'' method starts at the nipple (see Fig. 16-17A). The examiner should start the palpation by moving outward from the nipple to the 12 o'clock position. The examiner then should return to the nipple and move along the 1 o'clock position and continue the palpation around the breasts. The concentric circles approach (see Fig. 16-17B) also starts at the nipple, but the examiner moves from the nipple in a continuous circular manner around the breast. Any lesion found by either technique is described as being a certain distance from the nipple in clock time: for example, ''3 cm from the nipple along the 1 o'clock line.'' These techniques are illustrated in Figure 16-18.
Another method is the vertical strip, or grid, technique. The breast is divided into eight or nine vertical strips, each approximately one finger's width. The examiner's three middle fingers are held together and slightly bowed to ensure contact with the skin. The pads, not the tips, of the fingers must be used for palpation. Using dime-sized circles, the examiner evaluates the breast at each of three different levels of pressure: light, medium, and deep. Each strip consists of 9 or 10 areas of palpation, slightly overlapping the previous area, and each vertical strip is evaluated with the three pressures. Although this method has been shown to be superior to the other traditional types of breast palpation, it is more time consuming and may be best used by women for breast self-examination.
The examiner should be careful when evaluating the inframammary fold. This fold is commonly observed in older women and is the area where the mammary tissue is bound tightly to the chest wall. Often, this ridge is mistaken for a breast disorder.
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