Physical Examination

No special equipment is necessary for the examination of the breast. The examination of the breast consists of the following:

• Inspection

• Axillary examination

The examination of the breast is in two parts. The first is performed with the patient sitting up. Inspection of the breasts and palpation of the lymph nodes are done in this position. The second is performed with the patient lying down. The examiner systematically palpates the entire breast by using firm, gentle pressure exerted by the pulp of his or her finger rather than the fingertips.

To facilitate communication, the breast is pictorially divided into four quadrants. Two imaginary lines run through the nipple at right angles to each other. By visualizing the breast as a face of a clock, one line is the ''12 o'clock-6 o'clock'' line, and the other is the ''3 o'clock-9 o'clock'' line. The resulting four quadrants are the upper outer, upper inner, lower outer, and lower inner. The ''tail'' is an extension of the upper outer quadrant. These regions are illustrated in Figure 16-9.

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