Arms At Sides

■ The characteristics ofthe nipples, including size and shape, direction in which they point, any rashes or ulceration, or any discharge.

Occasionally, the shape of the nipple in inverted, or depressed below the areolar surface. It may be enveloped by folds of areolar skin, as illustrated. Long-standing inversion is usually a normal variant of no clinical consequence, except for possible difficulty when breast-feeding.

Tcm Asymmetry Breast

Asymmetry of directions in which nipples point suggests an underlying cancer. Rash or ulceration in Paget's disease of the breast (see p. 314).

Recent or fixed flattening or depression of the nipple suggests nipple retraction. A retracted nipple may also be broadened and thickened, suggesting an underlying cancer.

Arms Over Head; Hands Pressed Against Hips; Leaning Forward.

To bring out dimpling or retraction that may otherwise be invisible, ask the patient to raise her arms over her head, then press her hands against her hips to contract the pectoral muscles. Inspect the breast contours carefully in each position. If the breasts are large or pendulous, it may be useful to have the patient stand and lean forward, supported by the back of the chair or the examiner's hands.

arms over head hands pressed against hips arms over head

Breast Examination Pressing Against Hips

hands pressed against hips

Breast Cancer Signs Skin Dimpling

leaning forward

Dimpling or retraction of the breasts in these positions suggests an underlying cancer. When a cancer or its associated fibrous strands are attached to both the skin and the fascia overlying the pectoral muscles, pectoral contraction can draw the skin inward, causing dimpling.

Occasionally, these signs may be associated with benign lesions such as posttraumatic fat necrosis or mammary duct ectasia, but they must always be evaluated with great care.

This position may reveal an asymmetry of the breast or nipple not otherwise visible. Retraction of the nipple and areola suggests an underlying cancer. See Table 8-1, Visible Signs of Breast Cancer (p. 314).

leaning forward

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  • diana
    What is skin dimpling?
    7 years ago

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