Inspection

Inspect the breasts and nipples with the patient in the sitting position and disrobed to the waist. A thorough examination of the breast includes careful inspection for skin changes, symmetry, contours, and retraction in four views— arms at sides, arms over head, arms pressed against hips, and leaning forward. When examining an adolescent girl, assess her breast development according to Tanner's sex maturity ratings described on page 700.

*Barton MB, Harris R, and Fletcher S: Does This Patient Have Breast Cancer? The Screening Clinical Breast Examination: Should It be Done? How? JAMA 282 (13); 1270-1280, 1999.

Arms at Sides. Note the clinical features listed below.

■ The appearance of the skin, including Color

Thickening of the skin and unusually prominent pores, which may accompany lymphatic obstruction

■ The size and symmetry ofthe breasts. Some difference in the size of the breasts, including the areolae, is common and is usually normal, as shown in the photograph below.

■ The contour ofthe breasts. Look for changes such as masses, dimpling, or flattening. Compare one side with the other.

Breast Cancer Dimpling

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