A clinical breast exam is one that is performed by a health care professional usually during a regular office visit. Clinical breast exams are considered part of breast screening. All women should receive a clinical breast exam and a mammogram as part of the breast screening process. If a health care professional does not offer to perform a clinical breast exam or hasn't done so by the end of the office visit, the patient should request that one be done.
Visual Exam
While the patient is sitting up, the health care professional will look for visible changes in the breast. These can include lumps that can be seen with the naked eye; dimpling, which is a change in the appearance of the skin; and nipple retraction, which a turning or folding in of a normally visible nipple.
The examiner then asks the woman to raise her arms and looks for signs that the skin is not moving over a particular area. If this is present, it may be considered a sign of malignancy.
The woman is then instructed to place her hands on her hips and press her palms against her hips. This flexes the pectoralis major muscle, causing breast tissue that is supposed to move when the muscle contracts to do so, while breast tissue that should remain in place will do so.
Palpitation in Sitting Position
While the woman is still sitting up, she is told to raise one arm and the corresponding breast as well as under the armpit is felt for lumps, nodules or other abnormalities. The process is repeated on the other arm and breast. The examiner uses the middle part of the fingers, between the first and third knuckle joints, to perform palpitation. He or she uses a circular motion to feel each part of the breast. Depending on the size of the breast, the examiner will use one or both hands.
Palpitation in Reclining Position
The patient then either partially or fully lies on her back and the examiner uses the palpitation method described above to continue the exam. This position allows the examiner to more effectively feel any lumps or masses that may be present.
Stripping Milk Ducts
The examiner squeezes the nipple on each breast to determine if there is any abnormal discharge from the milk ducts. If so, it is noted for further consideration.
Confirmation
If anything is indicated during the exam, the examiner brings it to the patient's attention to ascertain if this is something she was aware of, or if it is a new occurrence.
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