A seated breast exam should be performed as part of any clinical breast exam. During the seated exam you should be asked to removed your arm from the gown and let it drop to the waist, so that both breasts can be observed. You may be asked be asked to place your hands on your hips and push tightly, raise your arms above your head, hands at your sides or lean forwards or a combination of these.
The visual examination of the breast during this seated exam is to look at your breast for changes in size, shape or symmetry. In addition to looking for evidence of skin or nipple dimpling (hollow area or crease) or retraction, discoloration, obvious masses, rashes, redness or sores.
Pushing tightly on the hips contracts the pectoralis major muscles and enhances identification of asymmetries which can further be enhanced with the arms positions above the head and at the sides as well as leaning forwards.
Following this visual inspection palpation of the breasts should be performed, which can be done using 1 of 3 methods, Vertical strips, Pie or Radial Spoke Pattern and the Circular Pattern using the pads of the index, third and fourth fingers. Looking for consistency, nodules, elasticity, tenderness and masses. Breast tissue in the upper outer quadrant and under the areola and nipple should be thoroughly palpated, as these are the two most common sites for cancer to arise.
After which palpation of the cervical nodes, axillary area and supraclavicular area for lymph node enlargement. Cervical nodes can be found along the sides of the neck, the axillary area is located in the arm pit, the supraclavicular area is found along the line immediately above the clavicle (collar bone). Lymph node palpation is usually conducted while sitting up and lying down to ensure a thorough examination.
Following this the patient is asked to lie in supine position (lie on your back) with the arm of the breast going to be palpated placed behind their head or on top of the forehead. This flattens the breast tissue on the chest wall thereby reducing the thickness of the breast tissue palpated. Again repeating the palpation of the breast tissue and lymph nodes.
The final part of a breast exam is to inspect and form a palpation on the nipples. When inspecting and palpating the nipples you or your doctor should be looking for size, shape, inversion, rashes, scaling, discharge, elasticity, retraction, aureola oedema, crusting and abnormal masses.
The nipple should then be gently grasped between the index finger and thumb and the nipple and aureola tissue should be compressed. It should then be noted what the colour consistency is and the quantity of any discharge released – if any. If there is discharge, a sample may be collected for examination under a microscope.