[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Clinical exam](https://durgical.com/en/clinical-exam/) › [Kidney, genitourinary, breast and obstetric exam](https://durgical.com/en/clinical-exam/#a-renal) › Clinical breast examination [Clinical exam](https://durgical.com/en/clinical-exam/) · [Kidney, genitourinary, breast and obstetric exam](https://durgical.com/en/clinical-exam/#a-renal) # Clinical breast examination - Exam technique A check of both breasts and armpits, with consent and a chaperone, to find lumps, skin or nipple changes and lymph nodes. Updated 2026-11-01 **See it in 3D:** [Breast region (male)](https://durgical.com/en/anatomy/mammary-region/) · [Mammary gland lobes](https://durgical.com/en/anatomy/mammary-gland/) · [Nipple](https://durgical.com/en/anatomy/nipple/) · [Areola](https://durgical.com/en/anatomy/areola/) · [Suspensory ligaments of breast](https://durgical.com/en/anatomy/suspensory-ligaments-of-breast/) ## Key points - Inspect sitting (arms down, up, on hips, leaning forward); palpate supine with the arm behind the head. - Pads of three fingers, small circles, three pressure levels, vertical-strip pattern. - Warning signs: hard fixed lump, skin or nipple retraction, peau d'orange, bloody discharge, hard axillary node. - Retraction comes from shortened Cooper ligaments; peau d'orange from lymphatic blockage. - The clinical exam complements mammography; it does not replace it. - Consent, chaperone and privacy throughout. ## What it is The clinical breast exam combines inspection with the patient sitting and systematic palpation of the whole gland, the nipple-areola complex and the axillary, supraclavicular and infraclavicular nodes. It finds lumps and warning signs, but it does not replace mammography as a screening test. Breast cancer is one of the most common cancers in women in Colombia and the region; the male breast is examined too (gynecomastia, cancer). ## Landmark anatomy - The breast extends from the second to the sixth rib and from the edge of the sternum to the midaxillary line; its axillary tail reaches into the armpit. - The suspensory (Cooper) ligaments tie the gland to the skin; a tumour that shortens them pulls the skin into a dimple or retraction. - Skin swelling with prominent pores ('peau d'orange') comes from blocked dermal lymphatics. - Most lymph drains to the axillary nodes; the inner quadrants also drain to the internal mammary nodes. ## Technique, step by step - Explain the exam, obtain consent, offer a chaperone, protect privacy and uncover only what is needed; ask about symptoms, cycle and history. - Inspect with the patient sitting, arms at the sides: size, symmetry, contour, skin, direction of the nipples. - Repeat with arms raised, hands pressed on the hips and leaning forward: look for skin dimpling or retraction. - Palpate with the patient supine and the arm on the side being examined behind the head, to spread the breast over the chest wall. - Use the pads of the three middle fingers in small circles, with light, medium and deep pressure at each point. - Follow a vertical-strip pattern from the clavicle to the inframammary fold and from the sternum to the midaxillary line, including the axillary tail. - Palpate under the areola and nipple; if the patient reports discharge, ask her to show it or gently compress the nipple. - Sitting, with her arm supported by the examiner: palpate the axillary node groups (central, anterior, posterior, lateral, apical) and the clavicular fossae. - Describe any lump: side, clock position and distance from the nipple, size, shape, consistency, mobility, tenderness and fixation to skin or deep tissue. ## Abnormal findings - A hard, irregular, painless, fixed lump with skin or nipple retraction, peau d'orange or a hard axillary node suggests breast cancer and needs imaging. - A smooth, rubbery, well-defined, very mobile lump in a young woman suggests a fibroadenoma. - Diffuse, tender nodularity that changes with the menstrual cycle: fibrocystic changes. - A red, hot, painful breast during breastfeeding: mastitis; a fluctuant area suggests an abscess. - Persistent one-sided eczema or crusting of the nipple: rule out Paget disease of the nipple. - Spontaneous, one-sided, single-duct or bloody discharge is a warning finding. - In men: firm glandular tissue under the areola suggests gynecomastia; a hard, off-centre lump means ruling out cancer. ## Common errors - A normal exam does not rule out cancer: it does not replace screening mammography. - Missing the axillary tail, the area under the areola or the supraclavicular nodes. - Palpating with the fingertips or a single pressure that never reaches deep tissue. - Examining only with the patient sitting: palpation is done lying down with the breast spread out. - Not recording the clock position and size of a lump, which makes later comparison impossible. ## Test yourself Think of the answer, then tap the question to see it. ## Where is the arm placed to palpate the breast with the patient lying down? The arm on the side being examined goes behind the head, to spread the breast over the chest wall. ## Which structure explains skin retraction over a breast cancer? The suspensory (Cooper) ligaments, shortened or pulled by the tumour. ## Which features of a breast lump point to a fibroadenoma? Smooth, rubbery, well defined, very mobile and painless, in a young woman. ## What is recorded when describing a breast lump? Side, clock position and distance from the nipple, size, shape, consistency, mobility, tenderness and fixation. ## Does a normal clinical exam make screening mammography unnecessary? No; the clinical exam complements mammography, which finds lesions too small to feel. [Add to my cards (5)](https://durgical.app/estudiar/?add=/en/clinical-exam/clinical-breast-examination/) ## See it in 3D The structures of Durgical's 3D anatomy where it is found. - [Breast region (male)](https://durgical.com/en/anatomy/mammary-region/) - [Mammary gland lobes](https://durgical.com/en/anatomy/mammary-gland/) - [Nipple](https://durgical.com/en/anatomy/nipple/) - [Areola](https://durgical.com/en/anatomy/areola/) - [Suspensory ligaments of breast](https://durgical.com/en/anatomy/suspensory-ligaments-of-breast/) ## Related - [Lymph node examination](https://durgical.com/en/clinical-exam/lymph-node-examination/) - [Gynecologic examination: speculum and bimanual exam](https://durgical.com/en/clinical-exam/gynecologic-examination-speculum-and-bimanual-exam/) - [Gynecologic and obstetric history](https://durgical.com/en/clinical-exam/gynecologic-and-obstetric-history/) - [Skin examination: primary and secondary lesions](https://durgical.com/en/clinical-exam/skin-examination-primary-and-secondary-lesions/) ## Related conditions - [Breast cancer](https://durgical.com/en/conditions/breast-cancer/) - [Breast fibroadenoma](https://durgical.com/en/conditions/breast-fibroadenoma/) - [Fibrocystic breast changes](https://durgical.com/en/conditions/fibrocystic-breast-changes/) - [Acute mastitis](https://durgical.com/en/conditions/acute-mastitis/) - [Breast abscess](https://durgical.com/en/conditions/breast-abscess/) - [Gynaecomastia](https://durgical.com/en/conditions/gynaecomastia/) - [Hereditary breast and ovarian cancer syndrome (BRCA1/BRCA2)](https://durgical.com/en/conditions/hereditary-breast-and-ovarian-cancer-syndrome/) [← All of the clinical exam](https://durgical.com/en/clinical-exam/) Educational content on the clinical exam; it is learned and practised under supervision. It does not replace assessment by a health professional and is not for self-diagnosis. Sources: [Screening for Breast Cancer | Breast Cancer | CDC](https://www.cdc.gov/breast-cancer/screening/index.html) (Centers for Disease Control and Prevention, 2024); [Breast self-exam: MedlinePlus Medical Encyclopedia](https://medlineplus.gov/ency/article/001993.htm) (MedlinePlus (U.S. National Library of Medicine), 2024). ## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake Representative model, for educational purposes only. --- Source: https://durgical.com/en/clinical-exam/clinical-breast-examination/ License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/clinical-exam/clinical-breast-examination/