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©2013 UpToDate ® Print Email Breast exam A. The breast exam is started with the patient in a seated position with her arms relaxed. Breast inspection is aided by patient positioning. The patient is asked to raise her arms over her head so the lower part of the breasts can be inspected for asymmetry, skin changes, and nipple inversion or retraction. The patient then puts her hands on her hips and presses in to contract the pectoral muscles so that any other areas of retraction can be visualized. B. The regional lymph node exam is completed while the patient is still in the sitting position and includes the cervical, supraclavicular, infraclavicular, and axillary nodal basins. C. A bimanual examination of the breasts can be performed while the patient is still in the sitting position. This is especially useful for women with large pendulous breasts. D. The breast exam is completed with the patient in a supine position with the ipsilateral arm raised above her head. The area examined should extend from the clavicle superiorly to the rib cage inferiorly and from the sternum medially to the mid-axillary line laterally. A systematic approach ensures that the entire breast is examined. This can be accomplished with either concentric circles, a radial approach, or vertical strips, referred to as the "lawnmower" method.