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StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-.

StatPearls [Internet].

Show detailsTreasure Island (FL): StatPearls Publishing; 2025 Jan-.Search term Breast Examination Techniques

Jessica A. Henderson; Doug Duffee; Troy Ferguson.

Author Information and Affiliations

Authors

Jessica A. Henderson1; Doug Duffee; Troy Ferguson2.

Affiliations

1 McLaren Greater Lansing2 Michigan State University

Last Update: January 16, 2023.

Continuing Education Activity

The ability to perform a thorough and accurate breast exam is an important skill for medical practitioners of many levels and across many specialties. A clinical breast exam is a key step in the diagnosis and surveillance of a number of benign and malignant breast diseases. When used as part of a multimodal evaluation, the breast exam provides important information that is utilized in both the workup and management of many diseases of the breast. Current recommendations for breast cancer screening intervals and tests vary; however, many guidelines agree that a clinical breast exam is warranted for women with abnormal findings on mammography and as part of annual screening for certain groups of women at increased risk for breast cancer. This activity reviews the current guidelines for the breast exam and highlights the role of the interprofessional team in the detection of breast masses.

Objectives:

• Describe the importance of performing a breast exam.
• Outline the current guidelines for breast examination by clinicians.
• Review how to perform a breast exam.
• Explain interprofessional team strategies for improving care coordination and communication to advance detection of breast masses during physical exam and improve patient outcomes.

Access free multiple choice questions on this topic.

Introduction

The ability to perform a thorough and accurate breast exam is an important skill for medical practitioners of many levels and specialties. A clinical breast exam is a key step in the diagnosis and surveillance of several benign and malignant breast diseases. When used as part of a multimodal evaluation, the breast exam provides important information used in both the workup and management of many diseases of the breast. Current recommendations for breast cancer screening intervals and tests vary; however, many guidelines agree that a clinical breast exam is warranted for women with abnormal findings on mammography and as part of annual screening for certain groups of women at increased risk for breast cancer.[1]

Anatomy and Physiology

Knowledge of the basic anatomy and physiology of the breast provides a framework for understanding the pathophysiology of breast disease. Many diseases of the breast arise from a derangement of normal function and follow along a spectrum of mild, benign abnormality to a malignant process.

Embryology and Physiology

The breasts originate from ventral ectodermal buds in the 5th to 6th week of fetal development. These buds are bilateral ridges that extend from the future axillary sites to the inguinal region, the so-called "milk line," along which accessory nipples and breast tissue may occasionally be found in the adult. Two buds of ectoderm penetrate the mesenchyme along the ventral ridges overlying the pectoral tissue, which are referred to as primary buds. These subsequently form 15 to 20 secondary buds, which later develop into the lobes of the adult breast. Supportive connective tissue derives from epithelial cells. Breasts develop similarly between males and females in utero and are identical until the onset of puberty. During puberty, various hormonal signals initiate further maturation of the female breast, most notably inducing ductal and connective tissue proliferation through the effects of estrogen and progesterone.[2] Complete breast maturity is not reached until pregnancy and delivery, during which time the epithelial tissue proliferates, and milk production is initiated. Lactation continues as long as the nipple–areolar complex receives ongoing neural stimulation from nursing. Once this ceases, the buildup of pressure of unexpressed milk in the ductal system results in epithelial atrophy. During menopause, decreases in circulating estrogen and progesterone cause lobular tissue to undergo involution.[3] At this time, connective tissue becomes denser and adipose tissue gradually replaces breast parenchyma.

Clinical Anatomy

The adult breast is roughly conical, the base of which overlies the pectoralis muscles in the upper portion of the chest.[4] The physical boundaries of the breast are the clavicle superiorly, the sternum medially, the insertion of the rectus abdominis muscles inferiorly, and the serratus anterior muscles laterally. The posterior breast tissue lies on the pectoralis major fascia. The breast contains 15 to 20 lobes, which are further divided into smaller functional lobules. Cooper's ligaments are connective tissue that attach perpendicularly to the dermis and help to support the breast. The breast is divided into quadrants, or described in terms of a clock face, for ease of communication of any findings. The upper outer quadrant of the breast contains a greater volume of tissue than elsewhere, and this is also the most common location for a breast malignancy to arise. The upper outer quadrant extends superior-laterally toward the axilla and shoulder. This portion of the breast is called the axillary tail of Spence. 

Common Physiologic Changes

The breast undergoes many changes throughout a woman's life and a typical menstrual cycle, and these are important to keep in mind when performing a breast exam. During pregnancy and lactation, hypertrophy of the lactiferous ducts leads to engorgement of the ducts and alveoli with breast milk. In a non-pregnant female in the late luteal phase before menses, fluid accumulation in the breast occurs as intralobular edema, which may cause discomfort. Fibrocystic changes may become exacerbated and resolve over the course of a menstrual cycle. After menopause, the breast undergoes involution, with the replacement of the pre-existing breast parenchyma with adipose and connective tissue.

Indications

Complaints of breast pain, skin changes, nipple discharge, lumps, gross changes in size or shape, or any other feature that causes concern to the patient warrant a clinical breast exam.[5] While there is currently controversy regarding the recommendation for women to perform self-breast exams for breast cancer screening, the medical practitioner nonetheless must evaluate a patient who presents with changes noticed during a self-breast exam (see Image. Breast Self-Examination).[6][7][8][9] Patients themselves, in fact, discover many breast cancers during an intentional or incidental self-breast exam. Additionally, abnormal findings on screening, surveillance, or incidental breast imaging (mammogram, ultrasound, magnetic resonance imaging, chest computed tomography, and positron emission tomography) that are deemed suspicious by the interpreting radiologist should be further evaluated with a clinical breast exam.[10]

Guidelines

The National Comprehensive Cancer Network screening guidelines suggest that women between 25 and 40 years old who are asymptomatic and have no special risk factors for breast cancer undergo a clinical breast exam every 1 to 3 years. Women older than age 40, women with increased risk factors for breast cancer, a history of breast cancer, and/or symptomatic patients are recommended to receive more frequent clinical breast exams.[9]

The American Congress of Obstetricians and Gynecologists recommends that any screening regimen should involve a discussion of the potential risks of screening with the patient. With this in mind, the group recommends offering a clinical breast exam for average-risk women aged 25 to 39 every 1-3 years, and an annual breast exam to women aged over 40 years.[6]

The American Cancer Society does not recommend regular clinical breast exams for cancer screening for women in any risk group. It does state, however, that all women should pay attention to the typical appearance and texture of their breasts and report any changes to their doctor right away.[11]

The United States Preventive Services Task Force does not currently provide recommendations for the use of clinical breast exams in breast cancer screening, citing a lack of complete evidence based on available studies.[1] However, they do recommend obtaining an extended medical history for increased genetic susceptibility to breast cancer. These historical risk features include a personal history of breast cancer before age 50, a personal history of bilateral breast cancer, a family history of an individual with breast and ovarian cancer, a family history of at least 1 male member with breast cancer, multiple family members with breast cancer, and Ashkenazi Jewish ancestry. Any of these historical issues noted on the initial and follow-up screening assessment should be further evaluated with genetic counseling. (PMID 24366376)

Contraindications

Contraindications include a lack of patient cooperation or consent. Patient anxiety may occasionally prevent an exam, but this may be minimized with calm assurance and working with the patient to optimize comfort.[4]

Preparation

Policies vary by institution, but it is often advisable to ask a same-sex chaperone to accompany the examiner into the patient's room for the patient's comfort and protection. Adopting a courteous, gentle approach toward the patient is encouraged, as patients may feel some anxiety during the exam. It is important to have the patient change into a hospital gown before the exam to facilitate exposure of the entire breast anatomy. A sheet should be available to cover the patient's lower half for comfort. During the exam, a sheet or the hospital gown should be used to cover the contralateral breast.[4]

Technique or Treatment

Practitioners use many techniques with success, and each examiner typically develops preferences. Regardless of the approach used, it is important always to follow a consistent pattern to minimize the risk of missing anything.[4][10][11]

Inspection

The breasts are first visually inspected with the patient in a seated position facing the examiner. The patient is instructed to place their hands on their hips and raise them above their head. This allows the examiner to assess the breasts in many positions and observe overall size, shape, symmetry, nipple size, shape, texture, and color. Variations in any of these should be noted concerning previous exams as well as in comparison to the contralateral breast. Areas of skin thickening, dimpling, or fixation relative to the underlying breast tissue should also be noted on visual inspection. These can be exaggerated during movement as well as by asking the patient to flex the pectoral muscles with hands on the hips.

Palpation

After completing the visual inspection, the patient should be instructed to lie supine. If a side-specific breast complaint is being evaluated, the examiner should begin his/her exam on the opposite, or "normal" side. As a breast is examined, the other is covered for the patient's comfort. The patient should place the ipsilateral hand above and/or behind their head to flatten the breast tissue as much as possible. The breast tissue itself is evaluated using a sequence of palpations that allow progression from superficial to deeper tissues. This is best accomplished utilizing the examiner's finger pads, usually with the hand in a slightly cupped position. A variety of techniques exist, but the most often used are the radial "wagon wheel" or "spoke" method, the vertical strip method, and the concentric circle method. As stated previously, it is important that the examiner chooses a method and is consistent from exam to exam. The overall consistency of the breast is documented (soft, firm, nodular). Any masses or tender lesions are noted concerning their location in a conventional quadrant or clock face configuration. When documenting findings, include characteristics of any abnormalities, such as size, shape, texture, mobility, delimitation, tenderness, and approximate depth. Attention is then turned to the nipple-areolar complex, where these tissues are palpated for abnormalities. Also, the examiner should assess for expressible nipple discharge by placing both hands on the breast, on either side of the areola, and gently but firmly pressing down into the breast tissue. 

Following a complete exam of the breast, the axilla and supraclavicular area should be palpated for lymphadenopathy. Lymph node abnormalities may present in various forms. Still, most often, any palpable nodes of concern are slightly enlarged and have a somewhat firmer texture than the typical soft, rubbery one. As with any masses, approximate document number, size, texture, mobility, and delimitation of any palpable lymph nodes. Occasionally, the entire axilla feels "full," without defined lymphadenopathy. This may relate to the patient's normal anatomy or indicate the presence of diffusely matted lymph nodes. 

A breast exam in a male is often somewhat simpler due to a smaller volume of tissue to assess, unless the patient is extremely obese or gynecomastia is present. The same principles apply to the examination of the male breast.

Documentation

Common terminology found in the documentation of a breast exam includes the following:

• Symmetrical or asymmetrical
• Shape (ptotic, pendulous, any scars or deformities with descriptions)
• Texture (soft, nodular, fibrocystic, dense, presence of inframammary ridge in large breasts)
• Masses (described as indicated above versus no masses evident)
• Nipple-areolar complex (pink, brown, everted, inverted, discharge present/absent with description, presence of dry, scaly texture concerning for Paget's disease)
• Skin (warm, dry, presence/absence of erythema, edema, peau d'orange appearance, open sores, draining fluid collections)

Clinical Significance

The findings of the breast exam are important in guiding future clinical care related to the specific complaint. For example, a lesion identified on imaging that cannot be palpated may need to be biopsied under image guidance.[5] For cellulitis or a breast abscess, clinical observation of the breast is crucial for determining whether the infection is responding to therapy. The presence or absence of palpably enlarged lymph nodes at the initiation of malignancy treatment dictates the next steps in both surgical and oncological management.

Enhancing Healthcare Team Outcomes

Many clinicians may perform breast exams. However, it is important to understand that current guidelines do not recommend regular clinical breast exams for cancer screening for women in any risk group. However, the women should be educated on the importance of changes to the typical appearance and texture of their breasts and report any changes to their doctor right away.[11]

Review Questions

• Access free multiple choice questions on this topic.
• Click here for a simplified version.
• Comment on this article.

Figure

Breast Self-Examination. Breast Self-Examination (BSE) is a simple, proactive method that individuals can use to check their breasts for any unusual changes or signs that might indicate a potential health issue, such as breast cancer. The lymphatic system, (more...)

References

1.Siu AL., U.S. Preventive Services Task Force. Screening for Breast Cancer: U.S. Preventive Services Task Force Recommendation Statement. Ann Intern Med. 2016 Feb 16;164(4):279-96. [PubMed: 26757170]2.Hens JR, Wysolmerski JJ. Key stages of mammary gland development: molecular mechanisms involved in the formation of the embryonic mammary gland. Breast Cancer Res. 2005;7(5):220-4. [PMC free article: PMC1242158] [PubMed: 16168142]3.Fendrick JL, Raafat AM, Haslam SZ. Mammary gland growth and development from the postnatal period to postmenopause: ovarian steroid receptor ontogeny and regulation in the mouse. J Mammary Gland Biol Neoplasia. 1998 Jan;3(1):7-22. [PubMed: 10819501]4.Dugoff L, Pradhan A, Casey P, Dalrymple JL, Abbott JF, Buery-Joyner SD, Chuang A, Cullimore AJ, Forstein DA, Hampton BS, Kaczmarczyk JM, Katz NT, Nuthalapaty FS, Page-Ramsey SM, Wolf A, Hueppchen NA. Pelvic and breast examination skills curricula in United States medical schools: a survey of obstetrics and gynecology clerkship directors. BMC Med Educ. 2016 Dec 16;16(1):314. [PMC free article: PMC5162080] [PubMed: 27986086]5.Weiss JE, Goodrich M, Harris KA, Chicoine RE, Synnestvedt MB, Pyle SJ, Chen JS, Herschorn SD, Beaber EF, Haas JS, Tosteson AN, Onega T., PROSPR (Population-based Research Optimizing Screening through Personalized Regimens) consortium. Challenges With Identifying Indication for Examination in Breast Imaging as a Key Clinical Attribute in Practice, Research, and Policy. J Am Coll Radiol. 2017 Feb;14(2):198-207.e2. [PMC free article: PMC5292278] [PubMed: 27744009]6.Anderson BL, Urban RR, Pearlman M, Schulkin J. Obstetrician-gynecologists' knowledge and opinions about the United States Preventive Services Task Force (USPSTF) committee, the Women's Health Amendment, and the Affordable Care Act: national study after the release of the USPSTF 2009 Breast Cancer Screening Recommendation Statement. Prev Med. 2014 Feb;59:79-82. [PubMed: 24246966]7.US Preventive Services Task Force. Screening for breast cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2009 Nov 17;151(10):716-26, W-236. [PubMed: 19920272]8.Cheng TM, Freund KM, Winter M, Orlander JD. Limited adoption of current guidelines for clinical breast examination by primary care physician educators. J Womens Health (Larchmt). 2015 Jan;24(1):11-6; quiz 16-7. [PubMed: 25405388]9.Bevers TB, Helvie M, Bonaccio E, Calhoun KE, Daly MB, Farrar WB, Garber JE, Gray R, Greenberg CC, Greenup R, Hansen NM, Harris RE, Heerdt AS, Helsten T, Hodgkiss L, Hoyt TL, Huff JG, Jacobs L, Lehman CD, Monsees B, Niell BL, Parker CC, Pearlman M, Philpotts L, Shepardson LB, Smith ML, Stein M, Tumyan L, Williams C, Bergman MA, Kumar R. Breast Cancer Screening and Diagnosis, Version 3.2018, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw. 2018 Nov;16(11):1362-1389. [PubMed: 30442736]10.Beitler AL, Hurd TC, Edge SB. The evaluation of palpable breast masses: common pitfalls and management guidelines. Surg Oncol. 1997 Dec;6(4):227-34. [PubMed: 9775409]11.Russo J, Russo IH. Toward a physiological approach to breast cancer prevention. Cancer Epidemiol Biomarkers Prev. 1994 Jun;3(4):353-64. [PubMed: 8061586]

Disclosure: Jessica Henderson declares no relevant financial relationships with ineligible companies.

Disclosure: Doug Duffee declares no relevant financial relationships with ineligible companies.

Disclosure: Troy Ferguson declares no relevant financial relationships with ineligible companies.

Copyright © 2025, StatPearls Publishing LLC.

This book is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) ( http://creativecommons.org/licenses/by-nc-nd/4.0/ ), which permits others to distribute the work, provided that the article is not altered or used commercially. You are not required to obtain permission to distribute this article, provided that you credit the author and journal.

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• Cite this PageHenderson JA, Duffee D, Ferguson T. Breast Examination Techniques. [Updated 2023 Jan 16]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-.

In this Page

• Continuing Education Activity
• Introduction
• Anatomy and Physiology
• Indications
• Contraindications
• Preparation
• Technique or Treatment
• Clinical Significance
• Enhancing Healthcare Team Outcomes
• Review Questions
• References

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