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Everything you need to know about visiting the Ob-Gyn

Palpation of the Breasts

 

Palpation Technique

Following the head-to-toe path of the body, the seated exam begins by palpating the supraclavicular and infraclavicular lymph nodes located above and below the clavicle (collar bone). So that you are not unnecessarily exposed, be advised that you may raise your gown up to just below the collarbone (either tucking it under your arms, or putting your arms into the sleeves). The doctor should let you know that you are beginning the physical exam and explain what she/he is doing.

The technique they will use is the same technique used for self breast examination so I will describe it in detail. This palpation technique should be used throughout the breast exam. With the pads or flats (the entire area from the last joint to the end of the finger) of the 3 middle fingers (or 2, depending on hand size) apply a light, medium, then deep pressure in dime-size circles (imagine tracing the outline of a dime with your middle finger). The light pressure is very gentle, enough to move the skin without disturbing the tissue underneath. The deep pressure should be deep enough to reach the chest wall. The pads are the most sensitive part of the fingers, so the tips should not be used. Holding your hands straight or even bowed back a little will help keep your fingers flat. After each palpation, drag fingers to the next location, allowing them to overlap the areas palpated. A good technique for dragging after each circular palpation, and to ensure proper spacing, is to step over about 2 cm (or about 1 inch) with the leading finger, then slide the other two fingers over, being careful to keep the 3 fingers together for the next palpation. Be sure not to lift all 3 fingers from the surface as you don’t want to lose your place. The doctor should begin palpating supraclavicular and infraclavicular lymph nodes.

Palpation of the Breasts

Now the doctor should palpate the right breast and axilla. (It doesn’t matter which breast is examined first, as long as the breasts are examined one at a time, and that both breasts of patient are to be examined.) The doctor may want to use cornstarch powder (baby powder) dispensed from an individual container so that there fingers glide more easily. You can also use cornstarch to make self-exam more comfortable. So that you are not unnecessarily exposed, you may cover your left breast. Expose only what is necessary to examine at the time.You should be asked to either place your right hand on your hip, or your arm over your shoulder. Using the 3 degrees of pressure and the pads of their 2 - 3 fingers, the doctor begins to palpate the breast tissue starting at the top of the tail. The breast tissue goes up this high and is more than what fits into the bra cup; this should also be a part of your monthly self-exam. Never losing contact with the breast tissue, the doctor drags her/his fingers to the next location; overlapping the areas palpated. In horizontal strips, they palpate the upper boundary of breast tissue, starting near the collarbone, back and forth from the sternum to the axilla, working down to the beginning of the breast fullness, the part of the breast that fits into the bra cup.

Continue on to Manual Mammogram

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