Examination of the breast of the patient in the supine position
To do this, ask the patient to lie on his back. It is better to examine the mammary gland in the position when it is freely located (spread) on the chest. This position is achieved when a small pad is placed under the shoulder on the same side, and the arm is held behind the head. The highest accuracy of breast palpation is achieved when there is a minimum amount of gland tissue between the skin and the chest. The doctor should evaluate the mammary gland as a whole by palpating from the sternum to the mid axillary line and from the clavicle to the edge of the costal arch.
Palpation is carried out with the whole palm or only with your fingers, and it should be remembered that the desired changes may be minor. Examine all quadrants of the breast. Because of the greater frequency of malignant tumors in the upper outer quadrant, we made it a rule to start the examination with this quadrant, palpating the rest in the clockwise direction and returning to the upper outer quadrant (palpable twice). In some women, palpation of a tumor with a diameter of less than 1 cm is available, and other tumors of a larger size may remain unnoticed.
The physician must evaluate the consistency of the main mass of breast tissue, in premenopausal patients, examined before menstruation, it is apparently impossible to assess the accumulation of swollen glandular tissue. Repeated study after 1-2 weeks. after menstruation can reveal a significant decrease in glandular elements. After menopause, the amount of adipose tissue prevails over the glandular elements, which makes palpation and mammography more accurate. These patients do not have cyclic changes in the mammary gland, therefore, an increase in its density over time can be more significant in them than in women during the premenopausal period.
During the examination in the supine position, it is necessary to look for bulk formations or areas of significant tissue compaction. Malignant tumors are characterized by dense or massive lesions with a heterogeneous structure, fixed to the skin or underlying fascia. Benign tumors tend to have a softer texture and a smoother surface, sharper edges and free dislocation. Fibroadenoma, the most frequent benign breast disease, occurs in young women, and it is easiest to diagnose. Fibroadenomas have clear boundaries and are felt in the form of solid (“marble”) balls, sharply different from dense glandular parenchymal tissue.