i have large breasts so i have had this type of breast exam. it helps the doctor feel through my dense breast tissue. i would prefer to be examined while on my hands and knees with my breasts dangling freely down
there is no real need to be in your "hands and knees" so the Doctor can make a good bimanual breast palpation with your breasts hanging free from the chest wall: this what I do in playexams: I have the topless patient seated at the front of the exam table betwenn the knee-crushes. then I sit in front of her on medical stool that puts me in a lower position than her: I then ask her and help her to lean forward resting her hands at my shoulders: this position is ideal for feeling the differences in breast density and possible lumps, tenderness or other clynical signs that coul be missed in laying down palpation.
All the hanging breast tissue is palpated between my 2 hands and axilary tails are simetrically palpated and compared.
This step is fourth of my breast examination (only with very small breasts I won't do this).
first I start with inspection, static and dynamic moving to light and deep axilary lymphnodes (all the 4 chains, central, lateral, subscapular and pectoral) and supra and infraclacicular areas.
Systematic reclyning palpation with expression of nipples at the end complete the exam.
I will also discuss the sel-exam of the patient.
I have the abilty and knowledge to identify breast clinical signs so I don't take this exam light asking also the patient if possible to bring the last mamogram or echo to the exam for me to take a look before physical examination.
Breast Exam must have present the 7 p's:
positions, palpation, perimeter, pattern of search, pads of fingers for palpation, pressure, and patient education.