asymmetry of breast – swelling, skin changes and scar, wasting  or deformity 
    dimpling, paudorage  – nipplesz normal and equal 
 keep hands at hip and push down 
 pulls hand with each other 
 lifts the hands up 
Axilla – examination – 
 slow and rolling movement ( anterior, posterior and apex ) 
Palpation – patient laying flat with hand over the head – 
  including the tail of the breast 
  first soft and then hard 
palpate the nipple 
get patient to express any discharge 
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