secondary sexual characteristics, hirsutism, or abnormal skin coloring may indicate the presence of an endocrinopathy A detailed evaluation of the breasts and adjacent structures is essential The chest wall should be inspected for any gross deformities, asymmetry, or skin changes The physician should have the patient lean forward with hands on hips and again observe for any asymmetry or skin retraction With the patient supine with arms above the head, the physician should palpate each breast in a series of concentric circles radiating outward from the nipple, looking and feeling for nodules, cysts, masses, or inconsistencies in the breast tissue Each areola should be gently compressed to assess for masses or nipple discharge If present, the color, character, and odor of any discharge should be noted The physician should feel for the presence of any masses or lymphadenopathy in both axillae