Golden rule: examine both breasts in lying and sitting positions, palpate the normal side first.
Inspection
Breast Assess size, shape, symmetry, skin changes, dilated veins, dimpling, puckering, ulceration, peau d'orange, and nodules
Nipples

Assess level, direction (normally, downward, forward and lateral), retraction, discharge

Look for the 6 Ds: Destruction, Deviation, Depression (retraction), Discoloration, Discharge, and Dermatitis

Areola Color, surface, size
Palpation
Breast

Palpate the normal side first

Palpate the following 7 areas: 4 breast quadrants, subareolar region, axillary tail, and the undersurface of the breast

Mass: site, size, shape, tenderness, mobility, surface (smooth vs irregular), consistency (cystic, soft, firm, hard), edge (well vs ill defined), relation to surroundings (skin, muscles)

Axillary lymph nodes

Consistency: hard/rubbery, nodular/smooth

Size and mobility (fixed/mobile)