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Positioning Challenge #5 – Nipple Excessive Exaggeration (CC view)

Kathy Willison – Senior Clinical Product & Onboarding Manager – Published on November 12, 2018

The second positioning challenge for the CC view is excessive exaggeration of the nipple.

Is Nipple Excessive Exaggeration a Real Issue?

The CC should be acquired with the nipple centrally located to the breast, without medial or lateral exaggeration. This maximizes visualization of medial tissue while optimizing capture of the lateral breast tissue. Obtaining the CC with exaggeration in one direction or the other potentially omits medial tissue from the two-view mammogram, as the MLO may not capture medial tissue well. On the other hand, extreme medial exaggeration does not optimally capture and demonstrate posterior-lateral breast tissue. Nipple Midline is achieved in the CC view when the PNL is perpendicular to the chest wall without medial or lateral exaggeration. The breast is brought forward such that the medial tissue is visualized and the lateral tissue is optimally brought into view without loss of medial tissue.

Helpful Positioning Tips

Struggling to achieve Nipple Midline? Our partners at Mammography Educators, LLC have provided the following tips:

  • Choose the appropriate image paddle size so that you can properly center the breast on the image receptor and keep good control of the breast while applying compression.
  • Have the patient stand so that she is facing the mammography system.
  • Standing on the medial side of the breast to be imaged, pick up the breast with your hands in an under-and-over position.
  • Lift and draw the breast onto the image receptor so that the nipple is centrally located, with the medial tissue captured and the posterior lateral tissue optimized.
  • Ensure that the patient’s body does not turn to either side, which may result in medial or lateral exaggeration.
  • Gently move your hand toward the nipple as you apply compression.

This is the final post in our series of the Top Mammography Positioning Issues. We hope you have enjoyed the series. Please reach out to us to learn more about how you can take advantage of Actionable Breast Imaging Analytics. If you are attending RSNA, stop by booth #2565 in the South Hall, November 25–30, 2018, or visit to request a demo.