BREAST EXAMINATION
1. IINTRODUCTION AND CONSENT
2. EXPOSURE
From supraclavicular fossa up to waist of the patient
3. POSITION
Sitting position (not good for palpation)
Lying position
Recumbent position (45 degrees, best)
Sitting with arms raised above head ( for axilla inspection)
Sitting with bending forward
4. INSPECTION
Sitting with hands on sides, then with arms raised above head, then
bending forward
Compare both breasts
Nipple
Position
Size and shape
Retraction
Cracks/fissure
Eczema
Discharge
Areola
Cracks/fissures
Ulcer
Eczema
Discharge
Swelling
Skin
Peau d’ orange
Visible lump
Colour
Fungation
Scar marks
Size of the breasts and symmetry
Compare both breasts
Arms and thorax
Cancer-en-cuirasse
Edema of arms
Axillary fungation/discharge
Accessory nipples or ectopic breast tissue
5. PALPATION
(Sitting position and then recumbent position)
PALPATE NORMAL BREAST FIRST
BREAST TISSUE
(with flat of hand)
AREOLA
NIPPLE
Discharge on pressing
PALPATION OF LUMP
Size
Shape
Site…….mention quadrant
Tenderness
Temperature
Surface
Consistency
Margins
Compressibility
Mobility
Fluctuations
Fixity to skin
Fixity to breast tissue
Fixity to underlying muscles
o Pectoral fascia and pect. Major muscle (for lump in in upper outer.upper
inner and lower inner quadrants…..ask patient to press her hand against
hips to contract the muscle and check mobility of lump in transverse and
horizontal planes)
o Serratus anterior (for lump in lower outer quadrant…..ask patient to press
her hands against wall or against your hand and bend forward and check
for mobility/fixity
6. PALPATION OF AXILLARY LYMPH NODES
o From front
Lateral group (with same hand)
Anterior and central group (with opposite hand)
o From back
Posterior group (with same hand)
7. PALPATION OF CERVICAL LYMPH NODES
Especially supraclavicular group….by asking her to shrug shoulders
8. PALPATION OF LIVER
For metastatic workup
9. ASCULTATION OF CHEST
For metastatic work up
10. COVER AND THANKS