Breast Examination
1
Ali Abdulazeem
Breast Examination
Ali Abdulazeem
2015/2016
Breast Examination
2
Ali Abdulazeem
Position:
- The patient must be fully undressed to the waist.
- upper body raised at 45° to the legs.
- Lying flat, which makes the breasts fall sideways.
- And sitting upright, which makes the breasts pendulous.
- Ask the patient to raise her arms above her head.
- Ask the patient to press her hands against her hips to tense the pectoral muscles.
- Patients sometimes say that their lump can only be felt when they adopt a certain
posture, e.g. standing or lying on one side, and they should therefore be examined in this
position as well.
Inspection:
- Inspect in various positions.
1. Size
2. Symmetry
3. Skin:
Puckering,
Odema (peau d’orange),
Nodules,
Discolouration,
Ulceration.
4. The nipples and areolae:
Look for (7Ds):
Destruction,
Depression
(retraction or inversion)
,
Discolouration,
Displacement,
Deviation,
Discharge,
Duplication.
- Inversion of nipple could be unilateral or bilateral, unilateral inversion is more
significant.
- Nutaral nodules (Montgomery’s tubercles).
Breast Examination
3
Ali Abdulazeem
5. Discharge:
Character
Cause
Red (blood)
Pink (serum blood)
Clear pale yellow (serum)
Duct papilloma
Duct carcinoma
Duct ectasia
Brown
Green
Black
Duct ectasia
Cysts
Creamy white or yellow (pus)
Thin white (milk)
Duct ectasia
Lactation
Breast Examination
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Ali Abdulazeem
6. Inspect the axillae, arms and supraclavicular fossae.
Palpation:
1) The breast:
- palpate with the flat of the fingers, With the patient sitting up at 45°.
- Palpate in various positions, you may ask the patient to tense the underlying muscles.
- Feel both breasts together, then feel the axillary tail.
- bimanual examination of lumps, controlling movement of the lump with one hand and
feeling it with the other.
- Lump examination: SET CFR DPB
- Fixed lump: a lesion cannot be moved or separated from skin.
- Tethered lump: A tethered lesion puckers and pulls the skin inwards, but remains
separate from the skin and can be moved independently.
2) The nipple:
- If there is nipple inversion, try to evert it or ask the patient do it for you, If the nipple
will not evert, there is likely to be underlying disease.
- Discharge: gently press and observe whether any fluid comes out.
- Character of the fluid: red, white, creamy yellow or watery.
3) The axillae:
- Right axilla:
▪ Stand on the patient’s right side
▪ Take hold of her right elbow with your right hand and let her forearm rest on your
right forearm.
Y
ou should hold the weight of her arm
;
▪ Place your left hand flat against the chest wall and feel for any glands that may lie
in the central or medial aspects of the right axilla
;
▪ Reach the apex by pushing the tips of your fingers upwards and inwards;
▪ Feel the edge of the pectoralis minor muscle and the axillary tail
;
▪ Feel the subscapular glands on the posterior wall of the axilla;
Breast Examination
5
Ali Abdulazeem
▪ Feel the lateral aspect of the axilla
- To palpate the left axilla, hold her left elbow with your left hand and use your right
hand to feel the axilla.
- Or ask her to place her hands on her iliac crests and slacken her muscles, and then
approach from in front.
4) palpate the supraclavicular fossa and the neck.
Don't forget to examine:
1.
Check the arms for swelling or any neurological or vascular abnormalities.
2.
Palpate the abdomen looking for hepatomegaly or ascites,
3.
Examine the lumbar spine for pain or restricted movements.