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