Breast Examination

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Breast Examination

• Dr Polly Drew

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Introduction

• Wash hands
• Introduce
• Position patient sat on the edge of the couch
• Explain the examination
• Reposition
• Is there an area of concern and are you in any
  pain?
• Explain that you would have a chaperone (if male)

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General Inspection

• Age?
• Obese?
• Cachetic?
• Jaundice?
• Cyanosis?
• Pallor?
• Asymmetry
• Scars?

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Inspection

• Arms by side
• Arms in the air
• Arms behind head
• Hands on hips
• Press on hips
• ? Obvious lump/tethering/inflammation/nipples
  puckering/skin tethering?

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Palpation

• Position at 45 degrees on the couch
• Ask pt to point to lump
• Enquire about tenderness
• Do the normal breast first
• Palpate each quadrant
• Palpate the areolar area (ask specific permission)

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Palpation

• Ask patient to lift arm up examine the axillary
  tail
• Ask the patient to lift their arm, put the weight
  of it on yours, and then palpate for axillary
  nodes
• Palpate the supra and infra-clavicular nodes

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Palpation

• Go on to examine the breast with the area of
  concern in the same way
• Test fixation by asking patient to tighten
  pectoralis mm
• Ask the examiner if they would like you to
  ellicit a nipple discharge

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Then

• Cover the patient
• Turn to the examiner
• Stethoscope behind your back
• Look examiner in the eyes!!

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I would complete my examination..

• (If indicated)
• By palpating for boney tenderness of the spine
• Palpating for hepatomegaly
• Percussing both bases to ellicit pleural
  effusions

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Describing a breast lump

• Site
• Number of lumps
• Size
• Shape
• Surface
• Temperature
• Consistency (hard/rubbery/soft)
• Mobility

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Differentials for a breast lump

• Fibroadenoma
• Fibrocystic adenoma
• CA
• Phyllodes tumour
• Fat necrosis
• Etc

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Investigating a breast lump

• TRIPLE ASSESSMENT
• 1. Clinical
• 2. Radiological u/s scan / mammogram
• 3. Histological FNA, punch biopsy, open
  excision and biopsy
• Metastatic assessment CXR, spinal imaging, abdo
  USS