Breast Examination
Content
BREAST EXAMINATION GET A (SAME SEX) CHAPERONE!!! HIPEEP Hand-wash Introduce self Permission (verbal consent) Explain examination Expose Position sitting => 45o PAINFUL areas/lumps? INSPECTION pt sat on edge of bed GENERAL (END OF BED) INSPECTION cachexia, mastectomy, prosthesis, dressings PERFORM INSPECTION - AT REST - ARMS ABOVE THEIR HEAD allows you to see the axilla - PRESS HANDS AGAINST HIPS (PECTORAL CONTRACTION MANEOUVRE) accentuates fixations to muscle (lumps less mobile if muscle tensed) CLOSER INSPECTION OF BREAST noting: - size - symmetry - contour - colour - scars - venous pattern on the skin - dimpling/ tethering of the skin - ulceration - skin - eczema - visible nodularity? - peau d orange; rare, caused by local oedema, seen in Br Ca and post-radiotherapy CLOSER INSPECTION OF NIPPLE - symmetry - everted/flat/inverted? - discharging - single duct (~ papilloma/ Ca) or multiple duct (duct ectasia)? - scaling? ~ eczema/ Paget s disease of the breast - any extra nipples? occur anywhere along mammary line
PALPATION pt at 45o PALPATE SUPRACLAVICULAR FOSSA 30% of the lymph from the breast drains to supraclavicular LNs PALPATE BREASTS hands behind head for access to upper outer quadrant - PALPATE NORMAL BREAST FIRST, beginning with asymptomatic side!! - systematically palpate each quadrant, not forgetting axillary tail of Spence - if you find a lump, note- position - shape - size - surface - consistency - tenderness - temperature - mobility - tethered/ fixed (tethering allows some movement before pulling on skin) - assess in 2 planes; up/down, left/right - see how it changes with the pectoral contraction manoeuvre - no mobility whatsoever suggests invasion of chest wall - ask the PATIENT to squeeze the nipple to assess for discharge (if pt is c/o of it) - note - colour - milky/ serous/ green-brown ~ benign - blood? ~ papilloma/ Ca - smell PALPATE THE AXILLAE - take their right arm in your right arm and palpate with your left and vice versa - palpate medially, laterally, posteriorly, anteriorly, apically (PALPATE INFRACLAVICULAR NODES) PERCUSSION of the spine tenderness suggesting bony metastases
THANK & COVER PATIENT
TO COMPLETE THE EXAMINATION - palpate neck lymph nodes - full abdominal exam nodular hepatic edge/ hepatomegaly would suggest liver mets - full respiratory exam pleural effusions would suggest lung mets - triple assessment; hx/exam + histology (FNA/biopsy) + radiology (mammography/US)
COMMON CASES - FIBROADENOMA - BREAST CARCINOMA - BREAST CYSTS - PAGET S DISEASE OF THE BREAST - POST-BREAST SURGERY
PALPATION pt at 45o PALPATE SUPRACLAVICULAR FOSSA 30% of the lymph from the breast drains to supraclavicular LNs PALPATE BREASTS hands behind head for access to upper outer quadrant - PALPATE NORMAL BREAST FIRST, beginning with asymptomatic side!! - systematically palpate each quadrant, not forgetting axillary tail of Spence - if you find a lump, note- position - shape - size - surface - consistency - tenderness - temperature - mobility - tethered/ fixed (tethering allows some movement before pulling on skin) - assess in 2 planes; up/down, left/right - see how it changes with the pectoral contraction manoeuvre - no mobility whatsoever suggests invasion of chest wall - ask the PATIENT to squeeze the nipple to assess for discharge (if pt is c/o of it) - note - colour - milky/ serous/ green-brown ~ benign - blood? ~ papilloma/ Ca - smell PALPATE THE AXILLAE - take their right arm in your right arm and palpate with your left and vice versa - palpate medially, laterally, posteriorly, anteriorly, apically (PALPATE INFRACLAVICULAR NODES) PERCUSSION of the spine tenderness suggesting bony metastases
THANK & COVER PATIENT
TO COMPLETE THE EXAMINATION - palpate neck lymph nodes - full abdominal exam nodular hepatic edge/ hepatomegaly would suggest liver mets - full respiratory exam pleural effusions would suggest lung mets - triple assessment; hx/exam + histology (FNA/biopsy) + radiology (mammography/US)
COMMON CASES - FIBROADENOMA - BREAST CARCINOMA - BREAST CYSTS - PAGET S DISEASE OF THE BREAST - POST-BREAST SURGERY
