Breast Examination
Introduce yourself
Exposure: to umbilicus (not infront other pt.
& ask for chaperon)
1- Inspection (45o →
RAISING ARM → ELEVATE BREAST→ HAND ON WAIST)
45o Foot of bed · Symmetry → Br. symm.& Nipples same
level · contour → regular/irregular
OR Side
· 4 Quadrants → Mass/ No
· Nipple → retraction/ erosion/ discharge
& areola→ fissure
· Skin: scar
(ask), stage IV signs (peau d’orange 1, ulcer 2, red,
dimples)
RAISING
ARM ·
Axillary tail & Arm for
mass · Teethering of skin
ELEVATE
BREAST
· Back of
breast → Mass/ No · Teethering of skin
HAND
ON WAIST
· 4 Quadrants →
Mass/ No · Teethering of skin
→ Describe Mass: 5S
3- Palpation (45o→ HAND ON WAIST) Ask about ds breast & Start by NORMAL breast
1-
Superficial
palpation: for mass (using pulp of middle
3 fingers) & If do not find ask pt.
· 4
quadrants · Areola
· Axillary
tail · Back of breast (inframammary area)
→
Mass 3S TT ESCRS
- Site,
Shape, Size
- Temperature, Tenderness
- Edge → well/ ill defined, - Surface
→ smooth/ irregular,
- Consistency → firm/ hard, -
Mobility in 2 planes → mobile/ fixed
- Relation to Skin (pinch) → teethered
(1 point)/ fixed (all mass)/ not
- Relation to pectoralis ms 3 (Hand on waist) →
fixed/ not
2- Axillary & Supra-clavicular L.N.s (support
by ipsilateral hand & palate by contralat. hand by tip of fingers & rolling movement)
1- Anterior group 2- Central group 3- Lateral (humeral) group 4- Apical group (bimanual below clavicle) 5- Posterior group (reverse hands)
6- Supra-clavicular
L.N. ( pt. shrug shoulders & examine from behind)
3-
Discharge: Ask pt. to express any discharge
3- Percussion of
vertebrae → tender/ not (for metastasis)
I would like to finish my examination
by:
1- Auscultation of lung base
(for malignant lung effusion)
2- Examination of Abdomen (for
hepatomegaly or ascites due to liver metastasis)
3- Percussion of back for
tender segment (if not done)
1 Ulcer = cancer encurise 2 Peau d’orange = superficial edema
3 Ask the patient to put her hands in her waist, move the mass in 2
perpendicular directions, then ask her To press against her hips, move the mass
in 2 directions (inline & perpendicular to the fibres of the pectoral
muscles), if the movement is limited then the mass is fixed to the muscle.
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