Breast Examination

General Principles

  • Explain the examination and the reason prior to examining
  • Obtain consent
  • Have a chaperone present and document this (along with the chaperone’s name)
  • Ask about any areas of pain
  • Allow the patient to get undressed and dressed in privacy
  • Ask the patient to point out any abnormalities they have noticed
  • Use your examination to teach the patient how to self examine

 

Inspection

Examine the patient relaxed, while lifting hands overhead and pressing hands into hips (tensing muscles of the chest wall)

  • Scars
  • Cosmetic Augmentation
  • Asymmetry (size/shape)
  • Tethering or fixation of overlying skin
  • Nipple eversion/inversion
  • Nipple discharge
  • Erythema
  • Peau D’orange
  • Paget’s disease of the nipple

 

Palpation

  • Place flat part of fingers over the area and roll tissue underneath
  • If necessary support tissue with your other hand
  • Examine away from the abnormal area first to note patients normal breast tissue and so as not to miss other lumps
  • Choose a strategy so as not to miss any areas (including four quadrants, subareolar and axillary regions).

 

Examining the Lump

  • Location
  • Size
  • Shape (round / oval / irregular)
  • Consistency (soft / firm / hard)
  • Margins (irregular / smooth)
  • Mobile / fixed to skin or chest wall
  • Tenderness
  • Discharge
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