Breast Examination

Question 1

Introduction?

Answer 1

1. wash hands
2. introduce self to patient
3. confirm patient name and age
4. have you ever had a breast exam?
5. ask for any breast complaints?
6. explain examination
7. gain consent
   Note: you need a chaperone

Question 2

Inspection?

Answer 2

1. asymmetry
2. swelling
3. masses
4. skin changes
5. nipple changes

Question 3

Movements during inspection?

Answer 3

1. pressing in to hips
   - contraction of pectoralis major
2. hands behind head and push elbows back
3. bend forward with hands behind your head
   - exaggerates skin dimpling

Question 4

Palpation?

Answer 4

patient lies in supine
1. start with the breast with no complaint
2. ask patient to put the hand on the side you are examining behind their head
3. palpate all 4 quadrants in a circular motion using the flat palmar surface of your fingers
- note masses and areas of tenderness
4. palpate the axillary tail
5. ask patient to palpate the nipple to check for discharge
- pinch between thumb and index finger
6. palpation of lymph nodes
Note: if you find a lump examine the rest of the breast first then further inspect the lump

Question 5

Examination of a breast lump?

Answer 5

1. size
2. borders
3. fluctuance
4. location
5. consistency
6. attached to structures underneath
   - ask patient to tense chest muscles whilst you are holding the lump

Question 6

Examine axillary nodes?

Answer 6

1. size
2. consistency
3. fixation

Question 7

Palpation of lymph nodes?

Answer 7

1. supraclavicular
2. infraclavicular
3. cervical

Question 8

Further investigations?

Answer 8

1. ultrasound
2. is lump secondary to something else
   - disseminated malignancy
3. biopsy
4. fine needle aspiration of the mass