History and Physical

Examination of the
Breast

Radhika L Gen Surgery TTSH 07

 History

 Age
 History of lump/nipple d/c
- Risk Factors

Prolonged estrogen exposure

 early menarche
 late menopause
 late age of 1st live birth ( > 30 )
 OCP/HRT

- Alcohol
- Smoking
- Ionizing radiation
- genetic predisposition ( aberrations in BRCA 1 and 2 genes )
- family history ( maternal )
- Hx of pre-malignant lesions
 Physical Examination
Basics
 introduce yourself

 ask permission for examination

 exposure to waist

 which is problem breast

 where is problem
 Inspection
 At rest ( sitting up )
 Arms lifted up
 Hands pressed on hips
 Inspection
 Size : symmetry / breast conyour
 skin changes ( include submammary fold )
-puckering,peau
d’orange,nodules,discolouration
 ulceration,telengiectasia,surgical scars
 nipples and areolae:inversion,discharge,skin
changes
 axillae ,arms and neck
 Palpation
 Reclined position 45 degrees ( ipsilateral arm
raised above and relaxed over the head )
 palpate normal breast first
 flat of hand palpate circumferentially
 each quadrant
 areola and nipple ( press areola )
 axillary tail
 Breast Lump
 Site,size,shape,surface,edge,colour,consistency
,temperature,tenderness,relations to
surrounding tissues
 Mobility of lump in 2 directions ( pect major
relaxed and contracted --hands on hips )
 Axillae
 Support patient’s elbow and forearm with your
ipsilateral hand and forearm
 Examine left axilla with R hand and vice versa
 Feel palpable lymph nodes
 pectoral ,subscapula,central,lateral,apical
 lateral to medial fashion or vice versa
 General Examination
 Supraclavicular lymph nodes
 Arms ( lymphoedema )
 Abdomen : hepatomegaly ;ascites
 Per rectal : Pouch of Douglas nodules
 Lumbar spine ( percussion ,neurological
deficits )
 Lungs