BREAST EXAMINATION

 INTRODUCE yourself to the patient. EXPLAIN the examination to the

patient, this will make the patient be aware and expect what to feel upon
examination. SINCE I’m a male examiner, explain need for a chaperone, I
could ask the patient relative or female staff to accompany the exam.
 A complete history should begin with the review of patient’s concerns
and risk factors such as in personal history, family history, and
reproductive history. Most significant risk factors are AGE, BRCA
STATUS, BREAST DENSITY ON MAMMOGRAM.
 Take the opportunity for patient education and discussing benefits of
breast exam, this will help patient rapport and enhance patient
understanding and compliance.
 Be respectful of different cultural and modesty issues.
INSPECTION
 Adequate inspection may require full exposure of the chest, but we may
cover one breast when palpating the other.
 Before asking the patient to do any position, do GENERAL INSPECTION
FIRST. Note for…..
 Arms on the side: Skin COLOR, THICKENING (PROMINENT PORES), SIZE
& SYMMENTRY, CONTOUR OF BREASTS, SIGNS OF INFECTION
 Nipples: SIZE, SHAPE, DIRECTION they point, DISCHARGE or rashes
PALPATION
 ASK and EXPLAIN again to the patient.
 Patient should be on supine, 45 deg angle HAND BEHIND the head
 Palpate gently along the scar using tip of 2nd – 4th fingers in circular
motion
 Palpate in small, concentric circles applying light, medium, and deep
pressure at each examining point. Vertical-strip pattern/Radial/Spiral
method
 Lateral breast – supine, put hand on her forehead, begin in AXILLA
 Medial breast – lie shoulders flat against the bed, bring down hand at
level of shoulder. Begin NIPPLE DOWN TO BRA LINE, then go back to
clavicle, then to the mediastinum
 NIPPLE: HISTORY OF NIPPLE DISCHARGE, ASK PX TO SQUEEZE THE
NIPPLE
-History of nipple discharge
-Palpate areola with index finger
BREAST MASS
 Note for: CONSISTENSY of tissues (FIRM/SOFT), TENDERNESS (MAY
OCCUR PRIOR TO MENSES)
NODULES: Location (QUADRANT), Size (IN CMs), Shape
(ROUND/CYSTIC), Mobility (IN RELATION TO SKIN)
 Examine entire breast including periphery and axilla.