MINOR SX 2

Dr. Wallace Medina

 CLINICAL BREAST EXAMINATION

• Physical examination of the breast done by a health

professional

• Breasts vary in sensitivity and texture at different

times during the menstrual cycle and different stages
of life

• A small percentage of cancers are discovered during

breast self-exams; most are benign
 CLINICAL BREAST EXAMINATION
Performing the breast examination
1. Explain to the patient the purpose of the CBE and secure consent.
For male physicians, it is prudent to be accompanied by a female
companion, preferably, a nurse or other paramedical personnel.
2. Ask the patient to disrobe and start by looking closely at the breasts
with arms at the sides and look for puckering, dimpling or changes in
size, shape or symmetry. Check to see if the nipples are inverted.
3. Inspect the breasts with the patient’s arms in two other positions:
hands on the hips and hands raised overhead, palms pressed
together.
4. With the patient in supine position, the examiner's hand is moved
over the breast using one of three techniques:
 CLINICAL BREAST EXAMINATION

Clock pattern Wedge pattern

Sweeping technique
 CLINICAL BREAST EXAMINATION

Performing the breast examination

5. Check the nipple for any discharge by gently pinching the

nipple with the fingers positioned at 12 o'clock and 6 o'clock
and again with fingers at 3 o'clock and 9 o'clock.

6. If any changes, such as a mass, thickening, asymmetry,

dimpling, redness, nipple discharge or nipple inversion is
detected → fine needle aspiration or excision biopsy as
necessary
 CBE: FINDINGS
Normal:
• The nipples, breast tissue, and areas around the breast look
normal and are normal in size and shape
• One breast may be slightly larger than the other
• A small area of firm tissue may be present in the lower curve of
the breast below the nipple
• Tenderness or lumpiness that occurs in both breasts
• Lumpiness or thickening in both breasts during the menstrual
cycle
• Clear or milky discharge (galactorrhea) may be present when
the nipple is squeezed (i.e. nursing, breast stimulation,
hormones, or some other normal cause)
 CBE: FINDINGS

Abnormal:
• A firm lump or area of thickening
• Changes in the color or feel of the breast or nipple (e.g.
wrinkling, dimpling, thickening, or puckering or an area that
feels grainy, stringy, or thickened
• A red, scaly rash or sore on the nipple
• Redness or warmth over a painful lump or over an entire
breast (i.e. abscess or mastitis or cancer)
• Spontaneous bloody or milky discharge (galactorrhea) without
stimulation
 When to perform clinical breast examination?

• General recommendation: A female should have a clinical breast

exam by a health professional at age 20 then, every three years until
the age of 40.

• After age 40, a clinical breast exam and a mammogram are done
every year.

• The best time to perform a breast self-exam is about a week or 7-10

days at the start of the monthly period.
INCISION AND DRAINAGE OF ABSCESS (I & D)
 INCISION AND DRAINAGE OF ABSCESS (I & D)

What is an abscess?
• Abscesses are localized infections of tissue marked by a
collection of pus surrounded by inflamed tissue

• May be found in any area of the body, but most abscesses

presenting for urgent attention are found on the extremities,
buttocks, breast, perianal area, or from a hair follicle

• Causative organisms commonly include Streptococcus,

Staphylococcus, enteric bacteria (perianal abscesses), or a
combination of anaerobic and gram-negative organisms
 INCISION AND DRAINAGE OF ABSCESS (I & D)

Why drain an abscess?

• Abscess resolve by drainage.

• Larger abscesses will require incision to drain them, as the

increased inflammation, pus collection, and walling off of the
abscess cavity diminishes the effectiveness of conservative
measures

• Smaller (<5mm in diameter) abscesses may resolve to

conservative measures (warm soaks) to promote drainage
 INCISION AND DRAINAGE OF ABSCESS (I & D)

Contraindications:
1. Extremely large abscesses which require extensive incision,
debridement, or irrigation (best done in the OR)
2. Deep abscesses in very sensitive areas (supralevator,
ischiorectal, perirectal) which require a general anesthetic
to obtain proper exposure
3. Palmar space abscesses, or abscesses in the deep plantar
spaces
4. Abscesses in the nasolabial folds (may drain to sphenoid
sinus, causing a septic phlebitis)
 INCISION AND DRAINAGE OF ABSCESS (I & D)

Materials:
1. Universal precautions materials
2. 1% or 2% lidocaine WITH epinephrine for local anesthesia, 10
cc syringe and 25 gauge needle for infiltration
3. Skin prep solution
4. Scalpel blade #11 with handle
5. Draping
6. Gauze
7. Hemostat, scissors, packing (plain or iodoform, 1/2”)
8. Tape
9. Culture swab
 INCISION AND DRAINAGE OF ABSCESS (I & D)

Pre-procedure education:
1. Obtain informed consent
2. Inform the patient of potential severe complications
and their treatment
3. Explain the steps of the procedure, including the not
insignificant pain associated with anesthetic
infiltration
4. Explain necessity for follow-up, including packing
change or removal
 INCISION AND DRAINAGE OF ABSCESS (I & D)

Procedure:
1. Observe universal precautions
2. Cleanse site over abscess with skin prep
3. Drape to create a sterile field
4. Infiltrate local anesthetic and allow 2-3 minutes for
anesthetic to take effect
5. Incise widely over abscess with the #11 blade,
cutting through the skin (Figure 1) into the abscess
cavity. Follow skin fold lines whenever able while
making the incision
Figure 1: Making the incision
 INCISION AND DRAINAGE OF ABSCESS (I & D)

Procedure:
6. Allow the pus to drain, using the gauzes to soak up
drainage and blood. Use culture swab to take culture
of abscess contents, swabbing inside the abscess
cavity
7. Use the hemostat to gently explore the abscess
cavity to break up any loculations within the abscess
8. Using the packing strip, pack the abscess cavity
(Figure 2)
Figure 2: Packing the abscess

Gauze strip for

drainage

9. Place gauze dressing

over wound and tape in place