Breast Examination

Sub Bag Bedah Onkologi

Kepala & Leher
Bag/SMF Ilmu Bedah FKUP/RSHS
 Initial Evaluation of Patients with
Possible Breast Disease
 Complete medical history

 Be sure to inquire about any history of

nipple discharge or any change in size,
shape, symmetry and contour of the
breast

 Physical Examination
 Physical examination
 Inspection : note color, symmetry, size,
shape, and contour, check for dimpling,
erythema, edema, or thickening of skin
with a porous appearance ( peau d’
orange)

 Palpation : Palpate all four quadrants ,

the axillary lymph nodes, and the nipple –
areolar complex for any discharge
 Facts
 The smallest mass palpable on physical
exam is 1 cm

 All persistent breast masses require

evaluation

 If age < 30, serial physical examination

with observation for 2 to 4 weeks or until
next menstrual period is an option
 Diagnostic Options
 Physical Examinations

 Ultrasonography

 Mammography
Picture 13
T4
 Normal Variations in the Breast
 Size
 Texture - variable amounts of fibrous,
glandular, and adipose tissue.
Fibrocycstic changes are normal
 Nipple appearance - flat, erect, inverted,
small/large
 Each of these variations will change with age,
menstrual cycle, pregnancy and lactation
Three Finger Technique

 Use the circular, line,

or wedge pattern in
examining your
breasts…just be
consistent
 Use the pads of your
fingers when
examining your
breasts
 Breast Cancer Signs &
Symptoms
Look for Breast Changes that Persist:
 Lump  Skin irritation
 Retraction  Nipple discharge
 Scaliness  Swelling
 Tenderness  Distortion
 Thickening  Pain
 Dimpling
 Lumps & Thickenings
 Remember:
 Most breast lumps or thickenings are not
cancer - but every change should be
evaluated promptly!!

 All persistent breast masses require

evaluation
 SCENARIO
 Female presents complaining of nipple
pain during breast-feeding with focal
erythema and warmth of breast on
physical exam.

 Think : Mastitis ± breast abscess. Incise

and drain if fluctuance (abscess) present.
 Year-old female presents with a painful
breast mass several weeks after
sustaining breast trauma by a seat belt in
a car acident.

 Think : The most common cause of a

persistent breast mass after trauma is fat
necrosis.
 Year-old female presents with a well
circumscribed mass in her left breast. It is
mobile, nontender, and has defined
borders on physical exam.

 Think : Fibroadenoma until proven

otherwise

 Ten percent of all women develop clinically

apparent fibrocystic changes.
 Year-old female presents with a straw-
colored nipple discharge and bilateral
breast tenderness that fluctuates with her
menstrual cycle.

 Think : Fibrocystic changes. Consider a

trial of OCPs or NSAIDs.
 Year-old female presents with breast pain
that does not vary with her menstrual cycle
with lumps in her nipple – areolar complex
and a history of a nonbloody nipple
discharge.

 Think : Mammary duct ectasia.

 Year-old female presents with a 1 month
history of a spontaneous unilateral bloody
nipple discharge.

 Radial compression of the involved breast

results in expression of blood at the 12
o’clock position.

 Think : Intraductal papilloma