Examination of the Breast
Inspection:
Inspection is initially from the foot of the bed.
 Patient stripped to the waist.
 Patient sitting comfortably at 450 with arms by sides.
 Note size, symmetry, contour, colour, venous pattern and scarring.
 Nipples: note symmetry, eversion, flattening, and inversion.
 Ask the patient to raise arms above head. (?tethering of a mass to skin)
 Ask patient to press hands against hips. (?fixation of a mass to muscle)
Abnormalities that may be seen:
 Lumps.
 Nipple retraction or deviation.
 Prominent veins.
 Oedema, with or without skin dimpling.
 Reddening, thickening or ulceration of the areola.
Palpation:
 Patient lying on the couch with hands by sides, or arms above head.
 Use the palmar surface of the middle three fingers.
Palpation of the Breast:
 Concentric: begin at the axilla, end at the nipple.
 Parallel: each half, from side-to-side, top-to-bottom.
 If a mass is palpated, again ask the patient to
 Raise arms above head, and assess for tethering to the skin
 Press hands firmly against the hips to assess for fixity to deep muscles (Pec. Major)
 Axillary tail: arms above head. Use thumb and forefinger.
Palpation of the nipple:
 Hold gently between thumb and finger.
 Gently compress: to express any discharge.
Palpation of the Lymph nodes:
 Axillary nodes: lying or sitting; apical, anterior, posterior, lateral chest wall, medial border of the
humerus.
 Infraclavicular nodes.
 Supraclavicular nodes.
Abnormal Palpation:
 Lumps: benign or malignant.
 Abscess: mastitis.
 Nipple and areola: blood stained discharge implies intraductal carcinoma. Retraction or distortion in
malignancy. Red crusty scaling in Paget’s disease.
 Lymphadenopathy: can be seen in infection, malignancy, and fibrocystic disease.
Complete the Examination:
 Palpate the liver (as per abdominal examination) for hepatomegaly secondary to metastasis.
 Ask the patient about bone-pain and inspect any sites for swelling, tenderness, deformity etc (bony
metastasis)
 Bloods: FBC, U+E, LFT, Coag, G+S.
 Xrays: Chest/Any bones
 USS: to assess breast mass, also check liver for metastasis
 Refer: breast surgeon for FNAC or biopsy.