breast examination for students slide share.pdf

Breast examination for students' reference purpose only

1. Check list Breast Examination

1. Initial steps
Greet the patient & introduce yourself.
Confirm the name & ID of patient & Examine from the right side of patient.
Explain the procedure and reassure the privacy. Take verbal consent.
Keep the chaperone by the side if male doctor is examining.
Hand hygiene with alcohol gel.
Ask the patient to undress down to the waist to adequately expose their breasts.(Do not over or
underexpose)
2. General Inspection
Mention: Different Examination positions a.Place her hands behind her head
b.Place her hands on her hips
c.Bending forward
d.Lying down with her arm by the side
3. Inspection of Breast proper and Axillary tail
Inspect the Symmetry of both breasts
Position of Nipples Right Left
Nipple abnormalities:
Inversion or eversion
Discharge (bloody/serous/milk…) or any other..

Skin Changes: Scars/Eczema/Peau’deorange/Discharge/Visible
Lumps/Swelling/Ulceration…

Mention

Scars: May indicate previous breast surgery (lumpectomy, small scar or mastectomy, large diagonal
scar).
Asymmetry: Identify gross abnormalities by comparison on both side
Masses: Any visible lumps. Mass. If present
Describe the number/ skin over it / color /… scaling, erythema, puckering and peau d’orange.

4. Palpation of breast
Start palpating from nontender area of breast.
Be gentle during examine
Mention the techniques of palpation: a:Up/Down
b:Circular
c:Wedge
Right Left
Palpate the nipple confirm the inspection for Tenderness/Discharge/Swelling
Axillary tail
Examination of Breast Swelling/Mass/Lump

2. Location: upper right or left quadrant / lower right or left quadrant /central / involve nipple s
Tenderness/ Temperature/ surface/color of skin over the area
Texture of skin over the swelling/ mass: tethering/ Peu’d orange appearance
Number of mass
Size/Shape: in cms / irregular or regular/ round /…
Consistency Smooth /rubbery/firm/ stony hard
Discharge and its Consistency: bloody/serous/watery
Mention the amount and consistency: in ml.(appox) and thin, thick, sticky….
Mobility/Fixed to breast tissue/Fixed to chest wall
Assess the degree of mobility the mass: freely mobile in all direction or one direction
Move with the overlying skin
Move with pectoral contraction
Fluctuance

Examination Nipple-areolar area (Palpation)
If history of nipple discharge/ you observe discharge: Only then go for further step of examin..
Use the flats of your middle three fingers to compress the areolar tissue towards the nipple.
Assess the following characteristic of discharge:
Colour: blood-stained, green, yellow/colorless…
Consistency: thick, watery/serous/sticky/
Volume: approx.. in ml

Palpation of axillary tail
Palpate the axillary tail along the upper quadrant to axilla
Asses the presence of mass/ number consistency/ discharge…….
5. Lymph node Examination Right Left
Supraclavicular
Axillary groups
8. Professional & Ethical Attitude
Be polite and Thanks & Cover the patient. Wash your hands
Summaries the findings. and mention if any further investigation required


SINISTER SIGNS
Firm to hard or hard consistency
Irregularity
Skin dimple overlying lump or any other evidence of skin
tethering or fixation on skin pinching
Nipple defacement/ retraction
Peau’d orange
Chest wall fixation
Axillary lymph node enlargement
Size ≥ 2 cm