The Breast

Ask the patient about:

Menstruation

Pregnancies

Abortions

Ingestion of contraceptive pills

Family history of breast cancer

Menstrual cycle

Pregnancy

Lactation

Inspection

Palpation

Examine the arms, axillae, supraclavicular fossae

General examination

Expose the whole upper half of the patient

Relax the patient in semi-recumbent position

Size

Symmetry and contour

The skin

Nipple discharge, duplication

Look to the axilae, arms and supraclavicular fossae

Finding a lump in one of your breasts can cause you a lot of anxiety.

Most breast lumps, particularly in younger women, are not caused by cancer but are benign

Look with her arms at her sides and with her arms above her head.

Is a lump visible?

Do the breasts look symmetrical? Slight asymmetry is quite normal.

Is there an inverted nipple and if so is it unilateral or bilateral?

Is there puckering of the skin or peau d’orange (orange peel)

The next stage is palpation and a systematic search pattern improves the rate of detection. Ask the patient to lie supine with her hands above her head.

Examine from the clavicle medially to the mid-sternum, laterally to the mid-axillary line and to the inferior portion of the breast.

Remember the axillary tail of breast tissue.

Examine the axilla for palpable lymphadenopathy.

Be aware that 50% of breast tissue is found in the upper outer quadrant and 20% under the nipple.

Using the second, third and fourth fingers held together moved in small circles is the most sensitive technique.

Begin with light pressure and then repeat the same area using medium and deep pressure before moving to next area.