Breast: History, Exam
- History, CA risk factors
- Setup
- Inspect: whole
breasts, skin, nipples,
maneuvers
- Palpate: nodes,
quadrants, axillary
tails, nipples
- Discharge, bleeding.
- Tenderness (inflammatory, eg abscess).
- Location: quadrants, proximity to nipple, unilateral vs. bilateral,
- Timing: spread of masses.
- Timing: midcycle tenderness (fibrocystic change).
- Currently breast feeding (mastitis).
- A History ALONE:
• Age: older
• History: family, prior dz
• Abortion
• Late menopause
• Obese
• Nulliparity
• Early menarche
- Pt removes upper body clothing, in gown, sitting up.
- Briefly describe examination to pt.
- Pt. removes gown.
- Pt. relaxes arms by side.
- Symmetry.
- Swelling.
- Visible masses.
- Dimpling.
- Peau d'orange (CA).
- Skin retraction.
- Veins: bilateral vs. unilateral (CA).
- Nipple position, inversion, retraction (fibrosis, CA, normal).
- Red, bleeding (Paget's dz of nipple).
- Discharge.
- Pt. raises arms above head. Look for:
• Change in a mass's relative position.
• Nipple or skin tethering.
- Examine axillae while pt's arms are raised.
- Pt. pushes hands down on hips. Look for:
• Dimpling.
• Fixation.
- Large breasts: pt. leans forward, hands on knees.
- Axillary nodes.
- Supraclavicular nodes.
- See Hemolymphoid Examination.
- If exam normal so far, tell pt.
- Pt. lies down.
- Pt. places hands behind head.
- Ask if any part tender before palpate (inflammatory).
- If sores visible, wear gloves.
- Use fingerpads of middle 3 fingers.
- Press breast against chest wall by rolling fingers in small, circular
motions.
- Press lightly for superficial layers, medium pressure for middle layer,
firmer pressure for deepest layers.
- Start at sternoclavicular junction.
- Move in overlapping vertical strips, until all 4 breast quadrants are
covered.
- See Examining A Mass Reference.
- Pt. places arms above head.
- Palpate tail between fingers and thumb.