Method Of Exam

• Examination of breast

  • General

    • a week after menstrual period

    • tell patient

    • attendant present

    • move to the front of the patient. Instruct her to drop her gown to the waist.
    • inspect the breast in supine and sitting positions:

    • full exposure of the chest Both breasts initially

    • cover one breast at a time subsequently

    • Positions

      • supine (palpation)

      • sitting position (inspection)

    • Views

      • arms by the side

      • arms over head

        • with pectoral muscles tensed

        • The pectoral muscles can be tensed by pushing hands together and by pressing hands against hips.

      • arms pressed against hips

        • brings out dimpling and retraction

        • fibrous strands of cancer attach to both skin and the facia overlying the pectoral muscle

      • leaning forward

        • pendulous breast

        • may reveal asymmetry of the breast or nipple not otherwise visible

  • inspection

    • breasts

      • size

      • symmetry of breasts

      • contour of the breasts

        • recent change in contour raises suspicion for cancer

        • masses

        • dimpling

        • flattening

    • areola

      • pigmentation

    • skin

      • color

      • thickening

      • edema

      • venous pattern

    • nipple

      • size

      • shape

      • direction (normal outward and downward)

      • ulcerations

      • discharge

   
• Observe the symmetrical excursion of breasts while moving arms and tightening pectoral muscles.
• Assess breast development to age.
• Note for any retraction particularly with tensing

Normal: Breast and areola  vary in size depending on age and physiologic cycle (lactation, menstruation). Be aware, asymmetry is common. Nipples point downward and outwards.