Method Of Exam
|Author: A. Chandrasekhar, MD
||Consultant: F. Folk, MD
Examination of breast
- 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
- supine (palpation)
- sitting position (inspection)
- 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
- symmetry of breasts
- contour of the breasts
- recent change in contour raises suspicion for cancer
- venous pattern
- direction (normal outward and downward)
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
- Breast and areola vary in size depending on age and physiologic cycle (lactation, menstruation). Be aware, asymmetry is common. Nipples point downward and outwards.