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.