Breast Examination
Present your self to the patient
Take permission
Wash your hand
Proper exposure and positioning
The patient is examined first in sitting position on examination couch
Ensure privacy of the patient
patient should be exposed to the level of umblicus
Inspection
in Three positions
:In sitting position with arm beside the legs(A) for
Symmetry of the two breasts
Nipple for Deviation Destruction ,Depression,Displacement ,Discharge and duplication
look for skin color changes
skin Dimpling
Surgical scars
Dilated veins
:With both arms elevated looking for
Skin tethering
Axillary masses
inframammalary folds for change in color ,ulceration and surgical scars
With hand at the hip(C)
The tethering will became more obvious
palpation
The breast is divided in to 4 Quadrants +Axillary tail
Begin with normal breast looking for tenderness or masses
then shift to the diseased one:looking for
Tenderness
Temperature
Masses:size ,site, shape ,surface,consistancy ,edges ,attachment to skin , attachment to the chest wall and attachment to breast tissues
Palpate the axilla for palpable lymphnode(lateral ,anterior ,posterior,central and apical)+supraclavicular lymphnodes
patient should be in sitting position with anterior group examined posteriorly and the posterior anteriorly like picture (c)
begin by the contralateral breast and the ipsilateral one
If you find enlarge lymph node comment on the number ,site, single or matted together, attachment to skin and underlying structures
