Approach
- Be accompanied by a chaperone
- Expose patient from waist up
- Lie at 45' on couch
- Inspect
- Look from the front
- Ask patient to lift both hands over head (stretches skin) and emphasises any tethering of a breast tumour
- Ask patient to place both hands on hips, ask to press firmly on hips with both hands
- Inspect nipple and areaola
Seven Ds of nipple signs
Discolouration
Discharge
Depression (inversion)
Deviation
Displacement
Destruction
Duplication - Inspect breasts for size, shape, asymmetry, subcutaneous nodules, previous scars from excision of benign and malignant lumps
- Palapte
- Ask patient to tell you where the breast lump is first
- Start by palpating normal breast
- Palpate symmetrically around breast, using tips of fingers (obviously! What else are you going to use?)
- Retract the breast with one hand and palpate with the other
- Imagine breast as a clock face and make sure each area is palpated
- Pay attention to axillary tail (of spence) and underneath the nipple where masses are frequently missed
- When palpating the abnormal breast,ensure that the area of abnormality that you have found is teh same that the patient has noticed
- Location of a lump within the breast should be named according to the quadrant
- Describe any lump
- Palpate the 5 areas of lymph nodes in the axilla - medial, lateral, anterior, posterior, apical
- Palpate supraclavicular fossa for lymphadenopathy
- Percuss
- Auscultate
Completion
- Percuss and ausculatate the breast (!?)
- Palpate abdomen for hepatomegaly
- Percuss axial spine for tenderness
- Complete general physical examination to determine patient's fitness for surgery