Approach

• Expose patient to waist
• Adequately expose breasts and chest wall

1. Inspect
   • Lump may be tethered to skin / underlying muscle
   • May be associated nipple changes, or changes to skin of the breast
   • There may be scars from previous surgery
2. Palpate
   • Begin with the normal breast - examine with patient's hand behind the head
   • Site - name quadrant lump lies within
   • Size - measure lump approximately
   • Surface - smooth / irregular / nodular
   • Edge - well / poorly defined
   • Consistency - soft / firm /hard
   • Tenderness
   • Fluctuation
   • Fixation
   • Palpate axilla, supraclavicular fossa
3. Percuss
4. Ausculate

Investigations

1. History
2. Imaging - USS / mammography (if young)
3. Cytology - FNAC / trucut

Differential diagnosis of breast lump

1. Single lump
   • Fibroadenoma
   • Breast cyst
   • Breast cancer
2. Multiple lump

Features suspicious of breast cancer

• Surface - irregular / nodular
• Edge - poorly defined
• Consistency - firm rather than hard
• Tenderenss - usually non-tender
• Fluctuation - usually not fluctuant
• Fixation - to skin or underlying chest wall
• Any involvement of the nipple in the lump or concurrent nipple charnges

Fibroadenomas

• Benign tumours developing from a single breast lobule
• Hormonally dependent - involute after the menopause and increase in size with menstruation
• Commonly present in women 15-25 years
• Well defined, regular, smooth, firm mass
• Freely mobile "breast mouse" 

Breast cysts 

• Distended, involuted lobules
• Most common in women between 40-55 years old
• Usually fluctuant
• Can be painful
• Well defined and smooth
• Can be multiple