BREAST EXAMINATION DR. RAMI AYYOUB mammary or milk line FIRST ;
Introduce yourself chaperone Ensure privacy LIGHT
EXPOSURE Permission Position Fully
undressed to waist SITTING , AND SUPINE WITH Upper body raised at 45 at the legs If the lump appear only in certain position ,you should examine pt
in that Inspection YOU are on the right of pt.
pt sitting : 1) Size 2) Symmetry 3) Scar 4) Visible discharge
5) Skin : - pulled or puckering - peau dorange ( oedema raised by obstruction of lymph)
-Nodules or ulcer - Dicoloration - Tetharing - Rash , Hypo or hyperpigmentation - Ulceration
6) Any Lumb : ** 3 positions -site -size -shape
-overlying skin 7) Nipple and areola :
Nipple: - inversion or retraction/ destruction/ displacment or deviation - discharge
-Skin change - Duplication -Are at Same level ** Normal areola are darker than adjacant skin and contain small
nodule ( montgomerys tubercles) 8) Ask pt to elevate her breast to see underweath Ask pt to lay down 9)Axilla :
- Ask pt to raise her arms above her hand - look for any skin change or enlargment - Ask pt to press her hans against hip to tense pectoralis muscles >
some masses become visible - look for visible LN - distended vein - arm lymph edeama Muscle wasting
10) Supraclavicular fossa : - Look virchows gland. Palpation>> Pt must sitting 45 2) Normally breast texture varies
according to age, parity, body mass, and hormonal activity, from featuless to firm and fibrous with nodule also at the end of the 2nd half of menstrual cycle , breasts enlarge and become tender . 1)
Feel breast with flat of finger not with palm of hand. 1.temp. 2.tenderness 3. Mass
site, size, shape, surface, edge, consistance. check nipple for discharge 4.Check for nipple discharge : massage the breast toward the nipple then press
5.Feel axilla you may find normal ectopic breast tissue
