Breast- History and Physical Examination

Daniel Eshetu

Introduction Breast disease is dominantly seen in Female

Affects mainly adults

Benign conditions are commonly seen in young

Malignant breast conditions are seen in middle age and elderly

Infectious conditions mainly affects lactating breast

Topographic Anatomy The female breast lies between the 2nd and the 6th ribs

Horizontally extends between the sternal edge and mid axillary line

Two thirds of it is superficial to the pectoralis major while one third to the serratus anterior

It can be divided into four quadrants by horizontal and vertical lines crossing at the nipple

Three principal components

-the glandular tissue

-the fibrous tissue

-Fat tissue

History

Pain

Lump

Nipple discharge

Diffuse swelling

Risk factors

Physical examination General approach

-understand that the patient could be embarrased

-communicate with your patient

-be gentle

-better to examine a week or two after menstrual period

Inspection Disrobed to the waist in sitting position

The appearance of the skin

The size and symmetry of the breasts

The contour of the breasts

The Nipples

-size and shape

-the direction in which they point

-any rash or ulceration

-any discharge

Palpation Lying position with a small pillow under the patient’s

shoulder on the side to be examined

Ask her to rest her arm over her head

Fingers flat on the breast, compress the tissues gently in a rotary motion against the chest wall

Proceed quadrant by quadrant not to forget the areola and the tail

palpation Note

-the consistency of the tissues-tenderness-nodules

Determine-location-size-shape-consistency-delimitation-mobility-tenderness

palpation Nipple

-check for elasticity

-compress the areola with the index finger, watch for discharge and note for the color, consistency , quantity, and the exact location where it appears

Palpation cont’d Axillae

-the purpose is to check for the lymph nodes (LN)

-better in a sitting position

-hold the arm for her to relax the axilla

- use your left hand to examine the right axilla and vice versa

-check for central, anterior, posterior, lateral,apical group of LN

- complete LN search by examining for the supraclavicular and infraclavicular LN

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