Breast Examination.
Introduction:
Explain the procedure and take consent.
History: carcinoma can occur at any age after puberty. If the patient presents with a lump
enquire about its mode of onset, duration and rate of growth.
Pain? Discharge: colour, character and quantity.
Local examination: patient must be in sitting posture and stripped to the waist to expose completely both the breasts before inspection is commenced.
Inspection: this is carried out u with the arms by the side of the body, v With the arms raised above the head, with the hands on the hips pressing and relaxing x bending forward so that the breasts fall away from the
body. Nipple: ® its position ® size and shape ® surface: look for cracks, fissures or eczema ® discharge if any.
Areola: look for cracks, fissures, ulcer, eczema, discharge or a swelling.
Skin over the breast: look for redness, warmth, oedema, engorged veins, dimpling, retraction, puckering, peau d' orange, nodules, fungation and cancer en cuirasse.
Breasts: u position v size and shape w puckering or dimpling.
Arm and thorax: 'cancer en cuirasse' i.e. multiple cancerous nodules and thicken infiltrated skin like a coat of armour may be seen in the arm and the thoracic wall. Brawny oedema of the arm may be due to extensive neoplastic infiltration of the axillary nodes. It is mainly due to lymphatic blockage.
Palpation: should be made initially in sitting position and later on in recumbent position. Palpation should be made between the pulps of the fingers and the thumb. 1. Local temperature and tenderness, 2. Situation,
3. Shape and size, 4. Surface, 5.Margin, 6. Consistency, 7. Fluctuation, 8. Fixity to the skin, 9. Fixity to the breast tissue, 10. Fixity to the underlying fascia and muscles, 11. Fixity to the chest wall, 12. transillumination, 13. Abnormal discharge.
Palpation of lymph nodes: axillary group: pectoral, brachial, subscapular, central and apical and Cervical lymph nodes.
While palpating the lymph nodes careful assessment must be made as to their number, size, consistency, mobility.
General examination: liver: for secondary deposits, lungs and bones for metastasis. Rectal and vaginal examinations are also necessary to detect Krukenberg's tumour of the ovary, which occurs by transcoelomic implantation or lymphatic permeation.
Special investigations: aspiration, mammography, thermography, USG, biopsy, CXR, bone X-ray, bone scan, liver scan, CT, look for GGT & alk phos.
DD: mastitis, abscess, duct ectasia, cysts, fibroadenosis, fibroadenoma, duct papilloma, Carcinoma and sarcoma.