BREAST EXAMINATION

OBJECTIVES OF THE DISCUSSION:  By the end of this discussion, the reader/learner/medical student will be able to;

1.  List the importance of conducting breast examination

2.  Describe the normal findings that follows breast examination

3.  Explain the possible abnormal finding that can follow breast examination

INTRODUCTION: The breast examination by a physician remains the best means of early detection of breast cancer when combined with appropriately scheduled mammography. The results of the breast examination may be expressed by description or diagram, or both, usually with reference to the quadrants and tail region of the breast or by allusion to the breast as a clock face with the nipple at the center.

INSPECTION OF THE BREASTS: The breasts are first examined by inspection, with the patient’s arms at her sides, and then with her hands pressed against her hips, and/or with her arms raised over her head. If the patient’s breasts are especially large and pendulous, she may be asked to lean forward so that the breasts hang free of the chest, facilitating inspection.

FINDINGS: Tumors often distort the relations of these tissues, causing disruption of the shape, contour, and symmetry of the breast or position of the nipple. Some asymmetry of the breasts is common, but marked differences or recent changes deserve further evaluation.

1. Discolorations or ulcerations of the skin of the breast, areola, or nipple, or edema of the lymphatics that causes a leathery puckered appearance of the skin are abnormal.

2. A clear or milky breast discharge is usually bilateral and associated with stimulation or elevated prolactin levels also medically termed galactorrhea.

3. Bloody discharge from the breast is abnormal and usually unilateral; it usually does not represent carcinoma, but rather inflammation of a breast structure with intraductal papilloma is often found. Evaluation is necessary to exclude malignancy.

4. Pus usually indicates infection, although an underlying tumor may be encountered.

PALPATION OF THE BREASTS: Palpation follows inspection, first with the patient’s arms at her sides and then with the arms raised over her head. This part of the examination is usually done with the patient in the supine position. The patient may also be seated, with her arm resting on the examiner’s shoulder or over her head, for examination of the most lateral aspects of the axilla. Palpation should be done with slow, careful maneuvers, using the flat part of the fingers rather than the tips. The fingers are moved up and down in a wavelike motion, moving the tissues under them back and forth, so that any breast masses that are present can be more easily felt.

FINDINGS: If masses are found, their size, shape, consistency, and mobility as well as their position should be determined. Women with large breasts may have a firm ridge of tissue located transversely along the lower edge of the breast. This is the inframammary ridge and is a normal finding. The examination is concluded with gentle pressure inward and then upward at the sides of the areola to express fluid. If fluid is noted on inspection or is expressed, it should be sent for culture and sensitivity investigations.

RELATED;

1.  PELVIC INFLAMMATORY DISEASE

2.  OXYTOCIN

3.  OVULATION AND MENSTRUAL CYCLE

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