Introduction

Breast examination can be embarrassing for both patient and doctor. It is vital to be professional and to keep any exposure required to a minimum length of time in order to ensure the patient feels comfortable.

That said, adequate exposure is essential to detect pathology. The patient should be undressed upto the waist, with any bras removed.

It is important to be able to accurately describe any lumps you find (see the section on 'lumps and bumps' for information).

Remember to start by: washing your hands, introducing yourself and gaining consent.

Position & Inspection

Look for:

• Start with the patient sitting with legs over side of bed
• Rest arms at side (gently on hips)
• Skin - distortion, puckering, tethering, peau d'orange (looks like an orange skin - sign of underlying malignancy), ulcers, eczematous change (if around nipples may be Paget's disease)
• Soft tissue - symmetry + contour changes, lumps, nipple changes (deviation, inversion)
• Slowly raise arms upwards (sideways)
• This exaggerates tethering and asymmetry (again, observe for any asymmetry)

Palpation

Feel for:

• With patient sitting with legs over side of bed, get patient to put arms on your shoulders (one at a time) - you can then feel for axillary lymphadenopathy more easily
• Feel all groups of nodes, including supraclavicular
• Lie patient at 45^o on couch, with arms by side/on hip
• If there is a known lump/pain, feel 'normal' side first (palpate all 4 quadrants + nipple/areolar area)
• Examine each lump as per usual ?lumps and bumps? examination
• Remember to palpate the abdomen ?hepatomegaly / ascites (possible if there is a metastasised malignancy)

Extras

For full marks:

• Always cover patient up with blanket/tell patient that they can re-dress once you have finished, and remember to thank the patient.
• Prepare a summary of your findings for a succinct presentation (see the 'system' examinations for examples of how to approach this)