Breast Examination

A. HISTORY

1. Particulars of the Patient

2. Chief Complaints

• Swelling in the right/left breast for last ………….. months/years.

• Pain in the breast over the swelling for last ………….. months/years.

• Ulceration over the breast for………….. months/years.

• Nipple discharge for ………….. months/years.

• Swelling in the axilla/neck for ………….. months/years.

3. History of Present Illness

• Detailed history about the swelling

− Duration

− Progress: Rate of growth

− Any history of rapid growth

− Any swelling in the opposite breast and axilla

• Pain

− Duration

− Site

− Character

− Relation with the swelling

− Relation with menstrual cycle

• If ulcer is present—details about the ulcer

− Duration

− Progress

• Any nipple discharge

− Duration

− Type of discharge: serous/blood/milky

− From one duct opening or multiple openings

• Any swelling in axilla and neck—details of the swelling

• Chest pain/cough/hemoptysis

• Appetite/weight loss

• Any pain in abdomen, any history of jaundice

• Any history of low back ache

• Any history of aches and pain in limbs

• Any history of headache/loss of consciousness/vomiting/weakness of any of the limbs

4. Past History

5. Family History

Detailed family history regarding similar illness or any history of gastrointestinal or ovarian

malignancy in 2–3 generations. Any history of breast carcinoma or gastrointestinal or ovarian

malignancy in sibling and cousins, in parents, aunts and uncle and in grandparents.

6. Personal History sabiston

• Details of menstrual history

• Details of obstetrical history

− Age at first pregnancy

− Total number of pregnancy (P2+O)

− Number of abortion

− Mode of delivery

− Last child birth

− Any history of oral pill intake or hormone replacement therapy.

7. Treatment History

8. History of Allergy

B. PHYSICAL EXAMINATION

1. General Survey

2. Local Examination—Examination of both breasts

Inspection: Examination of diseased breast (right or left)

• Symmetry and position of breast in comparison to normal side

• Size and shape of breast in comparison to normal breast

• Nipple

− Position in comparison to the normal side

− Drawn up or pushed down

− Displaced inward or outward

− Size and shape of nipple

− Surface of the nipple: Any cracks or fissure

− Any nipple retraction

− Any discharge from nipple

− Any ulcer over the nipple

• Areola

− Size of areola

− Any diminution of size due to retraction

− Any cracks, fissure, ulcer or eczema

− Any discharge

• Skin over the breast

− Scar

− Engorged vein

− Pigmentation

− Any redness or shininess

− Any skin change dimpling, retraction, puckering, peau d’orange, nodule, ulceration

(fungation), cancer-en-cuirasse

• Any swelling in the breast

− Position in relation to breast quadrant

− Extent

− Size and shape

− Surface and margin

− Skin over the swelling

• Any ulcer over the breast or over a swelling in the breast

− Position and extent

− Size and shape

− Margin

− Floor

• Any edema of the arm

Inspection of the breast with the arms raised over the head—to look for any nipple deviation

or any skin changes.

Inspection with the patient sitting and leaning forward—to look for whether both the breast fall

forward equally or there is fixity of the diseased breast.

Inspection with the patient sitting and pressing her waist with the hands—to look for any evident

skin changes.

Other breast on inspection—normal.

Palpation: Normal breast palpated first—describe as normal.

Diseased breast (right or left):

„ Temperature in all the quadrant of the breast

„ Tenderness over the breast

„ Any swelling, palpate, the details:

• Position and extent in relation to the breast quadrant

• Size and shape

• Surface and margin

• Consistency

• Fixity to skin

• Fixity to breast tissue

• Fixity to underlying pectoral fascia and pectoralis major muscle

• Fixity to chest wall

• Fixity to serratus anterior muscle for lumps in outer quadrant of breast

• If swelling is cystic—fluctuation and transillumination

If there is an ulcer over the breast—examination of ulcer:

• Site

• Size and shape

• Margin

• Floor

• Any discharge

• Surrounding area

• Tenderness

• Base of ulcer

• Mobility

Examination of regional lymph node:

Level I: Lymph node include anterior (pectoral), lateral and posterior group of axillary nodes.

This group of lymph nodes lie lateral to the lateral border of pectoralis minor.

Level II: Lymph node includes the central group of lymph nodes and lies behind the pectoralis

minor.

Level III: It is the apical group of lymph nodes and lies medial to the pectoralis minor.

Examination of supraclavicular lymph nodes.

Examination of opposite axillary lymph nodes: Level I to level III lymph nodes.

3. Systemic Examination

Examine all the systems

C. SUMMARY OF THE CASE