Breast examination
- To investigate breast problems
- As part of Adult Health Check if over 50 years and no mammogram in last 2 years
Ask
- Lump or change in shape or size of breast
- Change to nipple — crusting, ulcer, redness, inversion
- Nipple discharge
- Change in skin — redness, dimpling, puckering
- Unusual persistent pain especially if only in 1 breast
Do
- Show woman what lumps feel like using breast lump model if available
- Ask woman to take off shirt and bra and cover her from waist down
Look
With woman sitting up look at
- Size — normal for breasts to be a little different in shape and size, but should be about the same
- Skin — dimpling ('orange peel' appearance), ulcers, sores, rashes
- Nipples — discharge, sores, inversion (turning inward)
- If inversion seen ask if new or always been like that
Feel
- Feel for lumps in breasts and armpit
- Careful examination should take at least 3 minutes for each breast
Palpate using 3 pressures
- Make 3 circles with your finger pads, increasing the level of pressure with each circle — superficial — Figure 6.1, intermediate — Figure 6.2, then deep — Figure 6.3
- With woman lying on back — ask her to put hand behind her head to flatten breast
- If breasts very large — put pillow under same shoulder. Creates ‘poached egg' effect and centralises nipple in breast
- Using the 3 pressures start in middle of axilla (armpit) and work down to bra line below breast. Work up and down in straight lines until whole breast has been checked — Figure 6.4
- Make sure you feel carefully behind nipple — Figure 6.4
- Repeat with other breast
- Ask woman to sit up — better position to examine axilla
- Support woman’s arm and elbow to maintain optimal relaxation
- Using the 3 pressures, feel all 4 quadrants
- Ask about discomfort
- Repeat on other side
- If abnormal findings — medical consult — see Breast problems
Follow-up
- Encourage woman to be aware of her breasts. What is normal for her and check for changes
- Educate about normal changes — thickening of tissue, tenderness before period
- Educate how to perform self examination
- Look at her breasts in a mirror with arms by her side, then with arms lifted right up
- Feel her breasts
- If medium to large breasts — best lying down
- If small breasts — can do in shower
- Come to clinic for a check if she finds any changes