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