Breasts and Axillae

Ruler (if mass detected)


image Flashlight with transilluminator (if mass detected)

image Glass slide and cytologic fixative (for nipple discharge)

image Small pillow or folded towel




EXAMINATION
























































































TECHNIQUE FINDINGS
FEMALES
With patient seated and arms hanging loosely, inspect both breasts
Inspect all quadrants and tail of Spence as shown in figure. If necessary, lift breasts with fingertips to expose lower and lateral aspects.  
image
imageSize/shape/symmetry EXPECTED:Convex, pendulous, or conical. Frequently asymmetric in size.
imageTexture/contour EXPECTED:Smooth and uninterrupted.
UNEXPECTED:Dimpling or peau d’orange appearance. Changes or asymmetric appearance.
imageSkin color EXPECTED:Consistent color
UNEXPECTED:Areas of discoloration or asymmetric appearance.
imageVenous patterns EXPECTED:Bilateral venous networks, although pronounced generally only in pregnant or obese women.
UNEXPECTED:Unilateral network.
imageMarkings EXPECTED:Long-standing nevi. Supernumerary nipples possible (but could be a clue to other congenital abnormalities).
UNEXPECTED:Changing or tender nevi. Lesions.
Inspect areolae and nipples
imageSize/shape/symmetry EXPECTED:Areolae round or oval, bilaterally equal or nearly equal. Nipples bilaterally equal or nearly equal in size and usually everted, although one or both sometimes inverted.
UNEXPECTED:Recent unilateral nipple inversion or retraction.
imageColor EXPECTED:Areolae and nipples pink to brown.
UNEXPECTED:Nonhomogeneous in color.
imageTexture/contour EXPECTED:Areolae smooth, except for Montgomery tubercles. Nipples smooth or wrinkled.
  UNEXPECTED:Areolae with suppurative or tender Montgomery tubercles or with peau d’orange appearance. Nipples crusting, cracking, or with discharge.
With patient in the following positions, reinspect both breasts
imageArms extended over head, or flexed behind the neck EXPECTED: All positions breasts bilaterally symmetric with even contour.

image Hands pressed on hips with shoulders rolled forward or pushed together in front

image Seated and leaning over

image Recumbent
 UNEXPECTED:Dimpling, retraction, deviation, or fixation of breasts.
image
image
image
image
With patient seated and arms hanging loosely, palpate breasts
Chest wall sweep.Place the palm of your right hand at the patient’s right clavicle at the sternum. Sweep downward from the clavicle to the nipple, feeling EXPECTED:Tissue smooth, free of lumps.
UNEXPECTED:Lumps or nodules. Reassess with additional palpation and
for superficial lumps. Repeat the sweep until you have covered the entire right chest wall. Repeat the procedure using your left hand for the left chest wall. characterize any masses by location, size, shape, consistency, tenderness, mobility, delineation of borders, retraction. Use transillumination to assess presence of fluid in masses.
image

Bimanual digital palpation.Place one hand, palmar surface facing up, under the patient’s right breast. Position your hand so that it acts as a flat surface against which to compress the breast tissue. Walk the fingers of the other hand across the breast tissue, feeling for lumps as you compress the tissue between your fingers and your flat hand. Repeat the procedure for the other breast.

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Mar 25, 2017 | Posted by in PHYSIOLOGY | Comments Off on Breasts and Axillae

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