Makindo Medical Notes

Overview of Breast Examination

The breast examination is a critical clinical skill used to identify any abnormalities or changes in breast tissue. It involves inspection and palpation and is an important part of routine health checks and diagnostic processes. The breast is a complex structure made up of glandular, connective, and adipose tissues, with the primary function of milk production for breastfeeding.

1. External Structure

• Nipple: Small, raised area through which milk is delivered.
• Areola: Pigmented area surrounding the nipple, containing glands for lubrication.

2. Internal Structure

• Lobules: Milk-producing glands clustered within the breast.
• Ducts: Tubes that carry milk from lobules to the nipple.
• Adipose Tissue: Fat tissue that gives the breast its size and shape.
• Fibrous Connective Tissue: Supports the breast and anchors it to the chest wall.

3. Blood Supply and Lymphatic System

• Blood Supply: Primarily from the internal mammary and lateral thoracic arteries.
• Lymphatic System: Contains lymph nodes that aid in immune function and drainage.

Preparation

• Ensure privacy and obtain consent from the patient.
• Explain the procedure to the patient and answer any questions they may have.
• Ensure the patient is comfortably positioned, either sitting or lying down, with adequate exposure of the breasts while maintaining their dignity.

Inspection

• With the patient sitting upright and disrobed to the waist:
  • Inspect both breasts for size, shape, symmetry, and contour.
  • Observe the skin for any abnormalities such as dimpling, puckering, redness, or rash.
  • Check the nipples for inversion, discharge, or changes in position.
  • Ask the patient to raise their arms above their head, press their hands on their hips, and lean forward to observe for any changes in breast contour or skin retraction.

Palpation

• With the patient lying down, place a pillow under the shoulder of the side being examined to flatten the breast tissue.
  • Use the pads of your fingers to palpate the breast in a systematic pattern:
    • Vertical Strip Pattern: Start at the outer edge and move in vertical lines toward the sternum.
    • Spiral Pattern: Begin at the nipple and move in concentric circles outward.
    • Wedge Pattern: Start at the nipple and move outward in a wedge shape.
  • Palpate the entire breast, including the upper outer quadrant and the area extending into the axilla (tail of Spence).
  • Check for any lumps, masses, or areas of thickening, noting their size, shape, consistency, and mobility.
  • Palpate the nipple and areola to check for any discharge.
• Examine the axillary lymph nodes:
  • With the patient's arm slightly raised, palpate the axilla using a rolling motion to feel for any enlarged lymph nodes.
• Examine the supraclavicular and infraclavicular lymph nodes by palpating above and below the clavicle.

Common Findings

• Normal:
  • Breasts are symmetrical without any visible or palpable abnormalities.
  • No skin changes, nipple discharge, or lymphadenopathy.
• Abnormal:
  • Lumps or Masses: May indicate benign conditions such as fibroadenomas or cysts, or malignant tumours.
  • Skin Changes: Dimpling, puckering, redness, or peau d'orange appearance can suggest malignancy.
  • Nipple Changes: Inversion, discharge, or eczema may indicate underlying pathology.
  • Enlarged Lymph Nodes: May be a sign of infection, inflammation, or malignancy.

Documentation

• Record your findings in the patient's medical record, including:
  • Description of any lumps or masses (size, shape, consistency, location, mobility).
  • Any skin or nipple changes observed.
  • Presence of lymphadenopathy.
  • Any patient symptoms or concerns reported.

Patient Education

• Encourage regular self-breast examinations and provide instructions on how to perform them.
• Advise on the importance of regular mammograms and clinical breast exams as recommended based on age and risk factors.
• Discuss any findings and the next steps, including further investigations or referrals if needed.

Summary

Performing a thorough breast examination involves careful inspection and palpation to detect any abnormalities. Effective communication, patient comfort, and accurate documentation are key components. Educating patients about self-examinations and regular screening can aid in early detection of breast conditions.