Breast examination

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

Figure 6.1   

Figure 6.2   

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

Figure 6.4   
  • 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

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