Editing Breast history and exam (section)

== '''Examination''' ==

* Chaperone present
* Upright sitting position with hands by side
** Inspection
*** Inspect for obvious masses, asymmetries and skin changes
*** Nipples - retraction, nipple inversion, excoriation
*** Indirect lighting can help to identify irregularities
*** Hands on hips, then stretch arms above head or tense pectoralis to accentuate asymmetries or dimpling
*** Lymphoedema of arm
** Palpate
*** Axilla best examined while sitting
*** Both supraclavicular and infraclavicular spaces (from behind)
* Supine with head supported and arms above head
** Palpate both breasts systematically by quadrants, pushing breast tissue against chest wall
** Masses - size relative to breast, shape, consistency, location, fixation
* Specific findings
** Nipple discharge
*** Gently squeeze the nipple to express
*** Note whether emerging from single or multiple ducts, and whether blood is present
** Mastalgia
*** Differentiate chest wall tenderness from breast tenderness - use your hand from below to push away breast tissue, or put the patient on their side, allowing the breast to fall away medially
** Peau d'orange
*** Hallmark of inflammatory carcinoma
***
** Dimpling
***
** Flattening or inversion of the nipple
*** Caused by fibrosis in certain benign conditions, especially subareolar duct ectasia (usually bilateral)
**** Characteristic symmetrical appearance, usually with a central horizontal slit
**** In this case, the nipple can usually be manipulated by tension on the areolar margin to evert it
****
*** Malignant nipple inversion cannot be everted and is usually eccentric
****

[[Category:Breast]]