BREAST & AXILLA Normal ABNORMALITY

Compare size bilaterally Supernumerary breasts –

 symmetry of size & Not usually symmetrical accessory breast (on milk line)
shape
Skin Colour Peau D’orange – thick, leathery
 Thickening skin (blockage of lymph); Scars
 Prominent pores  implants, reduction, surgery;
Increased venous prominence
 erythema
 normal in pregnancy
INSPECTION Contour Cancer  dimpling, flattening,
(Pt is sitting up masses
disrobed to the waist, Inspect Nipples N = nipples point outward Inversion, retraction, flattening,
w/ her arms at the  size and often downward fixation; Supernumerary breasts;
sides) Galactorrhea  milky bilateral
 shape
d/c (pregnancy / hormonal
 recent or fixed
imbalance); Paget’s disease 
flattening rash or ulceration (assymetrical)
 retraction
 direction which they pt
 rashes
 ulcerations
 discharge
1. Arms over head Equal elevation of both Lag in movt in one breast; equal
breasts elevation, note any asymmetry,
dimpling or retraction suggests
MANEUVERS possible mass
 to bring out 2. Press hands against Contraction of pecs
invisible dimpling & hips
retraction of breast 3. Pt stands up and leans Symmetric free forward Cancer (fat necrosis/duct ectasia)
tissue forward supported by movt of both breasts  dimpling or retraction; note
chair or examiner’s hands symmetric mov’t of both breasts
4. Pts arms at the sides note any asymmetry, possible
masses
Axilla lymphadenopathy  infection ;
 Central axillary CA  enlargement possible
 Pectoral spread of CA cells from breast,;
LYMPH NODES
(palpate!)  Subscapular Acanthosis nigricans  deeply
 Lateral pigmented, velvety axillary skin
Supraclavicular
Infraclavicular

1
 Use pads of 2nd, 3rd, 4th finger for light, med & deep palpation  Radial, horizontal / vertical
lines, concentric circles (1 of 3)
PALPATION • Circular motions: 3 per area & overlapping or straight lines. Remember periphery, Tail of
(BILATERAL!) Spence, & areola
Should be done in • Palpate from clavicle to inframammary fold, & from midsternal line to post axilla line &
sitting & recumbent
position into the axilla for tail of breast
OR Note consistency, tenderness, nodules
Supine: place towel Nodules Cancer  hard, irregular, poorly
(support under side  location (quadrant/ clock w/cm from nipple) circumscribed nodules, fixed to the
being examined)  size in cm skin / underlying tissue
Palpate each breast  shape (round, lobular, irregular, stellate)
separately; drape  consistency (soft, firm, hard)
opposite breast  delimitation (well circumscribed or not)
 mobility
 tenderness
Ask pt if menstruating, family history, referral if necessary
Squeeze gently for any Local breast disease Non-
discharge milky unilateral discharge;
 Colour Intraductal papilloma  bloody
NIPPLES  Consistency d/c
quantity
Size, Shape & Elasticity Thickening or loss of elasticity
suggests underlying CA