Examination of the breast

History

Personal history 1- Name

2- Age
(Fibroadenosis: puberty&menopause)
(Hard fibroadenoma -> 20-30 yrs)
(Soft fibroadenoma -> 30-40 yrs)
Carcinoma -> 40-69)
3- Occupation
4- Marital status
5- Residence
6- Special habits (smoking (calculated by
number of cigarettes/day x years) -
>100 mild - >200 moderate, > 400
chronic heavy smoker. Ask for other
special habits like alcohol, cannabis,
morphine)
7- Lactating or not
8- Contraception?
Complaint Complain + duration in patient’s own words
HPI 1- Pain?
Site, character, radiation, what increase or
decrease, onset, course, duration.
(Painful breast masses include fibro
adenosis, mastitis malignancy)
2- Swelling?
Site
Size
Onset ‫( ابتدا اذاي‬Accidental, acute onset
gradual onet)
Course (Progressive, regressive, stationary,
fluctuating,)
Duration (Short, long, since birth)
Other swellings (Lymph?)
What increase/decrease?
3- Disturbance of function
Nipple discharge? Color, amount
Skin changes? Nipple retraction, erosion of
the areola? Dimpling? Skin nodules?
Ulceration? Arm edema? Sister Joseph
nodule?

Past Medical history 1- Similar attacks?

2- Major adult illnesses (DM, HTN, DVT)
3- Past surgical history, including type, date,
 and location of past surgical procedures.
4- Medications (Prescription drugs, Over-the-
counter drugs, Herbal remedies, Doses and ,
frequencies )
5- Allergies (Drugs or environmental factors,
Reaction to each allergen, or Food
intolerance)
6- Prior injuries (e.g., motor vehicle accidents,
falls)
7- Prior hospitalizations and/or transfusions
8- Immunizations
9- Screening exams (e.g., Pap smear,
mammogram, colonoscopy)

Psychiatric illnesses, including any psychological

intervention or hospitalization
Family History A history of disease in first-and second-degree
blood-relatives that reaches back at least two
generations.

Goal: try detecting hereditary pattern of the

disease

Ask about TB, diabetes, malignancy and other

relative disease s.

Review of systems Cough hemoptysis, chest pain (lung metastasis)

Bone ache, fracture (Bone metastasis)
Liver metastasis (Jaundice, rt hypochondrial pain)

General examinations

Local

Exposure Expose from above umbilicus with upper arms

exposed

Inspection
‫ارفعي ايدك فوق‬
‫مدي ايدك قدام‬

Compare 2 breasts in terms of size and shape

 (focal or general asymmetry)?
Compare the level of the 2 nipples

A - Swelling
1- Number
2- Site (Anatomical region of the swelling)
3- Size (olive, lemon, orange, melon)
4- Shape (rounded, oval, lobulated, irregular)

B- Skin overlying
1- Normal, stretched pigmented?
2- Show sign of inflammation? (Redness,
edema)
3- Dilated veins
4- Scar or previous operation
5- Nipple →
-direction (normal is downward, forward,
and lateral),
-retraction
-displacement (If the nipple is displaced,
notice whether it is displaced toward
(carcinoma) the mass or (benign) away
from the mass),
-discoloration

6- Areola → eczema, cracks, fissures

7- Skin proper → dimpling, pau de orange,
upper limb lymphedema, redness?
C- Inspect the arm for lymphedema

Palpation A- Swelling
(Start by the normal breast) 1- Warmth
2- Tenderness
3- Surface (smooth? Nodular? Regular?
Lobulated? Irregular?)
4- Shape
5- Size
6- Edge (ill defined vs well defined)
7- Consistency (solid → Firm, soft, hard /
cystic) If cystic, confirm by fluctuation test
8- Mobile?
9- (Relation)
1- Skin → pinch the skin
2- Breast tissue → fix the breast tissue by
one hand and move the swelling by
another hand
3- Pectoralis
Ask her to press by her hands against
 her waist → if attached to pectoralis
→ limited movement or fixed
4- Serratus anterior
Compare the range of movement
before and after compression against
wall
5- Bone → the mass will be fixed and
immobile from the start when the
patient is relaxed
10- Examine Lymph nodes axillary

Special tests
Percussion
Auscultation
Diagnosis
Investigations Laboratory
Radiologic