Preparation
The patient should lie on the examination couch in the supine position with fully unclothed upper body [Figure 73].
Figure 73
Procedure
- Palpate using the tips of the index finger, middle finger and ring finger. Make circular movements while lightly pressing the breast tissue against the chest wall.
- During palpation of the outer quadrants, a woman with large breasts can place the arm on the side of the relevant breast under her head [Figure 74].
Figure 74
In succession, palpate:
- the inner upper quadrant [Figure 75]
Figure 75
- the inner lower quadrant [Figure 76]
Figure 76
- the outer lower quadrant [Figure 77]
Figure 77
- the outer upper quadrant [Figure 78]
Figure 78
- the axillary tail of the breast [Figure 79]
Figure 79
- the nipple and areola [Figure 80]
Figure 80
- the area around the breast (parasternal region).
- Note the following:
- pain (inflammation, abscess)
- nipple discharge
- consistency of the breast tissue.
Tumours
Note:
- location
- size (estimated in centimetres)
- shape
- consistency (hard, fixed, firm, rubbery, soft, changing)
- surface (smooth, irregular, grainy, lobular)
- borders relative to surrounding tissue (well-defined or poorly-defined)
- mobility relative to the skin and subcutaneous tissue
- tenderness
- ‘dimpling’, seen when the skin over the tumour is pinched gently between thumb and index finger [Figure 81].
Figure 81
- Apply circular pressure to the nipple [Figure 82] and observe whether any discharge is released.
- Note the following: quantity, colour (blood, milk, pus).
- Carry out the same examination on the other breast.
Figure 82