Breast & Axilla Practical

BREAST & AXILLA

Normal

Compare size bilaterally  symmetry of size & shape Skin Colour  Thickening  Prominent pores  erythema INSPECTION (Pt is sitting up disrobed to the waist, w/ her arms at the sides)

MANEUVERS  to bring out invisible dimpling & retraction of breast tissue

Contour Inspect Nipples  size  shape  recent or fixed flattening  retraction  direction which they pt  rashes  ulcerations  discharge 1. Arms over head

N = nipples point outward and often downward

2. Press hands against hips 3. Pt stands up and leans forward supported by chair or examiner’s hands

Contraction of pecs

4. Pts arms at the sides

LYMPH NODES (palpate!)

Not usually symmetrical

Axilla  Central axillary  Pectoral  Subscapular  Lateral Supraclavicular Infraclavicular

Equal elevation of both breasts

Symmetric free forward movt of both breasts

ABNORMALITY Supernumerary breasts – accessory breast (on milk line) Peau D’orange – thick, leathery skin (blockage of lymph); Scars  implants, reduction, surgery; Increased venous prominence  normal in pregnancy Cancer  dimpling, flattening, masses Inversion, retraction, flattening, fixation; Supernumerary breasts; Galactorrhea  milky bilateral d/c (pregnancy / hormonal imbalance); Paget’s disease  rash or ulceration (assymetrical)

Lag in movt in one breast; equal elevation, note any asymmetry, dimpling or retraction suggests possible mass

Cancer (fat necrosis/duct ectasia)  dimpling or retraction; note symmetric mov’t of both breasts

note any asymmetry, possible masses lymphadenopathy  infection ; CA  enlargement possible spread of CA cells from breast,; Acanthosis nigricans  deeply pigmented, velvety axillary skin

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Use pads of 2nd, 3rd, 4th finger for light, med & deep palpation  Radial, horizontal / vertical lines, concentric circles (1 of 3) PALPATION (BILATERAL!) Should be done in sitting & recumbent position OR

Supine: place towel (support under side being examined) Palpate each breast separately; drape opposite breast

NIPPLES

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Circular motions: 3 per area & overlapping or straight lines. Remember periphery, Tail of Spence, & areola Palpate from clavicle to inframammary fold, & from midsternal line to post axilla line & into the axilla for tail of breast Note consistency, tenderness, nodules

Nodules Cancer  hard, irregular, poorly  location (quadrant/ clock w/cm from nipple) circumscribed nodules, fixed to the skin / underlying tissue  size in cm  shape (round, lobular, irregular, stellate)  consistency (soft, firm, hard)  delimitation (well circumscribed or not)  mobility  tenderness Ask pt if menstruating, family history, referral if necessary Squeeze gently for any Local breast disease Nonmilky unilateral discharge; discharge

 Colour  Consistency quantity Size, Shape & Elasticity

Intraductal papilloma  bloody d/c Thickening or loss of elasticity suggests underlying CA

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