Introduction
Introduce yourself
Wash Hands
Ask if patient has any pain anywhere before you begin
Explain procedure
Gain Consent
Chaperone – “I’m required to have a female chaperone by law, is that ok?”
Position patient at 45 degrees on bed
Ask patient to undress down to waist behind the curtain – provide sheet
General Inspection
Patient comfortable at rest?
Obvious masses, scars or asymmetry?
Close Inspection
Arms by side
Scars
Asymmetry
Masses
Deformity
Skin changes - puckering, peau d’orange, rashes
Nipple changes - retraction, discharge, eczema (Paget’s disease)
Arms above head
Repeat inspection
Look in particular for masses & puckering
Hands on Hips
Quickly repeat inspection again
Look for masses & signs of tethering
.
Palpation
Breast
Start with the normal breast
Ask to place hand behind head
Palpate 4 quadrants of breast - use flat of palm in circular motion
Palpate centrally around nipple
Assess any mass describing
- Size
- Shape
- Texture
- Tenderness
- Mobility
Nipple
Ask patient to squeeze nipple if discharge suspected
Axilla
Take the weight of the patients arm
Examine the 5 axillary areas - medial, lateral, anterior, posterior, apical
.Other lymph nodes
- Cervical
- Supraclavicular
- Infraclavicular
Repeat all steps on the other breast
To complete the examination
Thank patient
Cover patient up
Wash Hands
Summarise Findings
.Say you would…
- Do mammography if appropriate