history & examination of the breast
DESCRIPTION
History & Examination of the breast. M K Alam. Anatomy of the breast. Located between the subcutaneous fat and the fascia of the pectoralis major and serratus anterior muscles - PowerPoint PPT PresentationTRANSCRIPT
![Page 1: History & Examination of the breast](https://reader036.vdocument.in/reader036/viewer/2022082214/568165a6550346895dd88c9a/html5/thumbnails/1.jpg)
History &
Examination of the breast
M K Alam
![Page 2: History & Examination of the breast](https://reader036.vdocument.in/reader036/viewer/2022082214/568165a6550346895dd88c9a/html5/thumbnails/2.jpg)
Located between the subcutaneous fat and the fascia of the pectoralis major and serratus anterior muscles
Extend to the clavicle, into the axilla , to the latissimus dorsi, sternum and to the top of the rectus muscle.
Lymphatics: interlobular lymphatic vessels to a subareolar plexus (Sappey's plexus), 75% of the lymph drains into the axillary lymph nodes
Medial breast drain into the internal mammary or the axillary nodes.
Anatomy of the breast
![Page 3: History & Examination of the breast](https://reader036.vdocument.in/reader036/viewer/2022082214/568165a6550346895dd88c9a/html5/thumbnails/3.jpg)
![Page 4: History & Examination of the breast](https://reader036.vdocument.in/reader036/viewer/2022082214/568165a6550346895dd88c9a/html5/thumbnails/4.jpg)
• Level I: Lateral to the pectoralis minor muscle
• Level II: Posterior to the pectoralis minor muscle
• Level III: Medial to the pectoralis minor muscle
• Rotter's nodes: Between the pectoralis major and the minor muscles
Axillary lymph nodes
![Page 5: History & Examination of the breast](https://reader036.vdocument.in/reader036/viewer/2022082214/568165a6550346895dd88c9a/html5/thumbnails/5.jpg)
Increase in size in 2nd half of the cycle Slightly painful and tender during later part
of menstrual cycle Pre-existing complain may get worse Pre-existing lump may increase in size
Changes in the breast during menstrual cycle
![Page 6: History & Examination of the breast](https://reader036.vdocument.in/reader036/viewer/2022082214/568165a6550346895dd88c9a/html5/thumbnails/6.jpg)
Common complaints: Lump Pain/ tenderness (Mastalgia) Change in the breast size Change in the nipple Discharge from the nipple
History
![Page 7: History & Examination of the breast](https://reader036.vdocument.in/reader036/viewer/2022082214/568165a6550346895dd88c9a/html5/thumbnails/7.jpg)
Painless lumps: Carcinoma, fibroadenoma, fat necrosis, cysts
Painful lumps: Fibroadenosis, abscess
Breast pain: Fibroadenosis (fibrocystic disease) premenstrual pain
Presentation of breast diseases
![Page 8: History & Examination of the breast](https://reader036.vdocument.in/reader036/viewer/2022082214/568165a6550346895dd88c9a/html5/thumbnails/8.jpg)
Changes in nipple: Carcinoma(retraction) Paget’s disease (ulceration),
Changes in breast size: Giant fibroadenoma, Phylloides tumour, Benign hypertrophy (bilateral)
Discharge from nipple: Red: Duct papilloma, carcinoma, Yellow/ Green: Fibrocystic disease, duct ectasia, White/Milky: Galactorrhea
Presentation of breast diseases
![Page 9: History & Examination of the breast](https://reader036.vdocument.in/reader036/viewer/2022082214/568165a6550346895dd88c9a/html5/thumbnails/9.jpg)
History taking follows the standard pattern
Detailed analysis of complaints Important areas of history: menstrual ,
pregnancy, lactation, family, previous breast
problems
History
![Page 10: History & Examination of the breast](https://reader036.vdocument.in/reader036/viewer/2022082214/568165a6550346895dd88c9a/html5/thumbnails/10.jpg)
When noticed (duration)? How noticed? Any change in the lump since first noticed? Any change in the breast/ nipple? Any associated symptom ? Pain, discharge Any relationship with menstrual cycle? Any history of trauma?
History of a lump
![Page 11: History & Examination of the breast](https://reader036.vdocument.in/reader036/viewer/2022082214/568165a6550346895dd88c9a/html5/thumbnails/11.jpg)
Site Duration Onset and severity Relationship to menstrual cycle (cyclical
or non-cyclical) Aggravating factors Relieving factors
History of pain
![Page 12: History & Examination of the breast](https://reader036.vdocument.in/reader036/viewer/2022082214/568165a6550346895dd88c9a/html5/thumbnails/12.jpg)
Duration Colour of discharge: blood (red), serum (brown,
green, straw coloured), pus, milky Spontaneous or on pressure Unilateral/ bilateral Any change in the nipple Other symptom (pain)
History of discharge
![Page 13: History & Examination of the breast](https://reader036.vdocument.in/reader036/viewer/2022082214/568165a6550346895dd88c9a/html5/thumbnails/13.jpg)
Breast problemMammogram Breast biopsyObesity (BMI >25) - risk factor
Exposure to radiation (face, chest)- risk
factor
Other medical /surgical history
Past medical/ surgical history
![Page 14: History & Examination of the breast](https://reader036.vdocument.in/reader036/viewer/2022082214/568165a6550346895dd88c9a/html5/thumbnails/14.jpg)
Age of menarcheAge at menopause *early menarche (<12 year) , late menopause (>55 year)-
increases risk for carcinoma
Last menstrual periodRegularity of menstrual cycleBreast changes during menstrual cycle
Menstrual history
![Page 15: History & Examination of the breast](https://reader036.vdocument.in/reader036/viewer/2022082214/568165a6550346895dd88c9a/html5/thumbnails/15.jpg)
Age at 1st pregnancy- younger age
(<18) is protective - >30 years- increased risk
Number of pregnancy- protective
Lactational history- protective
History of pregnancy
![Page 16: History & Examination of the breast](https://reader036.vdocument.in/reader036/viewer/2022082214/568165a6550346895dd88c9a/html5/thumbnails/16.jpg)
Oral contraceptives- not known risk
Hormone replacement therapy- increased risk
Other medications
Medications
![Page 17: History & Examination of the breast](https://reader036.vdocument.in/reader036/viewer/2022082214/568165a6550346895dd88c9a/html5/thumbnails/17.jpg)
At least two generations Breast, gynecologic, colon, prostate, gastric, or pancreatic cancer
Age at diagnosis of these tumours.
Family history
![Page 18: History & Examination of the breast](https://reader036.vdocument.in/reader036/viewer/2022082214/568165a6550346895dd88c9a/html5/thumbnails/18.jpg)
Explain to your patient Patient’s permission Privacy Nurse’s presence Semi-recumbent position (45°) , supine, sitting Expose upper half of the patient, both breasts
exposed Arms by the sides
Clinical examination
![Page 19: History & Examination of the breast](https://reader036.vdocument.in/reader036/viewer/2022082214/568165a6550346895dd88c9a/html5/thumbnails/19.jpg)
Stand in front of the patient 4 quadrants Symmetry & size of breasts (underlying lump)
Any obvious mass or lump Skin changes- redness (infection, inflammatory carcinoma),
edema (peau d’orange), dimpling, ulceration (carcinoma)
Inspection of the breast
![Page 20: History & Examination of the breast](https://reader036.vdocument.in/reader036/viewer/2022082214/568165a6550346895dd88c9a/html5/thumbnails/20.jpg)
![Page 21: History & Examination of the breast](https://reader036.vdocument.in/reader036/viewer/2022082214/568165a6550346895dd88c9a/html5/thumbnails/21.jpg)
![Page 22: History & Examination of the breast](https://reader036.vdocument.in/reader036/viewer/2022082214/568165a6550346895dd88c9a/html5/thumbnails/22.jpg)
![Page 23: History & Examination of the breast](https://reader036.vdocument.in/reader036/viewer/2022082214/568165a6550346895dd88c9a/html5/thumbnails/23.jpg)
![Page 24: History & Examination of the breast](https://reader036.vdocument.in/reader036/viewer/2022082214/568165a6550346895dd88c9a/html5/thumbnails/24.jpg)
Changes in the nipple/ areola: raised level, retraction(carcinoma, duct ectasia), ulceration ( Paget’s disease)
Discharge from the nipple- spontaneous
Raise arms above the head- inspect breasts & axillae and note any change
Inspect supraclavicular area
Inspection of the breast
![Page 25: History & Examination of the breast](https://reader036.vdocument.in/reader036/viewer/2022082214/568165a6550346895dd88c9a/html5/thumbnails/25.jpg)
Semi-recumbent position Ask for any painful area Normal side first Palpate with palmer surface of the fingers for
presence of lump Lump characteristics: site, size, shape, surface,
mobility, temperature, tenderness, texture, edge, attachment to skin or deep tissue
For these characteristics- use pulp of your fingers
Palpation of the breast
![Page 26: History & Examination of the breast](https://reader036.vdocument.in/reader036/viewer/2022082214/568165a6550346895dd88c9a/html5/thumbnails/26.jpg)
Site: More carcinoma develop in upper outer quadrant
Size: Variable, Large mass- giant fibroadenoma, Phylloides tumor
Shape: Well defined- fibroadenoma, ill defined- carcinoma
Mobility: Fibroadenoma freely mobile
Temperature: Raised in inflammation, inflammatory carcinoma
Tenderness: Inflammatory –abscess
Texture: Hard- carcinoma, firm- fibroadenoma, fluctuant- cyst
Attachment: Carcinoma, sometime inflammatory lesions
Palpation of the breast
![Page 27: History & Examination of the breast](https://reader036.vdocument.in/reader036/viewer/2022082214/568165a6550346895dd88c9a/html5/thumbnails/27.jpg)
Skin tethering- tumour infiltration of Cooper’s ligament pulling on the skin. Skin dimples when tumour is moved to one side or arm raised above the head
Skin fixation- when tumour is directly fixed to skin. Skin cannot be moved separately
Muscle attachment- patient’s both hands resting on hips, test lump mobility before & after muscle contraction ( ask patient to press against hips)
Palpation of the breast
![Page 28: History & Examination of the breast](https://reader036.vdocument.in/reader036/viewer/2022082214/568165a6550346895dd88c9a/html5/thumbnails/28.jpg)
![Page 29: History & Examination of the breast](https://reader036.vdocument.in/reader036/viewer/2022082214/568165a6550346895dd88c9a/html5/thumbnails/29.jpg)
Any retraction/ ulceration
Palpate for a mass underneath the affected
nipple Nipple discharge- blood (red), serum (brown, green,
straw coloured), pus, milky
Pathological discharge: Bloody, spontaneous, unilateral
Discharge spontaneous or on pressure of a
segment of areola
Any mass associated with discharging duct
Palpation of the nipple
![Page 30: History & Examination of the breast](https://reader036.vdocument.in/reader036/viewer/2022082214/568165a6550346895dd88c9a/html5/thumbnails/30.jpg)
![Page 31: History & Examination of the breast](https://reader036.vdocument.in/reader036/viewer/2022082214/568165a6550346895dd88c9a/html5/thumbnails/31.jpg)
Axilla, supraclavicular, infraclavicular lymph nodes
Patient sitting upright Rt. Axilla: Hold patient’s right elbow in your
right hand. Palpate the axilla with your left hand. For the apex of axilla press the finger pulp upward and medially.
Lt. axilla- reverse
Palpation for the lymph nodes
![Page 32: History & Examination of the breast](https://reader036.vdocument.in/reader036/viewer/2022082214/568165a6550346895dd88c9a/html5/thumbnails/32.jpg)
![Page 33: History & Examination of the breast](https://reader036.vdocument.in/reader036/viewer/2022082214/568165a6550346895dd88c9a/html5/thumbnails/33.jpg)
Palpate for supraclavicular, infraclavicular lymph nodes
Size, number, and fixation of lymph nodes
Examine arm for any swelling
Palpation for the lymph nodes
![Page 34: History & Examination of the breast](https://reader036.vdocument.in/reader036/viewer/2022082214/568165a6550346895dd88c9a/html5/thumbnails/34.jpg)
![Page 35: History & Examination of the breast](https://reader036.vdocument.in/reader036/viewer/2022082214/568165a6550346895dd88c9a/html5/thumbnails/35.jpg)
Full general examination like any other patient
Concentrate on: Chest: any effusion Abdomen: hepatomegaly, ascites Spine: pain, tenderness, limitation of movement
General examination
![Page 36: History & Examination of the breast](https://reader036.vdocument.in/reader036/viewer/2022082214/568165a6550346895dd88c9a/html5/thumbnails/36.jpg)
Thank you!