What to look for in breast examination

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October 15, 2010 – The female breast lies against the chest wall from the collar bone and 2nd rib down to the 6th rib and from the sternum bone in the mid to the imaginary mid line drawn from the top of the armpit. The surface area looks like a rectangle. Its base lies on pectoralis muscles that cover the ribs.

The breast is a hormone sensitive tissue composed of fatty tissue, glands that secrete and store milk and other connective tissues. The male breast consists of chiefly the nipple and areola tissue.

What to look for

A study done in the UK in 2001 under the breast Cancer Care advocacy recommends a five-point code for breast awareness:

1.You should know what is normal for you.

2.You should know what changes to look and feel for.

3.You must inspect and feel the breast.

4.You must report any changes to the breasts to your doctor immediately.

5.If you are 50 yrs and over, you must attend routine breast screening.

On inspection

Changes to look out for include:

•Nipple retraction may be due to cancer, fibrous tissue formation or normal in some cases

•In Paget’s disease of the nipple, it may look reddened.

•One sided increased vein visibility may imply breast cancer

•Skin changes such as the one that is dimpled or pucker and looks like an orange fruit skin ( peau d’orange) imply a breast malignancy

•Larger outline/shape/size of the breast may also imply malignancy, milk engorgement or abscess formation

•A nipple that is tethered or with a shifted position may also indicate malignancy.

•Inverted and slit like nipple must be symmetrical and are usually normal. In malignancy there is asymmetry, distortion with pulling of the nipple to one side.

On palpation

•Look for new/discrete lumps. These may be of  benign nature such as those found in young girls. Usually they are smooth. Any fixed irregular non-mobile  and painful lumps must be examined by a doctor to rule out any problem.

•Some lumps with persistent asymmetrical nodularity are present early in the menstrual cycle

•During palpation of nipple for discharge, any unusual pain/discomfort, different from normal should be noted.

•Painful breasts may be due to trauma, infections that are common in breast feeding mothers, breast engorgement or last on the list, cancer of the breast.

•Any bright blood expressed from nipple palpation may indicate fibroadenoma, ductal papilloma or cancer. Serous fluid discharge is seen in early pregnancy, milk in lactating mothers and greenish discharge in a condition called duct ectasia.

•A swelling under the armpit or around the collarbone may be due to lymph node enlargement seen in infections such as TB, or local breast infections.

It is advised to check your breasts from time to time to become aware of how the breast tissue changes at different times of the month. A woman who has gone through menopause can have this done monthly.

If you are 50 yrs and over, you must attend for routine breast screening.

 

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