Position patient supine, with the hand on the side you're examining behind their head. Palpate the asymptomatic breast first. Palpate using the flat palmar surface of your fingers. Palpate using a systematic technique to ensure you examine all of the breast regions.

1. CLINICAL BREAST EXAMINATION
BY: HIRA ALTAF (202001)

2. Normal Anatomy of Breast
• The breast is located on
the anterior thoracic wall. It
extends horizontally from
the lateral border of the
sternum to the mid-axillary
line. Vertically, it spans
between the 2nd and 6th
costal cartilages. It lies
superficially to the
pectoralis major and
serratus anterior muscles.

4. Quadrants of Breast

5. LYMPHATIC DRAINAGE OF BREAST
The lymphatic drainage of the
breast is of great clinical
importance due to its role in the
metastasis of breast cancer cells.
There are three groups of lymph
nodes that receive lymph from
breast tissue – the axillary nodes
(75%), parasternal nodes (20%)
and posterior intercostal nodes
(5%).

6. CLINICIAL BREAST EXAMINATION
• It inclues :
• Careful History Taking
• Visual Inspection
• Palpation of :
_both breasts
_armpits and
_roots of the neck
Educating women on breast self examination and
awareness,particularly on breast lumps.

8. PRE REQUISTIES OF BREAST EXAMINATION
 Wash your hands and done PPE.
 Introduce yourself to the patient.
 Explain the procedure and gain consent.
 Assure privacy by draping parts of the body not being
examined
 Offer chaperone to the patient.
 Expose the patient Adequately
 Position the patient correctly.

9. POSITION OF THE PATIENT

10. INSPECTION

11. CHANGES THAT CAN OCCUR IN NIPPLE

12. PALPATION
• Use finger pads of middle 3 fingers.
• Palpate the normal breast first.
• First examine is sitting position and then in supine
position with hand of patient behind head.
• Palpate the breast from outside towards nipple.
• Use on or two hand to elicit lumps.
• Press the breast against chest wall.
• Rolling fingers in small circular motions.
• Press lightly for superficial layers and firmly for deeper
layers.

13. • Examine the axillary tail between your finger and
thumb.
• Palpate the nipple by holding it gently between your
index finger and thumb.
• Try to express any discharge and note the colour and
consistency and observe the number of ducts affected.
• Palpate the regional lymph nodes ,including the
supraclavicular group,cervical and infraclavicular.
• Palpate axillary lymph nodes as well.

14. Examination of axillary lymph nodes

16. If you find any mass then assess
wether it is fixed underneath.For this
ask the patient to place hands on her
hips,hold the mass between your thumb
and forefinger.Ask her to contract and
relax the pectoral muscles alternatively
by pushing into her hips.As the pectoral
muscle contracts ,note wether the mass
moves with it and if it is separate when
the muscle is relaxed.Fixation suggests
malignancy

17. Breast Lump
• Breast lump should be
assessed for :
• SIZE
• SITE
• SHAPE
• NUMBER
• SHAPE
• EDGE
• CONSISTENCY
• MOBILITYFLUCTUANCE

18. TRIPLE ASSESSMENT OF BREAST
History and Examination
Diagnostic imaging by
mammography or ultrasound
scan.
Cytology(FNAC) or Histolgy