7Ds of breast examination

BREAST EXAMINATION


Ask for chaperone
Remove clothes from waist up
Put patient in a lying position with 45 degree angle
Ask patient to point with 1 finger where exactly is the lump
Inspect the patient’s breast, compare both breasts
Tell patient to raise both hands, to see if there is any attachment
Check the level of both nipples, same or not
Any accessory nipple or deviation
Any apparent erythema, fissure in the nipple, any secretion or blood from the nipple
Look for peau d’orange
Tell patient to put her hands on the hips and press à to fix the pectoralis muscle
Come more closely and look at the nipple, look for 7D:
- Discolouration
- Discharge
- Depression
- Deviation
- Displacement
- Distraction
- Duplication (any double nipple)

Comment if both breasts are symmetrical in size, shape
Take permission to touch the breast
Palpation of the normal breast
Examine the left breast, ask patient to raise her left arm behind the head
Examine the right breast
With the tips of the finger start from midline of the chest to the breast around then armpits
Examine the lump: size, surface, edge, consistency, pulsation, tenderness if related to the skin and underlying muscle, fluctuant or not, transilluminate or not
Palpate the 5 areas of lymph node in the axilla à (anterior, posterior, lateral, medial, apical), supraclavicular fossa & cervical lymph node
Well defined lump, not painful, 1 cm, more or less solid in the right breast
Rapidly check all lymph nodes of the body
Chest, heart, abdomen

Coincide with benign lesion called fibroadenoma
Refer to the radiologist for a simple procedure to confirm the diagnosis à USG with a guided percutaneous core biopsy if needed, will be decided by the procedural radiologist