Medically Fit For Exams
Medically Fit For Exams

Breast examination

  • Wash your hands and introduce yourself
  • Check the patient’s name and DOB
  • Explain the examination and gain consent
  • Ensure a female chaperone is present/comment on the fact that the examiner will act as a chaperone



  • Ask the patient to undress from the waist up, ideally behind a screen and sit on the edge of the couch
  • Observe the breast for:
    • Symmetry
    • Dimpling
    • Peu d’orange
    • Nipple retraction
    • Scars
    • Discharge
  • Observe in different positions
    • Arms by their sides
    • Both arms raised above head
    • Hand on hips and pushing into hips
    • Pushing the body off the couch with hands pressing into couch
    • Patient leaning forward to look to muscle/lump tethering



  • Ask the patient to lie down on the couch at about 45 degrees
  • Ask the patient to relax, and place the arm on the side of examination above her head
  • Start with the normal side
  • Palpate 4 quadrants using the pulp of the finger
  • Feel under the nipple/areola
  • Palpate the axillary tail
  • Feel into pit of the axilla
  • Repeat for the other side
  • If the patient complains of discharge, ask them to produce it
  • Check for supraclavicular nodes from behind
  • Check for hepatomegaly
  • Listen to lung bases
  • If any lumps are found, note the following:
    • Size
    • Location
    • Shape
    • Colour if appropriate
    • Tenderness
    • Temperature
    • Consistency: soft, firm, hard
    • Surface: smooth, irregular
    • Well defined vs poorly defined
    • Tethering and mobility
    • Skin changes


Malignant lump

Benign lump


May be painful/tender

Tethered to chest wall/non-moveable


Irregular edge, may be poorly defined

Smooth, well defined edge

Hard consistency

Firm, rubbery consistency

Can cause dimpling of skin and nipple retraction

Dimpling and nipple retraction unlikely

May have unilateral bloody discharge

May have green/yellow/ white/clear discharge










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