We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.
We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.
from Section 3 - Breast surgery
Published online by Cambridge University Press: 05 July 2015
Checklist
WIPER
• A chaperone will help the patient get changed into an examination gown in a private area.
• The patient is positioned sitting on the edge of the bed with hands resting on hips.
• The breasts are exposed only when the examination begins.
Physiological parameters
General
• Weight loss
• Radiotherapy tattoos or Hickman line scar (for chemotherapy)
• Donor site scars: TRAM or DIEP flap (lower abdomen), LD flap (back) or other scars (e.g. gluteal or transverse myocutaneous gracilis)
• Bra: prosthetic or cosmetic inserts suggestive of breast asymmetry, bra cup size
Inspection
• Chest wall/spine/shoulder: symmetry/deformities (crucial to apparent breast appearance)
• Breast: volume, symmetry, shape, projection, chest wall position
• Nipples: deviation, retraction, inversion, discharge, Paget's disease, eczema
• Skin: scars, mammary fistulas, erythema
• Soft tissues: lumps, skin dimpling, peau d'orange, cancer en cuirasse, ulceration
• Haagensen manoeuvre: press arms on hips, lift hands behind head, slowly lower arms
• Axillae: masses, SLNB or ANC scars
• Supraclavicular fossae: swelling/masses
• Arms: lymphoedema (comment on any compression garment), muscle wasting
Palpation
• Breast: masses, tenderness:
•four breast quadrants (upper/lower, outer/inner)
•nipple and retroareolar tissues
•axillary tail of Spence
• Nipple: discharge
• Axilla: lymphadenopathy (five sites per side), accessory breasts
• Lateral chest wall: port sites for breast expander implants
To complete the examination…
• Neck/supraclavicular fossae: lymphadenopathy
• Spine: tenderness
• Abdomen: hepatomegaly
• Chest: pleural effusions
Examination notes
How are breast lumps assessed?
Any new breast lump requires triple assessment. Symptomatic patients should be assessed in a one-stop breast clinic.
What does the triple assessment involve?
Clinical: examination by a surgeon
Imaging: breast ultrasound (women under 40 years) or mammography (women 40 years or older)
Histology: fine-needle aspiration (FNA) or core biopsy
Each is scored 1–5 (1 = low, 5 = very high risk).
To save this book to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.
Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
Find out more about the Kindle Personal Document Service.
To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.
To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.
