SU25.5 | Breast Swelling Palpation — Summary & Reflection

KEY TAKEAWAYS

Breast palpation is the clinical arm of triple assessment and a competency demonstrated on a mannequin/simulator. It rests on surface anatomy (four quadrants + nipple-areola + the axillary tail, where most lumps arise) and on governing principles — consent, a documented chaperone, privacy/dignity, good light, examining both breasts and the regional nodes, and a systematic routine. The technique is a fixed sequence: inspect the seated patient in three positions (arms by sides, raised, hands on hips to tense pectoralis major) for asymmetry, dimpling, nipple change and peau d'orange; palpate the supine patient with the arm behind the head, using the flat of the fingers across every quadrant, the nipple-areola and the axillary tail; then examine the axillary node groups (anterior, posterior, lateral, central, apical) and the supraclavicular fossa, and the other breast. Characterise any lump by site, size, shape, surface, consistency, margin, mobility, fixity and tenderness — benign lumps feel smooth/mobile, malignant lumps hard/irregular/fixed — but a benign feel never excludes cancer. Document the findings structurally and feed them into the full work-up; repeated supervised practice builds fluency.

REFLECT

Picture yourself examining the next breast simulator, or a real patient with a chaperone present. Did you secure consent and dignity first, and did you inspect in all three positions rather than going straight to palpation? When you palpated, did you use the flat of your fingers across every quadrant and the axillary tail, and did you remember the axillary node groups, the supraclavicular fossa and the other breast — or did you stop at the lump? And could you write up your findings — site, characteristics, fixity, nodes, impression and plan — so clearly that a colleague could act on them without re-examining the patient? Reflect on one element of the routine you tend to rush or skip, and commit to making it automatic, so that your examinations are thorough, respectful and trustworthy.