M10.08.05 Recognizing normal and abnormal findings

Normal Breast Findings

Inspection

• Symmetry: Breasts are generally symmetrical in size and shape, though slight asymmetry is common.
• Skin: Smooth, even texture without dimpling or retraction. Normal variations may include faint striae (stretch marks).
• Nipples: Symmetrical, pointing slightly outward or upward. The skin is smooth, with no visible retraction or discharge.
• Areolae: Round or oval, uniform color, which may be darker in pregnant or breastfeeding women.

Palpation

• Consistency: Firm, elastic tissue; premenstrual fullness and nodularity are common.
• Mobility: Breast tissue is freely movable over the chest wall.
• No Tenderness: Except for mild tenderness related to the menstrual cycle.
• Lymph Nodes: Small, non-tender nodes in the axilla may be palpable and are considered normal.

Abnormal Breast Findings

Inspection

• Asymmetry: Noticeable difference in size or shape of the breasts.
• Skin Changes:
  • Dimpling: Skin appears puckered or dimpled, indicative of underlying tumor or fibrosis.
  • Edema (Peau d’Orange): Skin appears thickened with enlarged pores, resembling an orange peel, often due to lymphatic obstruction by cancer.
  • Erythema: Redness of the skin may indicate infection or inflammatory breast cancer.
  • Ulceration: Breaks in the skin can indicate advanced cancer.
• Nipple Changes:
  • Retraction: Nipple appears pulled inward, which can be a sign of underlying malignancy.
  • Deviation: Nipple points in an abnormal direction.
  • Discharge: Spontaneous, unilateral, and bloody discharge is particularly concerning.

Palpation

• Lumps or Masses: The presence of discrete lumps that are hard, irregular, and fixed to the skin or underlying tissue suggests malignancy.
• Tenderness: Diffuse tenderness not related to menstrual cycle, or tenderness associated with a localized mass.
• Axillary Lymph Nodes: Enlarged, firm, and non-mobile nodes are concerning for malignancy.

Specific Abnormal Findings

1. Breast Cancer

• Retraction Signs: Skin dimpling, nipple retraction, or abnormal contours.
• Skin Edema: Peau d’orange.
• Abnormal Mass: Hard, irregular, non-mobile, usually non-tender.

2. Fibroadenoma

• Well-Circumscribed Mass: Round, firm, mobile, usually non-tender.
• Typical Age: Young women, 15-35 years.

3. Cysts

• Soft to Firm Mass: Elastic, mobile, often tender.
• Typical Age: Women aged 35-50 years.

4. Mastitis

• Red, Swollen, Tender Area: Usually during breastfeeding.
• Systemic Symptoms: Fever, malaise.

5. Mammary Duct Ectasia

• Nipple Discharge: Thick, sticky, usually green or black.
• Nipple Retraction: Possible.
• Periareolar Mass: Sometimes present.

6. Paget’s Disease of the Nipple

• Eczemalike Lesion: Scaly, may weep, crust, or erode.
• Underlying Mass: Possible.

7. Fat Necrosis

• Irregular, Firm Mass: Often after trauma or surgery.
• Skin Retraction: Possible.

Summary Table

Recognizing these signs during a physical examination is essential for early detection and management of breast conditions.