Introduction (Use the acronym WIPER to prepare for the examination)
- W - Wash your hands
- I - Introduce yourself and confirm patient details
- P - Permission - gain consent to proceed with the examination, including explaining relevant details
- E - Expose the patient appropriately
- R - Position the patient lying back at 45 degrees comfortably
- Inspection with patient
- Lying back reclined at 45 degrees
- Patient with hands on hips
- Patient with hands raised above head
- Look for
- Asymmetry, lumps, dimples, scars
- Skin changes, peau d'orange
- Masses and tethering of any masses
- Lesions underneath the breasts
- Palpate the breasts with patient lying flat or at 45 degrees: Asks about pain and lumps felt by patient. Examine away from these areas
- All four quadrants (see below)
- Superior aspect
- Inferior aspect
- Anterior aspect
- Posterior aspect
- Nipple, including for discharge and underlying lumps Palpates axillary lymph nodes: Checklist P MP F
- Supports the patient's arm with their non-dominant arm and palpates following areas:
- Superior aspect
- Inferior aspect
- Anterior aspect
- Posterior aspect
- Apex
- All four quadrants (see below)
- Covers patient and offers to help her get dressed Tells the examiner that they would like to do the following to look for secondary metastasis:
- Palpate for cervical lymphadenopathy
- Palpate for hepatomegaly
- Auscultate the lung bases for effusions
- Percuss the spine for tenderness
- Advise the patient to sign up to breast screening
- Suggests a mammogram for greater diagnostic certainty