18. The breasts and axillae

Examination of the breasts can make a substantial contribution to the diagnosis of conditions including breast cancer. Both patients and physicians may find it embarrassing, but this can be reduced by carrying it out professionally and giving clear instructions to the patient. It will usually be carried out on indication, either because a patient feels a lump, or screening finds a suspicious lesion. It is important to discuss patients’ fears and concerns. Following a breast examination, the armpits will often be palpated, as any lymph node metastases are most likely to manifest themselves there. The differential diagnosis list for a palpable breast abnormality comprises cysts, fibroadenoma, lipoma, multinodular mastopathy, mastitis, abscess, haematoma and fat necrosis. Nipple disorders are also discussed in this chapter.