I. Significance of physical examination The physical examination of the breast is mainly through visual and palpation to check the shape of the breast, the condition of the skin surface of the breast, the condition of the nipple areola, breast lumps, nipple overflow, etc. Finally, do not forget the regional lymph node examination and the whole body examination. The physical examination of the breast includes 1. Breast morphology: the appearance, size and position of the breast should be checked for symmetry. 2.Breast skin surface: the color of the breast skin and the presence of edema, rash, ulceration, superficial venous anger, skin folds and orange peel-like changes should be checked. 3, nipple areola: check the nipple for deformity, elevation, retraction, depression, erosion and desquamation; areola color abnormalities, eczema-like changes, etc. 4. Breast lumps: The location, shape, size, number, texture, surface smoothness, mobility and tenderness of breast lumps should be checked. The main way to check is by palpation. Generally speaking, bilateral multiple lumps with periodic breast pain are more likely to be benign; while unilateral single painless lumps have the possibility of malignant lesions. 5. Nipple overflow: check whether there is nipple overflow, and check in detail whether it is spontaneous or extruded, unilateral or bilateral, and the nature of the overflow, etc. Regional lymph nodes and general condition: Since breast cancer is prone to axillary and supraclavicular lymph node metastasis, physical examination of breast should routinely check the size, texture and activity of lymph nodes in these areas. How to do the examination: The upper half of the body is completely naked, stand upright in front of the mirror, raise and lower both hands to observe the bilateral breasts, whether they are symmetrical, whether there is any change in size, whether there is any change in swelling, whether there is any change in skin color, whether there is any ulceration, and whether both breasts are on the same level. Fingers together, touch the breast with the abdomen of the fingers, and choose different strengths of light, medium and heavy to palpate, remember not to pinch and grasp the breast with the hand, generally the left hand to check the right breast, the right hand to check the left breast, to check the axillary lymph nodes also with the hand to put the flat corner of the, not to mention grasping the axillary tissue or axillary skin, found abnormalities, should promptly seek medical advice. Third, the specific steps are as follows 1, the correct breast examination touch the palm of the hand should be flat four fingers together, with the most sensitive index finger, middle finger, ring finger end finger belly in order to lightly search the outer breast on the outer lower, inner lower, inner upper region and finally the middle of the breast nipple and areola area. Do not use your fingers to grasp and pinch the breast tissue during the examination, otherwise the grasped breast tissue may be mistaken for a lump. 2.From sitting position any nipple inversion skin depression structure shape abnormality is a clue of deep breast cancer. If the patient claps her hands on her head to contract the pectoral muscles, the above signs will appear, and when the woman is in sitting position, it is easy to check the lymph nodes above and below the clavicle and in the axilla. Finally, palpation should be performed in a sitting position by touching the area under the nipple with joined fingers. 3. In the supine position, a more extensive palpation of the area is performed. A pillow is placed under the ipsilateral breast and the ipsilateral hand is raised above the head so that the breast is evenly spread on the chest wall, making it easy for the fingers to reach the deeper part. The palm surface of the middle finger of the index finger, not the fingertip, should be used for palpation, and palpation should be performed by turning the nipple outward in a circle, and it is especially important to examine the breast that extends to the axilla. 4, breast examination should first observe the development of the breast. Whether the size of both breasts is symmetrical, whether the nipples are similar on both sides, whether the nipples are at the same level, whether there is retraction depression; whether there is erosion of the nipple areola, how the skin color of the breast, whether there is edema and orange peel-like changes whether there is redness and inflammation, whether the superficial veins in the performance breast area are angry, etc. Fourth, the breast physical examination considerations Emphasis on follow-up If the initial visit to the physical examination is not very satisfactory, when the doctor instructs the patient to follow-up, it is important to conduct a follow-up examination again at the best time of physical examination. The best time is usually around the 10th day of the menstrual cycle, when the disturbance caused by the physiological changes of the breast during the menstrual cycle can be avoided. Cooperate with the examination Some patients intentionally cover up with clothes during the examination, trying to minimize the exposure of the body, resulting in insufficient light and unclear vision, causing signs caused by small lesions to be ignored. Warm tips After the results of relevant auxiliary examinations are available, if it is still difficult to confirm the diagnosis, you should go back to the doctor to examine the lesion site again meticulously, because in the comprehensive analysis of various examination results, the important signs obtained from physical examination are of great significance to the formation of the final diagnosis. TIPS: 2 reasons for not paying attention to breast physical examination Not paying attention to breast physical examination, resulting in more money or missed diagnosis or misdiagnosis. On the one hand, patients are reluctant to fully expose their breasts in front of the doctor, which hinders the examination; on the other hand, doctors neglect physical examination and rely too much on imaging, which results in a large number of tests, but ignore the clinical signs with diagnostic value and lead to missed diagnosis and misdiagnosis. The price of breast examination varies from region to region, so it is recommended to go to the local hospital for detailed consultation. The best time for breast examination During different periods of the menstrual cycle, the breast will undergo some physiological changes of enlargement and rejuvenation due to the influence of various related endocrine hormones. In the premenstrual period, the estrogen level is higher, the proliferation of glandular tissue in the breast will be more obvious, the breast tissue will appear different degrees of congestion, edema, the whole breast will be thicker, some of the examination is not so suitable, will affect the judgment of the nature of the breast lumps. If you need to take a molybdenum target X-ray examination, the clip will also be more painful. The most suitable time to do the examination for breast disease is the 5th to 10th day of menstruation. Because estrogen has the least impact on breast tissue at this time, breast tissue is in a relatively static state and abnormalities and lesions in the breast are most easily detected. This is the easiest time to go to the hospital and get an infrared breast scan from a specialist. For women after menopause, since they no longer have menstruation, it is sufficient to choose a convenient time for both yourself and your physician to visit. Seven, the results of physical examination of the breast 1, check the chest in addition to the skin content, should pay attention to the presence of venous anger, lumps, pressure pain, fistulas and breast abnormalities. 2.Venous. There is no obvious vein visible in normal chest wall, the superior vena cava or inferior vena cava produces collateral circulation when the blood flow is obstructed, and the chest wall veins are filled or varicose. 3.Subcutaneous emphysema. When the gas accumulates under the skin, it is called subcutaneous emphysema. There is a feeling of gripping snow when pressed by hand. It is caused by lung, trachea, pleura after injury or lesion, or occasionally due to gas escaping to subcutaneous during artificial pneumothorax or artificial pneumoperitoneum. Subcutaneous emphysema is also seen in Pneumocystis carinii infection. 4. Chest pressure pain. Normal pressure pain is absent. Localized pressure pain is commonly seen in costochondritis, intercostal neuralgia, local skin and soft tissue inflammation, rib fracture, etc. Sternal pressure pain and percussion pain can be seen in leukemia. 5.Breast. Breast palpation is performed in the lying position, but also in the sitting position. When palpation begins with the normal breast, the physician’s fingers and palm must be flat on the breast, gently pressing toward the chest wall and making circular strokes, not lifting the breast with the fingers to touch. The palpation usually begins in the upper outer quadrant, proceeds clockwise on the left side and counterclockwise on the right side, and ends with palpation of the nipple. Pay attention to physical signs such as hardness and elasticity, pressure pain and lumps. Red, swollen and hot breast pains are common in acute inflammation; breast lumps are seen in cysts, adenomas, fatty necrosis, tuberculosis, chronic abscesses and cancer; breast cancer occurs mostly after middle age, often in multiple lumps without inflammatory manifestations, and local skin may have edema and orange peel-like changes.