In our Practice, we perform clinical breast examination at least once a year as part of the regular health screening program for women. If needed, after the clinical examination further investigations will be performed, such as a mammography. We encourage each woman to perform a self- breast examination regularly and we offer training of the method.

Why do I need a regular breast examination?

Clinical (by the doctor) breast examination is done in order to:

identify a breast lump that might signify that there might be a more serious problem like breast cancer.
check for other problems in the breast that might need treatment, like mastitis or a fibroadenoma.

What preparation is needed?

It is important to inform us if you:

noticed the presence of a tumor or some change in your breasts. This includes some change in the nipples appearance or if there is any nipple discharge.. \
one breast is painful, especially if the pain is not relevant to your period.
are, or maybe you are pregnant.
breastfeed.
have implants.
have done breast biopsy.
are in menopause.
take hormone replacement treatment.
have a personal or family history of breast cancer.

When is the best time to have a clinical breast examination?

Preferably, breasts should be examined soon after the end of your period, that is approximately 1 to 2 weeks after the end of the period. This is the time breasts are less sensitive to examination. However, this is no reason to cancel a breast examination appointment if it is not within the suggested days.

If your period has stopped, then just pick a day of the year you can easily remember.

How is the examination done?

You will have to take off your clothes above the waist. You will wear a gown during the examination.

We will discuss your history with you, your risk factors nad whether there is something you noticed or if you have any concerns about your breasts.

First, we will observe your breasts for their shape, symmetry and skin appearance with your arms on the side, raised above your head or pressed against your hips. This positions improve any lesions identification.

Then we will meticulously palpate each breast using our fingertips. The whole breast surface will be covered as well as the area under the colar bone and the armpit. The whole procedure will be repeated after you lie down and put your arm behind your head. The examination will be completed after gently pressing the nipple to check for any discharge.

How is the examination for breast lumps done?

The lumps identified are the size of a pea (approximately 1.5- 2 cm big). If a lump is found, we will check its size, shape and structure. We will also check if the lump is easily movable. There are differences between benign and malignant tumors but if a lump is found then we will recommend having further tests for that.

In general, lumps that are soft, with regular shape and are easily moveable are most likely benign or cysts. A firm lump, with irregular shape that looks like it is fixed in the breast tissue, is more likely to be malignant but, nevertheless, further testing will be needed to identify its nature. Luckily enough, breast malignant tumors are uncommon.

After the end of the examination, we will show you how to perform a self- breast examination and help you do some practice. Breast- self examination is very important.

Will the examination make me hurt?

The clinical breast examination will not cause any discomfort unless you breasts are sensitive.

What are the expected results from the examination?

The clinical examination results will include some of the following findings:

Finding

Normal:	Nipples, breast mass and area around the breast are normal in appearance, size and shape. One breast might be slightly bigger than the other.
A small area of firm tissue might exist in the lower part of the breast, underneath the nipple.
Breast sensitivity or breasts with mulitple small cysts texture. Some women have this steady appearance in both breasts during their menstrual cycle.
Clear or milky fluid discharge when the nipple is pressed. This can be due to nursing, breast stimulation, hormones or other natural causes.
One breast might have more glandular tissue compared to the other, especially in the up and outer area of the breast.
Abnormal	Firm tissue or area of thickening in one of the breasts.
Change in colour or feeling of the breast or the nipple. This includes wrinkling, folding, thickening or pluckering of an area that may be felt as grainy or fibry or thckening.
A nipple might sink into the breast that was not like that before. Read or squamous rash or sore of the nipple.
Redding or heat feeling above a sensitive tumour or the whole breast. This can be a symptom of inflammation (mastitis or abscess) or cancer.
Bloody or milky discharge that happens without nipple stimulation (spontaneous discharge).

What further tests might be needed?

In case there are concerns, the next step depends on the nature of the problem found.

Cyclic pain of the breast, fibrocystic changes or cysts can be assessed again in order to see if they are gone by themselves. Especially for cysts, we can do an aultrasound scan to get further information about their structure.
In case a lump is found, we can do mammography, magnetic resonance imaging (MRI) or breast ultrasound scan. In case we need to check the lesion nature, we can perform thin needle biopsy, or a biopsy by a small cut so that the issue can be checked under microscope.
The nipple discharge, especially if it is spontaneous or bloody, can be cytologicaly checked under microscope to detect the presence of abnormal cells.