ASSESSING THE BREASTS

NUR211

Kathleen Hancock

Assessing the Breasts Obtain a breast history. Perform a breast physical

assessment. Document breast assessment

findings.Differentiate between normal and

abnormal findings.

Breast Composition3 types of tissue:

*Glandular

*Fibrous

*Adipose

Structures

Lobes and lobules Lactiferous ducts and sinuses Areola Montgomery’s glands

Structures

Nipple Cooper’s ligament Pectoralis major and serratus

anterior muscles

FunctionsWhat are the functions of…

Lobes & lobules: Contain alveoli cells that produce milk

Lactiferous ducts & sinuses: Carry and store milk

Areola: Dark tissue surrounding nipple

(Continued)

FunctionsWhat are the functions of…

Montgomery’s glands: Sebaceous gland

Nipple: Nursing and sexual stimulation

Cooper’s Ligament: Ligament attached to chest wall muscles that supports breasts

(Continued)

FunctionsWhat are the functions of…

Pectoralis major & serratus anterior muscles:

Breast overlies these muscles

Lymph nodes:

Drain breast, chest, and arms

Breast Health: Cancer Prevention Self Breast Exam (SBE)

Every month

Mammogram After age 40 every yearMore frequent if personal or family history

Breast Exam by nurse or doctor every year

DevelopmentalVariationsWhat developmental breast variations

might be seen with:ChildrenPregnant clientsOlder adults

HistoryWhat can the history tell you about the breast?Biographical dataCurrent health statusPast health historyFamily historyReview of systemsPsychosocial history

SymptomsWhat symptoms signal a problem with the breasts?

Breast lump or mass Pain or tenderness Nipple discharge

Physical Assessment

Anatomical landmarks: quadrants of the breast, include Tail of Spence

(Continued)

Inspection

Breasts: size, shape, symmetry, color, lesions, venous pattern, dimpling, or retraction

Nipple and areola: nipple position and direction; discharge

Axillae: color, lesions, rashes

Physical Exam - Inspection

Position: sitting, hands on hips, hands over head, leaning forward

Tools: small pillow or towel, ruler, gloves, slide, and culture slide.

Sitting, arms at sides

Arms overhead

Arms pressing on hips

Leaning forward

Palpation

Lymph nodes: axillary, clavicular while sitting

Breasts: consistency, masses, tenderness in supine position

Nipple: elasticity, masses, tenderness, discharge

Supraclavicular Nodes

Infraclavicular Nodes

Axillary Nodes

Palpation –Vertical Strip Method Preferred Approach: supine

with pillow or towel under shoulder

Pattern (vertical, wedge, or circular) light, medium, and deep

Supine with shoulder support –Use pads of fingers of dominant hand

Strip Method of PalpationCover all of breastUse 3 middle finger pads, not tipsUse sliding motionOverlapping dime size circles3 pressure levels: light, medium, deepInclude nipple and areola

Large Breasts

Bimanual palpation to adequately examine all areas

Often have an inframammary ridge

Male Breast

InspectionPalpation

Lymph nodes while sittingBreast while sitting or if large while

lying down

Male Breast Enlargement:Gynecomastia

Characteristics of MassesNote:

Location Shape/Borders Size Tenderness Mobility Consistency Temperature Redness

Example: Pertinent Physical Findings Right breast larger than left No dimpling, retraction Small, pea size (0.5cm), movable,

rubbery, smooth-edged lesion in right breast at 2 o’clock in RUQ

No palpable nodes