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Physical Assessment

The Breast and Axillae

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Anatomy of the Breast

Four breast

quadrants and the

tail of Spence

Upper outer Upper inner

Lower outer

Lower inner

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Anatomy of the Breast

Glandular tissue

Lobes

Areola

Nipple

Lactiferous duct

Adipose Tissue

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Anatomy of the Breast

Location of the lymph

nodes that drain the

lateral breast

Supraclavicular Lateral

Central

Intraclavicular Anterior

Posterior

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Assessing the Breasts and Axilla

Inquire if the client has a history of breast

masses and what was done about them

Pain or tenderness in the breasts and relation

to the womans menstrual cycle Discharge from the nipple

Medication history

Risk factors that may be associated with

development of breast cancer

If the client performs breast self examination

and techniques used

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Assessing the Breasts and Axilla

Inspect the breast size, symmetry and

contour or shape while the client is in s sitting

position

Inspect the skin of the breast for localizeddiscolorations or hyperpigmentation,

retraction or dimpling, localized hypervascular

areas, swelling or edema

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Assessing the Breasts and Axilla

Emphasize any retraction

Inspect the areola area for size, shape,

symmetry, color, surface characteristics and

any masses or lesions Inspect nipple size, shape, position, color,

discharge, and lesions

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Assessing the Breasts and Axilla

Palpate the

axillary,

subclavicular,

subraclavicularlymph nodes

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Assessing the Breasts and Axilla

Palpate the breast for masses,

tenderness, and any discharge

from the nipples

Palpation of the breast is

generally performed while theclient is supine

3 patterns for palpation: hands-

of-the-clock or spokes-on-a-

wheel, concentric circles, verticalstrips pattern

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Assessing the Breasts and Axilla

Palpate the areola and the nipples for

masses

Compress each nipple to determine the

presence of any discharge Teach the client the technique of breast self

examination (BSE)

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Assessing the Breasts and Axilla

If you detect a mass, record the followingdata: Location

Size Shape

Consistency

Mobility

Skin over the lump Nipple

Tenderness

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Lifespan Considerations

Infants

Newborns may have breast enlargement and white

discharge from the nipples

Supernumerary nipples

Children

Female breast development begins between 9 and 13

years

Boys may develop breast buds and may have slight

enlargement of the areola in early adolescence

Gynecomastia

Axillary hair appers

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Lifespan Considerations

Pregnant females

Breast, areola, and nipple size increase

Areola and nipples darken

Superficial veins become more prominent

Jagged linear stretch marks may develop

Colostrum may be expressed from the nipple

after the first trimester Breast change in shape, appear pendulous or

flaccid