I.

Introduction

Breast Examination

Like the uterus, the breast undergoes regular cyclical changes in response to hormonal
stimulation. Each month, in rhythm with the cycle of ovulation, the breasts become engorged
with fluid in anticipation of pregnancy, and the woman may experience sensations of
tenderness, lumpiness, or pain. If conception does not occur, the accumulated fluid drains
away via the lymphatic network. Mastodynia (premenstrual swelling and tenderness of the
breasts) is common. It usually lasts for 3 to 4 days before the onset of menses, but the
symptoms may persist throughout the month.

Monthly breast self-examination (BSE) is the best method for detecting breast masses early.
A woman who knows the texture and feel of her own breasts is far more likely to detect
changes that develop. Thus it is important for a woman to develop the habit of doing routine
BSE as early as possible, preferably as an adolescent. Women at high risk for breast cancer
are especially encouraged to be attentive to the importance of early detection through routine
BSE.

Breast self-examination should be performed on a regular monthly basis about 1 week after
each menstrual period, when the breasts are typically not tender or swollen. After menopause,
BSE should be performed on the same day each month (chosen by the woman for ease of
remembrance).

Clinical breast examination by a trained healthcare provider, such as a physician, nurse-

practitioner, or nurse-midwife, is an essential element of a routine gynecologic examination.
Experience in differentiating among benign, suspicious, and worrisome breast changes
enables the caregiver to reassure the woman if the findings are normal or move forward with
additional diagnostic procedures or referral if the findings are suspicious or worrisome.

II. Objectives
At the end of the lecture/ discussion, the sophomore students will be able to:
1. To focus on basic nursing skills on breast assessment necessary in the care of the woman
in a maternal health facility, like health center and hospital
2. Plan nursing care in preparing a woman for breast examination.
3. Render appropriate nursing care during the breast examination.
4. Evaluate the result obtained from the breast examination.

References:
Ladewig, P. et al (2006) Contemporary Maternal Newborn Nursing care (6th edition)

III. Content

CONTENT TEACHING METHOD

Discuss the factors associated with breast
cancer.
Stress the unique risk factors associated with
the woman’s personal history and lifestyle.
Breast cancer should be discussed in a
private are free of interruptions. The room
needs to have a mirror; bed, couch, or
examining table; pillows; a patient gown; and
private area fir the woman to disrobe.
Create a supportive, warm, and comfortable
atmosphere by attitude and communication
style – both verbal and nonverbal. A
discussion of breast cancer may bring forth
many emotions in the woman, including grief
for previous breast cancer-related losses.

Discuss the use of BSE in breast cancer
detection.
Describe and Demonstrate the Correct
Focus on open discussion. A brochure with
statistics and illustrations may be useful.
Stress the positive outcomes of early
detection to counterbalance fears.
Learning is best accomplished when material
Procedure for BSE. is broken down into smaller steps and
A. Instruct the woman to inspect her presented with multiple approaches. Prior to
breasts by standing or sitting in front of asking the woman to perform BSE, use a
a mirror. She needs to inspect her model or a chart to demonstrate the
breasts in three positions: with both procedure. Then have the woman perform
arms relaxed down at her sides, both BSE. Be very supportive and give a lot of
arms stretched straight over her head, positive feedback because some women may
and both hands placed on her hips while be embarrassed. Demonstrate a
leaning forward. nonjudgmental, accepting attitude.
Positions for inspection of the breasts:
a. Both arms relaxed at sides
b. Both arms stretched above the head
c. Both hands on hips while leaning
forward
B. Advise the woman to look at her breasts
individually and in comparison with one
another. Note and record the following
characteristics for each position:

Size and Symmetry of the Breasts

1. Breasts may vary, but the variations
should remain constant during rest or
movement – note abnormal contours.
2. Some size difference between the
breasts is normal
Shape and Direction of the Breasts
1. The shape of the breasts can be
rounded or pendulous with some
variation between breasts.
2. The breasts should be pointing slightly
laterally.
Color, Thickening, Edema, and Venous
Patterns
1. Check for redness or inflammation.
2. A blue hue with marked venous pattern
that is focal or unilateral may indicate an
area of increased blood supply due to
tumor. Symmetric venous patterns are
normal.
3. Skin edema observed as thickened skin
with enlarged pores (“orange marks”)
may indicate blocked lymphatic
drainage due to tumor
Surface of the Breasts
1. Skin dimpling, puckering, or retraction
(pulling) when the woman presses her
hands together or against her hips
suggests malignancy.
2. Striae (stretch marks) red at onset and
whitish with age are normal
Nipple Size and Shape, Direction,
Rashes, Ulcerations, and Discharge
1. Long, standing nipple inversion is
normal, but an inverted nipple
previously capable of erection is
suspicious. Note any deviation,
flattening, or broadening of the nipples.
2. Check for rashes, ulcerations, or
discharge
C. Instruct the woman to palpate (feel) her
breasts as follows:
1. Lie down. Put one hand behind your
 head. With the other hand, fingers
flattened, gently feel your breast. Press
lightly. Now examine the breast.
2. Remember to feel all parts of each
breast
3. Now repeat the same procedure sitting
up, with the hand still behind your head
4. Squeeze the nipple between your thumb
and forefinger. Look for any discharge –
clear or bloody
D. Take the woman’s hand and help her to Demonstrate “normal lumps” on the woman
identify her “normal lumps” (e.g., herself while guiding her hand and identifying
mammary ridge, ribs, and nodularity in the the area. This will increase confidence that
upper outer quadrants.) she will recognize an abnormal finding.
E. After she examines her breasts and Checking her immediately afterward will
identifies her normal lumps, instruct her to positively reinforce her and diminish the fear
palpate her breasts once more to identify associated with BSE.
any areas that she may have questions
about. If questions arise, the nurse should
palpate the area and attempt to identify
whether it is normal
F. If a breast model is available, instruct the
woman to palpate it and identify the
lumps.
G. Provide information on the warning signs
of breast cancer and what she should do
if she identifies any of these signs during
BSE.
Explain when and how to perform BSE.
Instruct the woman to perform BSE on a
monthly basis. Be specific based on
whether she is premenopausal,
pregnant, postmenopausal, receiving
hormone replacement therapy.