ASSESSMENT OF

THE BREAST
Jonalyn Sotero Esco RN., MAN.
 Anatomy Of The Breast

 What to Assess

1. Color
2. Thickening/ Edema
3. Contour
4. Discharges
5. Vascularity
6. Size and symmetry
7. Lesions/ massess
 Normal findings
1. Breast and axillae are flesh colored
2. Areolar areas and nipples are darker in
pigmentation
3. Moles and nevi are normal variants
4. No thickening or edema
5. No dischrage from nipples in nonpregnant,
nonlactating mother
6. Usually palpable lymph nodes less than 1 cm
(0.39 inches) in diameter are clinically
insignificant.
7. Palpation should not elicit pain.

8. Consistency of breast tissue is highly variable

depending upon age,time in mestrual cycle
and proportion of adipose tissue.

9. Breasts are usually nodular or granular prior

to menses.

10. Variation with breast augmentation- breast

feel fluid filled or firm throughout.
 Breast Changes With Aging
Breast development is an early sign of puberty in
females.
 It usually occurs between ages 8- 13.
 Menarche is the start of menstrual cycle,
typically occurs about 2 years later.
 Development of breast tissue in girls younger
than 8 years is abnormal.
 Breast development usually starts with the
breast and nipple protruding as a single mound
of flesh.
During puberty
 Breast development is commonly
unilateral or asymmetrical.

During the reproductive years

 woman’s breast may become full or
tender in response to hormonal
fluctuations during the menstrual
cycle.
During pregnancy
Breast changes occur in response to hormones from
corpus luteum and placenta.
 The areola becomes deeply pigmented and increases
in diameter.
 The nipple becomes darker, more prominent, and
erect.
 The breast enlarge because of the proliferation and
hypertrophy of the alveolar cells and lactiferous
ducts.
 Venous pattern may become visible.
 Striae may appear as a result of stretching.
 Montgomery’s tubercles may become prominent.
Types of Breast examination
1. Clinical Breast Exam (CBE) is a
physical exam done by a health care
provider. It's often done during regular
medical check-up.
A CBE should be performed by a health
care provider well-trained in the
technique (this may be a physician, nurse
practitioner or other medical staff).
2. Breast self-examination (BSE) is
a screening method used in an attempt to
detect early breast cancer.
 The method involves the woman
herself looking at and feeling
each breast for possible lumps,
distortions or swelling.
When to conduct SBE
• The best time to do a monthly self-breast
exam is about 3 to 5 days after the period
starts.
•  Do it at the same time every month. The
 breasts are not as tender or lumpy at this
time in the monthly cycle.
• For menopause client, do the  exam on the
same day every month
• Both men and women should perform a
BSE at least once each month beginning
at age 18 ..
• Breast self-examination can be
performed every month
 Abnormal Findings
1. Peau D’orange- (French for "orange peel skin"
or, more literally, "skin of an orange")
describes anatomy with the appearance and
dimpled texture of an orange peel. Peau
d'orange is caused by cutaneous lymphatic
edema, which causes swelling.
2. Lump or Thickening- Localized swelling that
feels different from surrounding breast tissue.

3. Gynecomastia- is an enlargement or swelling

of breast tissue in males. It is most
commonly caused by male estrogen levels
that are too high or are out of balance with
testosterone levels.

Steps:
1. Describe observations or findings made during
examination in relation to imaginary lines
that divide the breast into four quadrants
and tail.

R: Location of finding by common

reference point to help successive
examiners to confirm findings and locate
abnormalities.
QUDRANTS OF THE BREAST
2. Inspect both breast for size and symmetry.
Note position of breast and nipples in relation
to underlying intercostal spaces.
 Observe area of chest over which breast
extends.
R: Change in size or shape may indicate
underlying mass or presence of
inflammation.
3. Observe contour or shape of breast, noting
any masses, retraction of tissue, or flattening.
If retraction is suspected, ask client to raise
hand above the head.
R: Underlying mass or swelling, or
inflammation may cause bulging or
retraction of breast tissue . Maneuver
causes contraction of pectoral muscles which
accentuates presence of retraction.
Nipple Retraction
4. Inspect overlying skin for color and venous
pattern. If breasts are large, carefully lift breast
to inspect underlying skin surfaces. Normal
breast are same color as surrounding skin
surfaces.
R: Vascular changes, edema, or
inflammation may cause akin color changes.
Undersurface of breast is common site for
redness and excoriation caused by
rubbing of breast against chest wall.
5. Inspect areolas and nipples for color, size and
shape. Note direction in which nipples point,
presence of rashes or ulceration. If there is
discharge from nipples, note its color.
R: Hormonal changes cause changes in
color and size of areolas and nipple
throughout woman’s life spam.
Presence of underlying lesions may
cause change in size, shape, and
position of nipples.
6. Palpate lymph nodes:
a. Have client sit with arms at sides and
muscles relaxed.
 Face the client, stand on the side
being examined and support client’s
arms while abducting that arm away
from the chest wall.
R: This position allows easy palpation of
axillary lymph nodes.
b. Place hand against the client’s chest
wall and high in the axilla. Palpate axillary
nodes with the fingertips, pressing gently
down over the surface of the ribs and
muscles.
R: Breast cancer can metastasize to
lymph nodes.
c. Palpate the following areas: edge of the
pectoralis major muscle along anterior axillary
line, chest wall in mid axilla; upper part of
humerus , anterior edge of latissimus dorsi
muscle along posterior axillary line.
 d. Palpate upper and lower clavicular ridges.
R: Location of supraclavicular and
infraclavicular nodes.
e. Note number, location, consistency,
movability, and size of nodes. If enlarge nodes
is present , ask client if it is tender.
R: Characteristics of node help to
determine cause of enlargement.
7. Have client lie in supine with right arm
abducted and hand placed under head. A
small pillow can be placed under client’s right
shoulder blade.
R: Position allows breast tissue to flatten
evenly against client’s chest wall.
8. During this portion of examination, nurse should
review the steps of BSE.
R: Client is prepared for routine self examination.

9. If clients complain of lump or mass, xamine opposite

breast first.
R: Objective comparison of normal and abnormal
tissue is ensured.
10. Stand at client’s right side. Using systematic
approach , gently palpate the breast tissue
with palmar surface of the first three fingers of
right hand moving in rotary fashion and
compressing breast tissue against chest wall.
Begin in one quadrant and thoroughly
examine all surfaces before moving to other
three quadrants and tail.
 Each quadrant may also be examined by
moving from nipple outward, like spokes of a
wheel.
R: Entire breast tissue must be thoroughly
palpated to rule out presence of mass.
11. Palpate breast noting consistency of tissue.
Take client’s fingertips and move them
gently over breast tissue.
 Lobular feel of glandular tissue is normal.
Lower edge of each breast may feel
firm and hard.
R: Consistency of underlying tissue changes
with age, pathologic conditions, and
hormonal variations. Client must learn
how to feel normal variations of own
breast tissue to be able to recognize
abnormal masses. Lower edge is
inframammary ridge.
12. If mass is found, palpate for the following
characteristics:
a. Location and relation to quadrant
b. Size in centimeters,
c. Shape (e.g. round or discoid);
d. Consistency ( soft, firm or hard)
e. tenderness
f. Mobility
g. Discreteness- are boundaries of mass easily
detected.
R: Data allow for definitive identification of type
of mass.
13. Use fingertip to gently compress the areola.
Then with thumb and index finger gently
compress nipple, observing for discharge.
R: Involvement of glandular tissue may cause
discharge from nipple.

14. Repeat procedure on the opposite breast.

15. After palpation is completed have client
demonstrate self palpation.
R: Return demonstration provides feedback
to measure client’s learning and to determine
need for further instruction.
Male Client

** Inspect nipple and areola of male clients for

nodules, edema, and ulceration. Note any
swelling of breasts. Palpate breast tissue in
same systematic pattern as females.
R: Signs of breast cancer as same for
female client.
 Breast Self Examination
Steps
1.Stand before the mirror. Look at both breasts
for anything unusual , such as discharge
from the nipples, wrinkling, dimpling or
scaling of the skin.
a. Watch in the mirror while raising the arms
above the head.
b. Press hand firmly on the hips and bow slightly
toward the mirror while pulling the
shoulders and elbows forward.
3. In the shower or in front of the mirror,
palpate each breast.
 Raise the left arm and use three or four
fingers of the right hand to explore the
breast carefully.
 Then start at the outer edge, pressing the
flat part of the fingers in small circle
moving the circles slowly around the
breast, gradually working toward the
nipple. Pay close attention to the area
between the breast and armpit and feel
for unusual lumps or masses.
4. Repeat the process on the right breast.

5. Gently squeeze each nipple , looking for

discharge.

6. Repeat the third and fourth steps lying down.

Lie flat on the back with the left arm over
the head and a small pillow under the left
shoulder . Palpate the left breast.

7. Repeat the process on the right breast

•Thank you!!!