ASSESSING THE BREASTS

NUR211Kathleen 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 Montgomerys glands

Structures Nipple Coopers ligament Pectoralis major and serratus anterior muscles

FunctionsWhat are the functions ofLobes & lobules: Contain alveoli cells that produce milkLactiferous ducts & sinuses: Carry and store milkAreola: Dark tissue surrounding nipple

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FunctionsWhat are the functions ofMontgomerys glands: Sebaceous glandNipple: Nursing and sexual stimulationCoopers Ligament: Ligament attached to chest wall muscles that supports breasts(Continued)

FunctionsWhat are the functions ofPectoralis major & serratus anterior muscles: Breast overlies these musclesLymph nodes: Drain breast, chest, and arms

Breast Health: Cancer Prevention

Self Breast Exam (SBE)Every monthMammogram After age 40 every yearMore frequent if personal or family historyBreast 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 AssessmentAnatomical landmarks: quadrants of the breast, include Tail of Spence

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InspectionBreasts: size, shape, symmetry, color, lesions, venous pattern, dimpling, or retractionNipple and areola: nipple position and direction; dischargeAxillae: color, lesions, rashes

Physical Exam - Inspection

Position: sitting, hands on hips, hands over head, leaning forwardTools: small pillow or towel, ruler, gloves, slide, and culture slide.

Sitting, arms at sides

Arms overhead

Arms pressing on hips

Leaning forward

PalpationLymph nodes: axillary, clavicular while sittingBreasts: consistency, masses, tenderness in supine positionNipple: 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 BreastsBimanual palpation to adequately examine all areasOften have an inframammary ridge

Male BreastInspectionPalpationLymph 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 oclock in RUQ No palpable nodes