Breast Care

Breast examination

General Guidelines:
 Perform hand hygiene
 Prepare necessary supplies/ materials needed.

 Explain the procedure to the client.

 Provide optimal privacy

 Use inspection and palpation

 The patient should be undressed from her waist up with arms at her sides.
 Maintain a warm and relaxing environment, with good lighting
 Documentation

General Appearance:

1. Inspect for the breasts, areolas and nipples.

Breasts:

Assess for the

 Size and symmetry

 Characteristics of the skin (color, thickening, peau d’orange, edema,
superficial venous pattern of the breasts)
 Presence of dimpling, nipple or skin puckering

Observe the breasts while woman’s hands are over her head and presses her hands on
her hips. Normally, the breasts hang evenly.

Breast asymmetry involves having a breast with a different shape or size than the
other. Screening of breast cancer or mammogram may indicate asymmetrical size or
density of the breast.

(Note: it is common to have a slight asymmetry in size; usually the left

breast is slightly smaller than the right breast)

Areolas
  Observe the size, shape, symmetry, color and lesions
Nipples

 Note the symmetry, size, shape, appearance and direction to which the
nipples point (protruded, flat or inverted), presence of any rashes or sores and
nipple discharge or bleeding

2. Palpate for the breasts.

Assist the client in supine position
Rationale: This position will flatten the breast tissue and displace it medially

Put pillow under the side of the breasts to be palpated and raise her arm over her head.
Palpate the entire breast using the first three finger pads, in a gentle circular motion.
Note for any masses or lumps (location, size, shape, consistency, tenderness and
mobility) or presence of tenderness, swelling, and increase in warmth

Note: Patterns of palpation can be vertical strip, spokes-on-a-wheel or concentric

circles.

Gently squeeze the nipple. Check for any induration or subareolar mass. Using the
thumb and forefinger, gently depress the nipple tissue into the wall behind the areola.
Note for any discharge

Note: Milky discharge may be due to hypothyroidism, prolactinoma,

drugs. Bloody discharge may be due to papilloma, Paget’s disease

3. Inspect and palpate for the axillae

Inspect the skin for rashes and any signs of infection.
The patient’s forearm is rested across the examiner’s forearm.
(An alternative is to ask the patient to rest their hand on the examiner’s shoulder)
Rationale: The patient’s muscles are loose and relaxed
 4. Palpate for the left axilla using your right hand and reaching your fingers high
into the axilla.
Anterior (posterior surface of anterior axillary fold)
Medial (on the chest wall)
Lateral (against the humerus)
Posterior (anterior surface of posterior axillary fold)
Note for the texture: smooth without edema
5. Palpate for the right axilla using your left hand and reaching your fingers high
into the axilla.