Assessment of the

Breast
Inquire if the client has any history of the following:
 Breast masses
 Pain
or tenderness in the breasts and relation to the
woman’s menstrual cycle
 Discharge from the nipple
 Medication history (e.g., oral contraceptives, steroids,
digitalis, and diuretics, may cause nipple discharge,
estrogen replacement therapy may be associated with
the development of cysts or cancer)
 Riskfactors that may be associated with development of
breast cancer
Inspection
Assessment Normal Findings
Inspect the breasts Females: rounded
for size, symmetry, shape; slightly
and contour or unequal in size;
shape while the generally
client is in a sitting symmetric
position.
Males: breasts even
with the chest wall;
if obese, may be
similar in shape to
female breasts
Inspect the skin of the Skin uniform in color
breast for localized
discolorations or Skin smooth and intact
hyperpigmentation,
retraction or dimpling, Diffuse symmetric
localized hypervascular horizontal or vertical
areas, swelling or vascular pattern in light-
edema. skinned people

Striae (stretch marks);

Moles
Emphasize any No retraction
retraction by
having the client:
• Raise the arms
above the head.
• Push the hands
together, with
elbows flexed.
• Press the hands
down on
the hips.
Inspect the areola Round or oval and
area for size, bilaterally the same
shape,
symmetry, color, Color varies widely,
surface from light pink to
characteristics, and dark brown
any masses or
lesions. Irregular placement
of sebaceous glands
on the surface of
the areola
(Montgomery’s
tubercles)
Inspect the nipples for Round, everted, and
size, shape, position, equal in size; similar in
color, discharge, and color; soft and smooth;
lesions. both nipples point in
same direction (out in
young women and men,
downward in older
women)

No discharge, except
from pregnant or breast-
feeding females

Inversion of one or both

nipples that is present
from puberty
Palpation
Assessment Normal Findings
Palpate the No tenderness,
axillary, masses, or
subclavicular, and nodules
supraclavicular
lymph nodes
while the client
sits with the arms
abducted and
supported on the
nurse’s forearm.
Palpate the breast for No tenderness,
masses, and masses, nodules,
tenderness.
• To enhance
flattening of the
breast, instruct the
client to abduct the
arm and place her
hand behind her
head. Then place a
small pillow or
rolled towel under
the client’s
shoulder.
 3 Patterns for Palpation:

 Hands-of-the-clock or spokes- on-a-wheel

 Concentric circles
 Vertical strips pattern.
If you detect a mass, record the following data:
 Location: the exact location relative to the quadrants and
axillary tail, or
the clock and the distance from the nipple in centimeters.
 Size: the length, width, and thickness of the mass in
centimeters. If you are able to determine the discrete edges,
record this fact.
 Shape: whether the mass is round, oval, lobulated, indistinct, or
irregular.
 Consistency: whether the mass is hard or soft.
 Mobility: whether the mass is movable or fixed.
 Skin over the lump: whether it is reddened, dimpled, or
retracted.
 Nipple: whether it is displaced or retracted.
 Tenderness: whether palpation is painful.
Palpate the No tenderness,
areolae and the masses, nodules,
nipples for or nipple
masses. discharge
Compress each
nipple to
determine the
presence of any
discharge.
Assess any
discharge for
amount, color,
consistency, and
odor. Note also
any tenderness on
palpation.
Abnormal Findings
Retraction Signs
 Signsinclude skin dimpling, creasing, or changes in
the contour of the breast or nipple
 May be secondary to contraction of fibrotic tissue
that can occur with underlying malignancy
 May be secondary to scar tissue formation after
breast surgery
 Retraction signs may appear only with position
changes
Increased Venous Prominence

 Unilaterallocalized increase in venous pattern

associated with malignant tumors
 Normal with bilateral and symmetrical breast
enlargement associated with pregnancy and
lactation
 Peau d’Orange (Edema)
 Associated with inflammatory
breast cancer
 The lymph channels in the skin of
the breast become blocked by
cancer cells.
 Breastskin has orange peel
appearance
 Skin pores enlarge
 May be noted on the areola
 Skin
becomes thick, hard, and
immobile
Nipple Inversion

 Considered normal if long-standing

 Associated
with fibrosis and malignancy if recent
development
Acute Mastitis (Inflammation of the Breasts)
 Associated with lactation but may
occur at any age
 Nipple cracks or abrasions noted
 Breast skin reddened and warm to
touch
 Tenderness
 Systemic signs include fever and
increased pulse
 Paget’s Disease (Malignancy of Mammary Ducts)

 Early signs: erythema of

nipple and areola
 Late signs: thickening,
scaling, and erosion of the
nipple and areola
 Itching,burning, bloody
nipple discharge with
superficial skin erosion and
ulceration may be present.