CLINICAL

EXAMINATION
OF BREAST
LEARNING OBJECTIVES
1. Describe the structure and the function of the breast and major
axillary lymph nodes.
2. Differentiate between normal and abnormal findings of breasts
and axillary lymph nodes.
3. Describe the findings frequently seen with assessing the older
client’s breasts and axillary lymph nodes.
4. Analyze the data from the interview and physical assessment
to formulate valid nursing diagnosis, collaborative problems,
and/or referrals.
HE AREOLA
•PIGMENTED CIRCULAR AREA OF SKIN AROUND
THE BASE OF THE NIPPLE
IT CONTAINS A NUMBER OF
SUBCUTANEOUS GLANDS WHICH
ENLARGE DURING PREGNANCY.
THE NIPPLE {PAPILLA MAMMARY}
•CYLINDRICAL OR CONICAL STRUCTURE PROJECTING
FROM THE CENTER OF THE AREOLA
IT CONTAINS A ELABORATE
SUBCUTANEOUS NETWORK
OF SMOOTH MUSCLE
CELLS AND ELASTIC FIBERS
BREAST GLANDS

Each breast has 8 to 10

sections (lobes) arranged
like the petals of daisy
Inside each lobe are many
smaller structures called
lobules
At the end of each lobule
are tiny sacs (bulbs)
that can produce milk
 •IT IS SUPPLIED BY:
LATERAL THORACIC BRANCH OF 2ND
PART OF AXILLARY ARTERY

ARTERIAL • MEDIAL MAMMARY BRANCHES OF

INTERNAL THORACIC ARTERY
SUPPLY
• SUPERIOR THORACIC BRANCH OF
AXILLARY ARTERY
• LATERAL BRANCHES OF 2ND,3RD,4TH
POSTERIOR INTERCOSTAL ARTERIES
 • CIRCULAR VENOSUS -AN ANASTAMOTIC VENOUS PLEXUS
DEEP TO THE AREOLA AT THE BASE OF THE NIPPLE.

VENOUS • FROM THIS PLEXUS TWO SETS OF VEINS ARE

FORMED :
DRAINAGE • SUPERFICIAL SET- ENDS IN INTERNAL THORACIC VEIN

• DEEP SET - ENDS IN INTERNAL THORACIC ,AXILLARY AND POST

INTERCOSTAL VEINS
 5 GROUPS:
• ANTERIOR (PECTORAL) SET:
SITUATED ALONG THE LATERAL
THORACIC VEIN UNDER THE ANT
AXILLARY FOLD, THEY LIE
MAINLY ON THE 3RD RIB POSTERIOR
(SCAPULAR) SET:
LIES ON THE POST AXILLARY FOLD IN
RELATION TO THE SUBSCAPULAR

LYMPHATIC VESSELS
• LATERAL (AXILLARY VEIN) SET:
DRAINAGE ALONG THE UPPER PART OF
HUMERUS IN RELATION TO
THE AXILLARY VEIN
CENTRAL SET:
SITUATED IN THE FAT OF THE UPPER
AXILLA.
APICAL OR INFRACLAVICULAR SET:
LIE DEEP TO THE CLAVIPECTORAL
FASCIA ALONG THE AXILLARY
VESELS
Methods of Inspection
• Introduce yourself to the patient
• Ask Permission to perform the examination
• Assure privacy
• ask for chaperone to be present
• Explain what you want to do
• Expose the patient adequately
• Position the patient correctly
• If sores visible,wear gloves.
HISTORY

Lump – duration, onset, rate of growth

Pain

Fever

Discharge from nipple

Retraction of nipple

Trauma

Loss of weight/appetite
HISTORY
Swelling elsewhere
Related to metastasis- bone pain, jaundice ,cough with
hemoptysis,
Similar episodes

Smoking

Alcoholism

Diet habits(high fat diet)

Breast feeding

Drug intake
 HISTORY - CA RISK FACTORS

• AGE: OLDER
• HISTORY: FAMILY, PRIOR DZ
• ABORTION
• LATE MENOPAUSE
• OBESE
• NULLIPARITY
• EARLY MENARCHE
 EXPOSE

Pt removes upper inspect the

body clothing opposite side so
• Expose/ can compare for
asymmetry.
 INSPECTION
• Position : Sitting with arms by side
•Symmetry
•Any mass
•Skin
•Ulcer
TENDERNESS

Ask pt. if
Tenderness
before start
touching them.

Warm your hands

SKIN
Skin retraction

Dimpling
SKIN
NIPPLES
• Nipple number, position
• Inversion retraction;
(fibrosis, CA, normal)

Slit like
 NIPPLES
• Red, bleeding
• (Paget’s disease of nipple).
• Discharge
• Ask patient to raise arms and place
hands behind head
• Change in a mass's relative
position.
• Nipple or skin tethering
INSPECT WHOLE SKIN
• Raise the breast to inspect the
undermined skin.
OTHERS PALPATION METHODS

-Wedge

-Parallel lines

-Concentric lines
INSPECT THE AXILLA

Examine axilla while pt's arms are raised;

• Axillary tail
• Axillary LN’s
• any mass, ulcer
• Edema,nodules
• Cancer en cuirase
• Pt. pushes hands on hips.
Look for:
• Dimpling.
• Fixation.
Large breasts:
pt. leans forward Hands

on knees
• Ask patient to put hands
on hips and push inwards
flexes pectorals
• Again look for contour of
breast
PALPATION
USE FINGERPADS OF MIDDLE 3 FINGERS
-Palpation should not elicit pain
-Consistency is highly variable
SITTING POSITION
• First examine sitting
• Examine ‘normal’ side first
• Place hand behind head
• One quadrant at a time
SUPINE POSITION
• Spreads the breast more evenly across chest
Examine lying down
Use one or two hands to elicit lumps
If felt define lump with fingertips

• See Examining A Mass

GYNECOMASTIA
EVALUATION OF BREAST MASS CHARACTERISTICS
• Location
• Size
• Shape
• Number
• Consistency

• DEFINITION
• MOBILITY
• TENDERNESS
• ERYTHEMA
• DIMPLING OR
RETRACTION
• LYMPHADENOP
ATHY
COMPARISON OF BREAST LUMPS

• BENIGN BREAST Cancer/ Malignant

DISEASE
• MULTIPLE OR SINGLE • Unilateral
• RUBBERY TEXTURE • Firm texture
• MOBILE / SLIPPERY • Fixed firmly
• REGULAR BORDERS • Irregular border
• TENDERNESS (CYCLIC)
• Usually painless
• NO RETRACTION
• Usually w/retraction
• MAY INCREASE/DECREASE
IN SIZE RAPIDLY • Grows constantly
EXAMINATION OF
AXILLA
PALPATE THE AXILLA
• Support patient’s arm
• Palpate tail between fingers and thumb.
• Palpate axillary lymph nodes
• Supraclavicular nodes.
• Palpable lymph nodes less than 1 cm in diameter
usually are clinically insignificant
Pectoral group CENTRAL AND APICAL
POSTERIOR GROUP
 INFRACLAVICULA
supraclavicular
R
 BREAST SELF EXAM

•GOAL: EARLY DETECTION

IN PREPARATION FOR TEACHING:
ASSESS: KNOWLEDGE BASE , MOTIVATION
FEARS AND CONCERNS FAMILY HISTORY
RISK FACTORS
TEACHING: USE SHOW AND TELL; USE FINGER PADS
•EXAM: MONTHLY, DAY 5-7 OF MENSTRUAL CYCLE;
• AFTER MENOPAUSE SAME DAY EACH MONTH
•USE IN CONJUNCTION WITH MAMMOGRAPHY & CLINICAL BREAST EXAMINATION (CBE)
BREAST SELF EXAM
STEP 1
• Begin by looking at your breasts in
the mirror with your shoulders
straight and your arms on your
hips.
• Here's what you should lookfor:
• Breasts that are their usual size,
shape, and color.
• Breasts that are evenly shaped
without visible distortion or
swelling.
• If you see any of the following
changes, bring them to your
doctor's attention:
• Dimpling, puckering, or
bulging of
the skin.
• A nipple that has changed position
or become inverted (pushed
inward instead of sticking out).
• Redness, soreness, rash, or
swelling
STEP 2 AND 3

• Raise your arms and look

for the same changes.
• While you're at the mirror,
gently squeeze each
nipple between your finger
and thumb and check for
nipple discharge (this
could be a milky or yellow
fluid or blood).
STEP 4
• Feel your breasts while
lying down, using your right
hand to feel your left
breast and then your left
hand to feel your right
breast. Use a firm, smooth
touch with the first few
fingers of your hand,
keeping the fingers flat and
together.
• Cover the entire breast from
top to bottom, side to side
— from your collarbone to
the top of your abdomen,
and from your armpit to
your cleavage
STEP 5

• Finally, feel your breasts

while you are standing or
sitting. Many women find
that the easiest way to
feel their breasts is when
their skin is wet and
slippery, so they like to do
this step in the shower.
Cover your entire breast,
using the same hand
movements described in
Step 4.
 https://olfu.lecturio.com/#/lecture/c/48815/206577

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prof. rosanna p. suva, man, rn