This document provides guidance on assessing a patient's breasts for health issues. It describes preparing the patient and environment, inspecting the breasts visually for signs of issues like lumps or discoloration, and systematically palpating the breasts and lymph nodes with the hands to check for any abnormalities that could indicate problems. The assessment involves positioning the patient, thoroughly inspecting and palpating the breasts and surrounding areas, and documenting any notable findings or lack thereof.

1. HEALTH ASSESSMENT OF THE
BREAST
C.MAKUTE

2. OBJECTIVES
• By end of lesson the student should
be able to:
• Describe health assessment of the
breast

3. PREPARATION PRIOR TO
ASSESSMENT
EQUIPMENT:
 Ruler (centimetres)
 Small pillow
 Gloves
 Client handout for Self-Breast
Examination
 Slide for specimen (if any)
 Flash light with translluminator

4. PRESENTING PROBLEM
Breast discomfort:
• temporal sequence :onset gradual or
sudden
• Relationship to menses: timing ,severity.
• Character: pulling
,stinging,burning,drawing,stabbing
aching,throbbing_unilateral or bilateral,
localization or radiation.

5. Cont…
Breast lump or mass:
• Temporal sequence: length of time since
lump first noted .
• Symptoms: tenderness or pain,dimpling
or change in colour.
• Changes in lump:size,character,relation
to menses.

6. CONT…
• Associated symptoms: nipple discharge
or retraction, tender lymph nodes
• Nipple discharge:onset gradual or
sudden,retraction,relation to menses,

7. PAST MEDICAL HISTORY
• Previous breast disease
,cancer,fibroedema,fibrocystic disease.
• Any surgeries_biopsie,aspirations
,implants,oophrectomy.
• Menstrual history_age at menarche or
menopause,length of cycle,duration
,flow,regularity,pain

8. CONT..
• Pregnancy_age,length of each pregnancy,
date of delivery or termination.
• Lactation _number of children breast
fed,duration,date of termination, medication
used to suppress milk.
• Past use of hormonal medications_lenght of
time on hormones, name ,dosage, reason for
use

9. FAMILY HISTORY
• Breast cancer_relative,type of cancer, age
at time of occurrence ,treatment and
results.
• Other breast disease in female and male
relatives

10. PERSONAL AND SOCIAL
HISTORY
• Age ,
• any change in breast characteristics:
pain,lumps etc
• Date of first day of last menstrual period.
• Amount of caffeine intake,
• Breast self examination:frequencey,at
what time of menstrual cycle.

11. CONT…
• Mammography history.
• Use of alcohol.
• Any medications _ particularly oral
contraceptives.

12. PREPARATION PRIOR TO ASSESSMENT
POSITION OF THE CLIENT
• Upright position (sitting while the client
is asked to hold arms in different
position: arms at sides, arms over head,
arms pressed against hips, and leaning
forward)
• Supine/Standing (palpation)

13. INSPECTION
• Assess the breasts immediately after the
assessment of the thorax and lungs and
before a mammogram or pelvic
examination.

14. CONT…
INSPECTION: Requires full exposure of the
chest. Inspect skin for changes, symmetry,
contours, color, superficial vein patterns,
presence of retractions

15. CONT..
• Assess also for the size, shape, texture of
the areola
• Note also the characteristics of the
nipples, including size and shape,
direction in which they point, any rashes
or ulceration, or any discharge.

16. INSPECTION CONT..

17. INSPECTION CONT..

18. INSPECTION TO VALIDATE THE PRESENCE OF
DIMPLING OR RETRACTIONS

19. INSPECTION TO VALIDATE THE PRESENCE OF
DIMPLING OR RETRACTIONS

20. THE BREAST & AXILLAE:INSPECTION TO
VALIDATE THE PRESENCE OF DIMPLING OR
RETRACTIONS

21. INSPECTION TO VALIDATE THE PRESENCE OF
DIMPLING OR RETRACTIONS
• The three maneuvers presented above contract
the pectoral muscles.
• If the breasts are large or pendulous, it may be
useful to have the patient stand and lean forward,
supported by the back of the chair or the
examiner’s hands.
• Inspect the breast contours carefully to in each
position.

22. INSPECTION ASSESSMENT FINDINGS
• Color varies depending on the client’s skin tone.
Texture is smooth with no edema.
• Linear Stretch marks may be seen during and
after pregnancy or with significant weight gain or
loss.
• Veins radiate either horizontally and toward the
axilla (transverse) or vertically with a lateral flare
(longitudinal). Veins are more prominent during
pregnancy.

23. INSPECTION ASSESSMENT FINDINGS
• Redness from local infection or inflammatory
carcinoma. A pigskin-like or orange-peel
appearance results from edema, which is seen
in metastatic breast disease.
• A prominent venous pattern may occur as
result of increased circulation due to
malignancy. An asymmetric venous pattern
may be due to malignancy.

24. INSPECTION ASSESSMENT FINDINGS
• Breast symmetrical in size, shape, no
prominent pores,
• Breasts can be a variety of sizes and are
somewhat round and pendulous.
• One breast may normally be larger than
the other.

25. INSPECTION ASSESSMENT FINDINGS
• Areolas vary from dark pink to dark brown,
depending on the client’s skin tone. They are round
and may vary in size. Small Montgomery tubercles
are present.
• Nipples are nearly equal bilaterally in size and are in
the same location on each breast.
• Nipples are usually everted, but they may inverted
or flat. Supernumerary nipples, may appear along
the embryonic “milk-line”.
• No discharges should be present.

26. INSPECTION ASSESSMENT FINDINGS
• When doing the three manoeuvres that
validate the presence of retractions, the
client’s breasts should rise symmetrically
with no sign of dimpling or retraction.
• Breasts should hang freely and
symmetrically.

27. INSPECTION ABNORMAL ASSESSMENT
FINDINGS

28. INSPECTION ABNORMAL ASSESSMENT
FINDINGS

29. INSPECTION ABNORMAL ASSESSMENT
FINDINGS

30. INSPECTION ABNORMAL ASSESSMENT
FINDINGS

31. INSPECTION ABNORMAL ASSESSMENT
FINDINGS

32. PALPATION
• PALPATION: Cover one breast while you
are palpating the other.
• TEXTURE AND ELASTICITY
• CONSISTENCY OF THE TISSUES.
• TENDERNESS AND TEMPERATURE
(as in pre-menstrual fullness)

33. CONT…
• SUPINE: breast tissue is flattened
• palpate a rectangular area extending
from the clavicle to the inframammary
fold or bra line, and from the midsternal
line to the posterior axillary line and well
into the axilla for the tail of the breast.

34. CONT..
• A thorough examination will take 3
minutes for each breast.
• Use the fingerpads of the 2nd, 3rd,
and 4th fingers, keeping the fingers
slightly flexed. It is important to be
systematic.

35. CONT…
• Palpate the breasts using one of the three
different patterns ( circular or clockwise,
wedge, vertical strip). Choose one that is most
comfortable for you, but be consistent and
thorough with the method chosen.
• Start at one point for palpation and move
systematically to the end-point to ensure that
all breast surfaces are assessed.

36. CONT..
• Be sure to palpate every square inch of the
breast from the nipple and areola to the
periphery of the breast tissue and up to into
the tail of Spence.
• Vary the levels of pressure as you press.
• LIGHT – superficial
• MEDIUM – mid-level tissue
• Firm – to the ribs

37. CONT…
• Use the bimanual technique if the client
has large breasts.
• Support the breast with your non-
dominant hand and use your dominant
hand to palpate.

38. PALPATION

39. PALPATION

40. MASS OR LUMP
• LOCATION
TENDERNESS
by quadrant or clock, with centimeters
from the nipple
• SIZE AND SHAPE
SIZE: in centimeters
SHAPE: round or cystic, disc like, or
irregular in contour

41. CONT…
• CONSISTENCY
• DELIMITATION
• MOBILITY
CONSISTENCY: soft, firm, or hard
DELIMITATION: well circumscribed or not
MOBILITY: in relation to the skin, pectoral
fascia, and chest wall. Gently move the breast
near the mass and watch for dimpling.

42. PALPATION FOR THE PRESENCE OF NODULES

43. NIPPLES
• Palpate each nipple noting its elasticity
• Wear gloves to compress nipples gently
with thumb and index finger.
• Note any discharge_if present ,note
characteristics of
secretion(odor,colour,amount,consistenc
y).

44. CONT..
• If spontaneous discharge occurs from the
nipples, a specimen must be applied to a
slide and the smear to be sent to
laboratory for cytologic examination.
• Watch for discharge appearing through
one of the duct openings on the nipples
surface.

45. CONT…
• Note the colour,consistency,and
quality of any discharge and the
exact location where it appears.

46. PALPATION FOR THE NIPPLES

47. PALPATION FOR THE NIPPLES

48. INSPECTION OF THE LYMPH NODES
• Sitting position preferable.
• Inspect each skin of the axilla noting
evidence of rash, signs/symptoms of
infection, unusual pigmentation.

49. INSPECTION OF THE AXILLAE

50. PALPATION OF LYMPH NODES
• To examine the left axillae, ask the patient to relax
with the left arm down.
• Help by supporting the left wrist or hand with your
left hand.
• Cup together the fingers of your right hand and reach
as high as you can toward the apex of the axillae.
• Warn the patient that this may feel uncomfortable.
Your fingers should lie directly behind the pectoral
muscles, pointing toward the midclavicle.

51. CONT..
• Now press your fingers in toward the
chest wall and slide them downward,
trying to feel the central nodes against
the chest wall.

52. CONT…
• PECTORAL NODES: grasp the anterior
axillary fold between your thumb and
fingers, and with your fingers palpate
inside the border of the pectoral muscle.
• LATERAL NODES: from high in the axilla,
feel along the upper humerus.

53. CONT…
• SUB-SCAPULAR NODES: step behind the
patient and with your fingers feel inside
the muscle of the posterior axillary fold.
• Feel for infraclavicular nodes and re-
examine the supraclavicular nodes.

54. REFERENCES
• Nettina, S M (2006) Lippincott Manual of
Nursing Practice, Lippincott. Williams and
Wilkins. Washington DC.
• Phipps, W. J (1993) Medical Surgical Nursing: A
Nursing Process Approach. Mosby, St Louis.
• Potter, P. A and Perry, A. G (2006)
Fundamentals of Nursing Concepts, Process
and Practice. (2000) 4th edition. St Louis,
Mosby

55. THANK YOU