The document provides guidance on assessing the breasts and axillae. It describes inspecting and palpating the breasts and lymph nodes to identify any abnormalities. Key things to look for include lumps, discharge, dimpling, lesions, asymmetry, and enlarged or tender lymph nodes, which may indicate issues like breast cancer. A health history should also be taken to identify risk factors. Physical assessment focuses on thoroughly checking each breast quadrant and the axillae to detect any masses or other abnormalities.

1. Assessment of
breast and axilla

2. Assessing the Breasts and Axillae
Each breast has a lymphatic network that drains
into the underlying axilla
Although the assessments and disorders
described here focus on the female breast, men
also are at risk for breast disease.
The health history elicits risk factors for cancer of
the breast, especially in females.
Physical assessment of the breasts and axilla are
primarily conducted to identify any lumps in the
breasts and/or enlargement or pain in axillary
lymph nodes; if assessed, the patient should have
further diagnostic tests.

3. Health History
Identify risk factors for altered health during the health history by
asking about the following:
• History of pain in one or both breasts, including relationship to
menstrual period
• History of lumps or swelling, redness, change in size, or
dimpling in the breasts
• History of discharge from the breast
• Family history of ovarian or breast cancer
• History of breast disease, biopsy, or surgery
• Menstrual and pregnancy history
• Use of hormones, oral contraceptives
• Exposure to radiation, benzene, or asbestos
• Usual dietary intake and alcohol consumption
• Knowledge and practice of breast self-examination
• Most recent clinical breast examination and mammogram

4. Physical Assessment
The breasts and axilla are assessed in both men and women
using inspection and palpation.
The patient can be sitting or lying supine. When sitting, the
patient should sit erect,with arms at sides or raised overhead.
When supine, the patient’s hand on the side being examined is
placed under the head.

5. INSPECTING THE BREASTS
Inspect the breasts for size, shape, symmetry, color, texture,
and skin lesions.
The breasts should be relatively symmetric,although variations are normal.
The size varies among individuals. The shape of the breasts is round and smooth, and
there should be no skin depressions (retraction) or puckering(dimpling).
The color should be consistent with the rest of the skin, and the texture of the skin
should be soft.
Inspect the areola and nipples for size and shape and the nipples for discharge,
crusting, and inversion.

6. The areola and nipple areas should be equal in size, round or oval, withma smooth
surface.
Montgomery’s tubercles (sebaceous glands on the areolae of the breasts) are a normal
component of the areola.
The nipples are normally everted. Discharge from the nipples is an abnormal finding
except in pregnancy (leaking is normal during pregnancy and breastfeeding).
Other abnormal findings include dimpling, lesions, and asymmetry.

7. PALPATING THE BREASTS AND AXILLAE
Palpate the breasts in each of the four quadrants (the
upper outer quadrant, the lower outer quadrant, the
upper inner quadrant, and the lower inner quadrant) to
detect any abnormal lumps.
Palpate the nipple and areola and gently compress the
nipple between the thumb and forefinger to assess for
discharge.
The breast tissue should be smooth and firm, with a
granular consistency.
If a mass is detected, carefully assess its location,
size, shape, consistency, and tenderness.
The breasts are normally tender during the week
before menstruation.

8. An increase in the nodularity and tenderness
of the breasts may be associated with the menstrual
period or may indicate fibrocystic disease.
Discharge, lumps, lesions, dimpling,asymmetry,
and palpable lymph nodes may be indicative of
Breast cancer.
Palpate the axillary areas for lymph nodes which
normally are nonpalpable and nontender.
If any nodes are palpable, assess their location,
size, shape, consistency,tenderness, and mobility.
Palpable lymph nodes are an abnormal finding.

9. Normal Age-Related Variations
INFANT/CHILD
Common breast and axillae variations in newborns and
children include:
• Breast enlargement and a white discharge from the
nipples
(up to 2 weeks of age)
• Female breast growth beginning at 10 or 11 years of
age
• Temporary enlargement of one or both breasts
(gynecomastia) in pubescent boys
OLDER ADULT
Common breast and axillae variations in older adults
include:
• Granular, pendulous breasts in women