BREAST ASSESSMENT

• Inspect the areolae and nipples for position, pigmentation, inversion, discharge, crusting and masses.
• (Extra or supernumerary nipples may occur normally, most commonly in the anterior axillary region or just below the normal breasts).
• Examine the breast tissue for size, shape, color, symmetry, surface, contour, skin characteristics, and level of breasts. Note any retraction or dimpling of the skin.
• The nipple should be at the same level and protrude slightly.
• A supernumerary nipple usually consists of a nipple and a small areola and may be mistaken for a mole.
• TRUE OR FALSE?

  TRUE

  An inverted nipple (one that turns inward), if present since puberty, maybe normal.
• A difference in the size of the two breast is usually normal.
• Breast Assessment is best done with the patient recumbent or supine.
• The patient should be given a pillow to place under the ipsilateral (same side) scapula of the breast being palpated. This is to ensure the breast tissues are distributed more evenly over the chest wall.
• The arm on the side of the breast being palpated should be extended above the patient’s head.
• Palpate one breast at a time, using the fat pads of the fingers, in a rotating motion, compressing the breast tissue against the chest wall. Include the tail of Spence.
• Palpate from the center to the periphery or quadrant by quadrant.
• Squeeze the nipple gently and note for any discharge. Note the skin texture, moisture, temperature, or masses.
• Breast texture – in young females, tissue is soft at homogenous, in post-menopausal women, tissue may feel nodular or stringy.
• Breast tissue may be more nodular and edematous just prior to menstruation.
• Masses – there should be no breast mass, if a mass is present, note its location, size, consistency, mobility, and associated tenderness are reported.
• Discharge if the woman is nonpregnant, nonlactating, there is no nipple discharge.
• A sudden increase in the size of one breast. This signifies inflammation or new growth.
• Heat, redness, swelling indicate inflammation
• Edema, “orange peel” skin in the breast (peau d’ orange may indicate breast cancer).
• Recent nipple retraction. This signifies acquired disease, e.g., neoplasm (tumor).
• Mastalgia (pain in the breast). This occurs with trauma, inflammation, infection and benign breast disease.
• Discharge from the nipple (in nonlactating breasts) may indicate infection or presence of breast mass.
• Dimpling or puckering in the skin of the breast. This indicates presence of breast mass.
• Enlarged nodes. This may indicate local infection of the breast, arm, or hand, or breast cancer metastases. 
• Gynecomastia (enlargement of male breasts). This normally occurs during puberty, and it is temporary. It also occurs with use of steroids, some medications, and some disease states.