Breast

• Breast assessment


  Enables identification of abnormalities and obtains valuable data, especially information that can help in early detection of disease
• Breast cancer is the second leading cause of death in women, and successful treatment depends on early diagnosis
• Knowing how to perform an accurate and thorough breast examination is crucial
• Most breast masses are detected by self-examination, teaching patients how to examine their breasts is vital
• Mammary gland


  • The primary function of the breasts in female mammals is to produce nourishment to feed their offspring
• Breast location


  • Lies between the second and the sixth ribs and between the sternal edge and the midaxillary line
  • Tail of the breast extends into the axilla
  • Approximately two-thirds of the breast lies over the pectoralis major muscle, and the remaining one-third is superficial to the serratus anterior muscle
• Breast is divided into quadrants for the purpose of describing a lump
• COLDSPA mnemonic is used as a guideline for collecting information during history taking
• Information to collect during history taking


  • Noticed any lumps or swelling in breast or underarm area, when
  • Noticed any redness, warmth or dimpling of breasts, any rash on the breast, nipple or axillary area
  • Noticed any changes in the size or firmness of breast
  • Experienced any pain in breast, where
  • Have any discharge from the nipples, describe color, consistency and odor, when did it start, which nipple
• Past health history information to collect

  • Had any prior breast disease
  • Had any breast trauma, when and result
  • Age when began menstruating
  • Experienced menopause
  • Age had first child
  • First and last day of menstrual cycle
• Family history


  History of breast cancer in family
• Lifestyle and health practices information to collect


  • Taking hormones, contraceptives, or anti-psychotic agents
  • Home and work area
  • Typical daily diet
  • Alcohol intake, coffee, tea or cola
  • Exercises
  • Practicing self-breast examination
• Breast inspection


  • Size and symmetry
  • Color and texture
  • Superficial venous pattern
  • Areolas
  • Nipples
  • Retraction and dimpling
• Breast palpation


  • Texture and elasticity
  • Tenderness and temperature
  • Masses
• Breast self-examination


  1. Look at breasts and nipples

  2. Palpate breasts using different techniques

  3. Palpate lymph nodes
• Guidelines for palpating breasts


  • Ask client to lie down with arm overhead on same side
  • Use flat pads of 3 fingers to palpate
  • Palpate using consistent pattern, covering every square inch
  • Vary pressure from light to firm
  • Use bimanual technique for large breasts
• Abnormalities of the breast


  • Cancerous tumors - irregular, firm, hard, not defined masses that may be fixed or mobile, not usually tender, usually occur after age 50
  • Fibroadenomas - lobular, ovoid, or round, firm, well defined, seldom tender, usually singular and mobile, occur more commonly between puberty and menopause
  • Benign breast disease - fibrocystic breast disease, marked by round, elastic, defined, tender and mobile cysts, most common from age 30 to menopause, after which it decreases
• Abnormal breast findings


  • Pig-skin like or orange-peel appearance
  • Redness associated with inflammation
  • Prominent venous pattern
  • Retracted nipple
  • Dimpling or retraction of the breast
  • Restricted movement of breast or skin
  • Thickening of the tissues
  • Redness or inflammation of scar
  • Enlarged lymph nodes (greater than 1 cm)
  • Painful breast
  • Tumors
  • Abnormal discharges
• Gynecomastia


  A smooth, firm movable disc of glandular tissue that may be seen in one breast in males during puberty for a temporary time, can also be seen during hormonal imbalances, drug abuse, cirrhosis, leukemia and thyrotoxicosis