THE FEMALE BREAST GLANDULAR TISSUES – forms 15 to 20 septated lobes radiating around the nipple- drain into milk producing ducts and sinuses that open onto the surface of the areola
FIBROUS CONNECTIVE TISSUE provides structural support in the form of fibrous bands or suspensory ligaments (Cooper’s ligaments)
ADIPOSE TISSUE – fat; surrounds the breast, predominantly in the superficial and peripheral areas
LYMPHATICS Central nodes Pectoral nodes Subscapular nodes
Lateral nodes Infraclavicular and supraclavicular nodes
GENERAL APPROACHBEFORE If possible, instruct the patient to neither use creams, lotions or powders, nor shave the underarms 24 to 48 hours before the scheduled examination
Encourage patient to express any anxieties and concerns about the assessment
Inform patient that examination should not be painful but may be uncomfortable at times
Adopt a nonjudgmental and supportive attitude Instruct patient to remove any jewelry that might interfere with assessment
Ensure that the room is in a comfortable temperature
Warm hands Ensure privacy
GENERAL APPROACHDURING Inform patient of what you are going to do before you do it
Use this time to educate the patient about her body
Offer the patient the opportunity to ask questions about her body and sexuality
Keep areas not being assessed appropriately draped
Always compare right and left breasts Wear gloves if the patient has any discharge from the breast
GENERAL APPROACHAFTER Assess whether the patient needs assistance in dressing
After the patient is dressed, discuss the experience with her, invite questions and comments, listen carefully and provide her with information regarding the examination
INSPECTION Positions of patient
Arms at side
Arms overhead
Hands pressed against hips
Leaning forward
INSPECTION Inspect the breasts, areolar areas and nipples for:
Color Vascularity Thickening or Edema Size and Symmetry Contour Lesions and Masses Discharges
INSPECTIONCOLOR Normal Findings:The breasts and are flesh-colored and the areolar areas and nipples are darker in pigmentation.
Abnormal Findings Reddened areas Striae
INSPECTIONVASCULARITY Normal Findings:Normal superficial vascular patterns are diffuse and symmetrical
Abnormal Findings Focal or unilateral superficial vascular patterns
INSPECTIONTHICKENING OR EDEMA Normal Findings: Normally, thickening or edema should not be found Abnormal Findings Peau d’ orange
INSPECTIONSIZE and SYMMETRY Normal Findings: Difference in the size of the breasts and areolar areas
Nipple inversion Nipples pointing upward and laterally, or outward and downward
Supernumerary nipples Abnormal Findings Asymmetrical nipple direction Significant differences in the size and symmetry Sudden onset of nipple inversion, flattening or depression
Additional broadening or thickening of a previously inverted nipple
Unilateral reduction of breast tissue
INSPECTIONCONTOUR Normal Findings: Convex No flattening No retractions No dimpling Abnormal Findings Dimpling Retractions Flattening
INSPECTIONLESIONS or MASSES Normal Findings:Free of masses, tumors, and primary or secondary lesions
Abnormal Findings Breast masses, tumors, nodules or cysts of any kind
Persistent eczematous dermatitis of the areola and nipple region
INSPECTIONDISCHARGE Normal Findings No discharge for nonpregnant and nonlactating womanAbnormal Findings
Nipple discharge
PALPATION Be sure to palpate every square inch of the breast, from the nipple and areola to the periphery and up into the tail of Spence.
PALPATION Vary the levels of pressure:
Light – superficial
Medium – midlevel tissue
Deep – to the ribs
PALPATIONCONSISTENCY Normal Findings The consistency of the breasts is widely variable, depending on age, time in menstrual cycle, and proportion of adipose tissue Abnormal Findings Thickening of the tissues may occur with an underlying malignant tumor
PALPATIONTENDERNESS and TEMPERATURE Normal Findings Generalized tenderness associated with menstrual cycle or hormonal medications
Normal body temperature Abnormal Findings Painful breasts Heat in the breasts
PALPATIONIf a mass is noted, the following information should be obtained: Location Size Shape Number Consistency Definition Mobility Tenderness
PALPATION Palpate each nipple for elasticity Compress the nipple to express any discharge
Normal Findings: Elastic No discharge in nonpregnant and nonlactating women
Abnormal Findings Loss of elasticity Discharges and bleeding
INSPECTION Inspect for: Rash Infection Unusual pigmentation Normal Findings No rash or infection Abnormal Findings Redness and Inflammation Dark, velvety pigmentation
PALPATION Ask patient to relax shoulders and arms.
Support the client’s arm and use the three fingers of your other hand to palpate firmly the following axillary lymph nodes
Central nodes Pectoral nodes Lateral nodes Subscapular nodes
PALPATION Normal findingsNo palpable nodes or one or two <1cm nontender nodes in the central area Abnormal findings
Enlarged (>1cm) lymph nodes
INSPECTION AND PALPATION Inspect the nipple and areola for nodules, swelling or ulceration
Palpate the areola and breast tissue for nodules
Abnormal Finding: Gynecomastia
BSE should be performed once a month, 5 to 7 days after the onset of menses
Advise patient to avoid the time when her breasts might be tender due to menstruation or ovulation
BED (lying supine)1. Lie down with a pillow under right shoulder.
Place your right arm behind your head2. Use the finger pads of the three middle fingers
on your left hand to feel for lumps in the right breast.
3. Press firmly enough to know how your breasts feels, using firmer pressure for tissue closest to the chest and ribs
4. Press firmly on the breast in a vertical strip pattern. You can also use a circular or wedge pattern, but be sure to use the same pattern everytime.
5. Check the entire breast area, from the underarm to the sternum and from the collarbone to the ribs below the breast. Remember how your breast feels from month to month
6. Repeat the examination on the left breast, using the fingerpads of the right hand
STANDING1. While standing in front of a mirror
with your hands pressing firmly down on your hips, look at your breasts for any changes of size, shape, contour, or dimpling, or redness or scaliness of the nipple or breast skin