Assessing the breasts and axillae

Assessing the breasts and axillae

Inspect the breasts for size, symmetry, and contour or shape while the client is in a sitting position.	Females: Rounded shape; slightly unequal in size; generally symmetric Males: Breasts even with the chest wall	Recent change in breast size; swellings; marked asymmetry
Inspect the skin of the breast for localized discolorations or hyperpigmentation, retraction or dimpling localized hypervascular areas, swelling or edema.	Skin uniform in colour (same in appearance as skin of abdomen or back) Skin smooth and intact Diffuse symmetric horizontal or vertical vascular pattern in light-skinned people Striae (stretch marks); moles and nevi	Localized discolorations or hyperpigmentation Retraction or dimpling (result of scar tissue or an invasive tumor) Unilateral, localized hypervascular areas (associated with increased blood flow) Swelling or edema appearing as pig skin or orange peel due to exaggeration of the pores
Emphasize any retraction by having the client » Raise the arms above the head, a Push the hands together, with elbows flexed. : Press the hands down on the hips. Inspect the areola area for size, shape, symmetry, colour, surface characteristics, and any masses or lesions.	Round or oval and bilaterally the same Colour varies widely, from light pink to dark brown Irregular placement of sebaceous glands on the surface of the areola (Montgomery's tubercles)	Asymmetry mass or lesion
Inspect the nipples for size, shape, position, colour, discharge, and lesions.	Round, everted, and equal in size; similar in colour; soft and smooth; both nipples point in same direction (out in young women and men, downward in older women) No discharge, except from pregnant or breast-feeding females Inversion of one or both nipples that is present from puberty	Asymmetrical size and colour Presence of discharge, crusts, or cracks Recent inversion of one or both nipples
Palpate the axillary, subclavicular, and supraclavicular lymph nodes While the client sits with the arms abducted and supported on the nurse's forearm.  Use the flat surfaces of all fingertips to palpate the four areas of the axilla: the edge of the greater pectoral muscle (musculus  pectoralis major) along the anterior axillary line * the thoracic wall in the midaxillary Area  the upper part of the humerus, * The anterior edge of the latissimus dorsi muscle along the posterior axillary line.	No tenderness, masses, or nodules	Tenderness, masses, or nodules
Palpate the breast for masses, tenderness and any discharge from the nipples.  Palpation of the breast performed in supine position Rationale: In the Supine position, the breasts flatten evenly against the chest wall, facilitating palpation. To enhance flattening of the breast, instruct the client to abduct the arm and place her hand behind her head. Then place a small pillow or rolled towel under the client's shoulder. « For palpation, use the palmar surface of the middle three fingertips (held together) and make a gentle Rotary motion on the breast.	No tenderness, masses, nodules, or nipple discharge	Tenderness, masses, nodules, or nipple discharge a. Location: the exact location relative to the quadrants and axillary tail, or the clock and the distance from the nipple in centimetres. b. Size: the length, width, and thickness of the mass in centimetres. c. Shape: whether the mass is round, oval, lobulated, indistinct, or irregular. d. Consistency: whether the mass is hard or soft. e. Mobility: whether the mass is movable or fixed. f. Skin over the lump: whether it is reddened, dimpled, or retracted. g. Nipple: whether it is displaced or retracted. h. Tenderness

Three patterns for palpation

a. Hands-of-the-clock or spokes on- a-wheel

b. Concentric circles

c. Vertical strips pattern

® Start at one point for palpation, and move systematically to the end point to ensure that all breast surfaces are assessed.

» Pay particular attention to the upper outer quadrant area and the tail of Spence

Palpate the areola and the nipples for masses. Compress each nipple to determine the presence of any discharge. Assess any discharge for amount, colour, and consistency, and odor, tenderness on palpation.

Male breast

Inspect nipple and areola for nodules, edema, and ulceration

Enlarged male breast results from obesity or glandular enlargement. Same technique is used as in females. Men who have first degree relative with breast cancer- need to palpate their breast at regular intervals.

Breast Self-Exam

Breast examination, a process in which the breasts and the surrounding structures are assessed for changes that could indicate cancer.

 The BSE is usually done 1 week to 10 days after the first day of the menstrual cycle, when the breasts are smallest and swelling is least visible.

·         Detects the majority of breast abnormalities.

·         Potentially life-saving

·         Monthly exam, at end of menses.

Frequency:

Women ages 20-39 Monthly BSE, Clinical breast exam by a health professional every 3 years.

Women aging 40 and older- Monthly BSE, Every year by a professional, Screening mammogram every year.

METHOD:

·         The breasts are examined. Patient sitting with her arms at her sides, sitting with her arms over her head, back straight,  then leaning forward, and,  finally, sitting upright while contracting the pectoral muscles.

·         The breasts are checked for identical shape and size and for surface changes, including moles or coloured areas, dimpling, swelling, nipple withdrawal, unusual vein patterns showing through the skin, lumps, sores, or abnormal hair growth.

·         The lymph nodes under the arms and around the collarbones are checked for swelling. With the patient lying on her back, each breast is shifted, and the gland area in each is felt with the flat of the fingers in circles working from the outer edges toward the nipples. The areolar areas, the nipples, and the area extending toward the armpit are then felt. Many women find it helpful to check their breasts every time they shower for the first few months after being taught how to do it to become very familiar with their own breasts.

Different Methods for Breast Self-Examination

·         circular method,

·         wedge method,

·         Vertical strip method

Circular method

Place the flat surface of your middle three fingers against the outer edge of the breast. Press gently in small, circular motions around the breast. Move your fingers in smaller circles around the breast until you reach the nipple (try not to lift your fingers off the breast as you move from one point to another). Then squeeze

Wedge method (spokes on a wheel)

Place the flat surface of the middle three fingers against the outer edge of the breast. Press gently from the outer edge in a straight line toward the nipple. Move your fingers in parallel lines around the breast until each area is covered. Then squeeze the nipple.

Vertical strip method

Place the flat surface of the middle three fingers against the top outer edge of the breast. Press gently from the top outer edge down to the bottom edge. Continue up and down until you reach the inner aspect of the breast. Then squeeze the nipple.

Detect a mass

Location; - exact location to the quadrants   and distance from the nipple in cms.

Size; - length, width and   thickness of the mass in cms and determine the discrete edges.

Shape; - round, oval lobulated, irregular etc.

Consistency; - hard /soft

Mobility; - whether mobile/fixed

Skin over the lump- reddened, dimpled, retracted

Nipples; - retracted /displaced

Tenderness; - whether palpation is painful