Unit 5A.10: Breast Assessment | Breast, Chest & Lungs Assessment

Estrogen & Progesterone

What hormones bring about enlargement of the female breasts during puberty?

Pectoralis Major

Identify the Anatomic Breast Landmark.

(1)

Axillary Tail of Spence

Identify the Anatomic Breast Landmark.

(2)

Areola

Identify the Anatomic Breast Landmark.

(3)

Serratus Anterior

Identify the Anatomic Breast Landmark.

(4)

Nipple

Identify the Anatomic Breast Landmark.

(5)

Montgomery’s Glands

Identify the Anatomic Breast Landmark.

(6)

Upper Inner

Identify the component of the Breast Quadrants.

(1)

Lower Inner

Identify the component of the Breast Quadrants.

(2)

Upper Outer

Identify the component of the Breast Quadrants.

(3)

Lower Outer

Identify the component of the Breast Quadrants.

(4)

Axillary Tail of Spence

Identify the component of the Breast Quadrants.

(5)

Pectoralis Major

Identify the component of the Internal Breast Anatomy.

(1)

Fatty Tissue

Identify the component of the Internal Breast Anatomy.

(2)

Glandular Tissue

Identify the component of the Internal Breast Anatomy.

(3)

Cooper’s Ligaments (Fibrous Tissue)

Identify the component of the Internal Breast Anatomy.

(4)

Lactiferous Duct

Identify the component of the Internal Breast Anatomy.

(5)

Lactiferous Sinus

Identify the component of the Internal Breast Anatomy.

(6)

Lobule

Identify the component of the Internal Breast Anatomy.

(7)

Lobe

Identify the component of the Internal Breast Anatomy.

(8)

• Round

• Pendulous (hanging down loosely)

What is the normal shape of the breasts?

• Inflammation or

• Abnormal Growth

What does a recent increase in the size of one breast indicate?

Right breast slightly larger than the left

What is an example of the normal symmetry of the breasts?

• Color varies based on client’s skin tone

• Texture is smooth, with no edema

What is the normal color and texture of the breast?

Linear stretch marks

What may be seen on the breasts during and after pregnancy or with significant weight gain or loss?

Inflammation

What is a red color of the breast associated with?

Metastatic Breast Disease

What is pigskin-like or orange-peel appearance of the breast seen in?

Blocked lymphatic drainage

What is edema of the breast caused by?

• Dark pink to dark brown depending on the client’s skin tone

• Round and may vary in size

What is the normal color and shape of the areola?

Small Montgomery Tubercles

What can be seen in the areolas that is considered normal?

• Peau D’Orange Skin

• Red, scaly, crusty areas (Paget’s Disease)

What are abnormal findings that can be seen in the areolas?

Areola

Where can peau d’orange skin be first seen in?

Carcinoma

What is peau d’orange skin in the areola associated with?

• Nearly equal bilaterally in size

• Same location on each breast

• Usually everted but may be inverted or flat

What is the normal finding of the nipples?

Supernumerary Nipple

What is a normal finding on the nipple that may appear along the embryonic “milk line”? Click on the picture to see

Malignancy

What does a recently retracted nipple that was preciously everted suggest?

Spontaneous Discharge

If any of this is inspected from the nipples, cytologic study and further evaluation must be conducted?

• Size

• Direction

• Dryness

• Lesions

• Bleeding

• Discharge

• Retraction

• Dimpling

• Presence of supernumerary nipples

• Note areolas for…

  • Color

  • Size

  • Shape

  • Texture

  • Presence of Montgomery tubercles

What should be assessed when inspecting the nipples?

Peau D’Orange

Abnormal finding for the breast

• Resulting from edema

• Orange peel appearance

• Associated with cancer

Edema

What does peau d’orange result from?

Cancer

What is peau d’orange associated with?

Paget’s Disease of the Nipple

Abnormal finding for the breast

• Redness, mild scaling, and flaking of the nipple

• Tingling, itching, increased sensitivity, burning, discharge and pain in the nipple are late signs of this

• Can occur in both breasts, but is rare

• Approximately half of patients with this have a lump or mass in the breast

• Redness

• Mild Scaling

• Flaking

• Tingling

• Itching

• Increased sensitivity

• Burning

• Discharge

• Pain

What occurs in the nipple when one has Paget’s Disease of the nipple?

Retracted Nipple

Abnormal finding for the breast

• Suggest malignancy

Malignancy

What does a retracted nipple suggest?

Dimpling

Abnormal finding for the breast

• Suggest malignancy

Malignancy

What does dimpling of the breast suggest?

Gynecomastia

Abnormal finding for the breast

• Enlargement of breast for male patients

• Indicate a hormonal problem

Hormonal Problem

What does gynecomastia indicate?

1. Arms up

2. Hands on the hips

3. Hands together

4. Lean forward

What are the positions for assessing retraction and dimpling of breast tissue?

Inspect breasts accurately for retraction and dimpling

What is the purpose of making the client perform different maneuvers?

The malignant tumor has fibrous strands attached to the breast tissue and fascia of the muscles.

As the muscle contracts, it draws the breast tissue and skin with it, causing dimpling or retraction.

Why would dimpling and retraction show upon performing the different maneuvers?

No masses should be palpated

What is the normal finding for palpating for masses?

Firm Inframammary Transverse Ridge

Upon palpating for masses, what may normally be palpated at the lower base of the breasts?

Nodular/Glandular Breast Tissue

Upon palpating for masses, what should fibrocystic breast tissue that feels ropy, lumpy, or bumpy in texture be referred to as?

Benign Breast Disease

Upon palpating for masses, what consists of bilateral, multiple, firm, regular, rubbery, mobile nodules with well-demarcated borders?

Menses

Upon palpating for masses, what pain and fullness occurs just before what?

Upper Outer Quadrant

Where are malignant tumors most often found?

Malignant Tumors

What abnormal finding of the breast is usual unilateral, with irregular, poorly delineated borders, as well as hard and non-tender and fixed to underlying tissues?

Fibroadenomas

What are usually 1-5 cm, round or oval, mobile, firm, solid, elastic, nontender, single or multiple benign masses found in one or both breasts?

Milk Cysts

What are sacs filled with milk that may turn into an abscess and occur if breastfeeding or recently given birth?

Mastitis

What are infections that may turn into an abscess and occur if breastfeeding or recently given birth?

Blood that appears as a lump

If one’s breast bruised from an injury, what may occur that goes away in days or weeks or may need to be drained by a health care provider?

Lipoma

What are a collection of fatty tissue that may also appear as a lump?

Intraductal Papilloma

What is a small growth inside a milk duct of the breast, often near the areola but is harmless and occurs in women aged 35-50?

• May become erect

• Areola may pucker in response to stimulation

• Milky discharge during pregnancy or lactation

• Some women may normally have a clear discharge

What is the normal finding upon palpating the nipples?

• Endocrine Disorders

• Medications (like Antihypertensives, Tricyclic Antidepressants, Estrogen)

What is abnormal discharge of the nipples seen in?

• Benign intraductal papilloma

• Fibrocystic disease

• Breast cancer

What may discharge from one breast indicate?

Watery, pink discharge

What type of discharge from the nipple should be referred to a primary care provider?

Embryonic Milk Line

Identify the figure.

• Circular

• Wedge

• Vertical Drip

What are the patterns for palpating for masses?

Circular

Identify the pattern for breast palpation.

Wedge

Identify the pattern for breast palpation.

Vertical Drip

Identify the pattern for breast palpation.

Bimanual palpation

What type of palpation should be used for large breasts?

Lateral (Brachial)

Identify the Axillary Lymph Node.

(1)

Central (Midaxillary)

Identify the Axillary Lymph Node.

(2)

Posterior (Subscapular)

Identify the Axillary Lymph Node.

(3)

Anterior (Pectoral)

Identify the Axillary Lymph Node.

(4)

Supraclavicular

Identify the Axillary Lymph Node.

(5)

Infraclavicular

Identify the Axillary Lymph Node.

(6)

Ask patient to lift arm and palpate

How to palpate the Axillary Lymph Nodes?

Epitrochlear

What lymph node is being palpated?