breast/axilla assessment

changes across the lifespan

1) reproductive years - menstrual cycle

• normal cycle changes

• nodularity may increases from midcycle to menstruation

• breast fullness/volume decreases after menstruation

2) pregnancy - common early changes

• breasts enlarge and may feel more nodular

• nipples and areolae become larger and darker

• montgomery tubercles become more prominent

  • raised bumps around areola

• colostrum may be present after 4th month

3) postpartum and lactation - after delivery

• colostrum is produced first

• increasing milk volume commonly occurs 2-5 days after birth

4) normal aging

• decreased estrogen and progesterone

• glandular tissue atrophies and fatty tissues increases

• smaller, softer, less elastic, and more pendulous

• normal aging does not increase breast cancer risk

report new changes of:

persistent unilateral lump

skin dimpling

spontaneous bloody discharge

nipple retraction

inspection techniques

note size and shape

skin should be smooth and even in color

• notes areas of redness, bulging, dimpling, hyperpigmentation

note any edema

nipple → placed symmetrically on both breats

• no deviation in pointing, retraction

• note any supernumerary nipples

assess with position changes

• arms up, behind neck, down

inspect axilla

palpation techniques

patient supine and arms overhead

palpate in vertical lines

palpate under axilla with opposite hand

note any lumps, masses, or areas of tenderness

• location

• size

• shape

• consistently

• movable

• distinctness

palpate nipple nothing any firmness or masses

post-mastectomy:

• inspect incison site

• palpate intact breast first

• palpate mastectomy from clavicle to 3 inches above waist

• note any lymph node enlargement

male breast exam:

• asses for gynecomastia

abnormal findings of breast exam

dimpling, edema, peau d’Orange, fixation, deviation

breast lumps

benign fibrocystic breast disease

• tender masses with swelling and tenderness, nodularity, dominant lumps

• green nipple discharge

• dull, heavy, cyclic pain

invasive cancer (malignant)

• solid, stony, hard dense, and fixed to underlying tissues

• irregular borders

fibroadenoma (benign)

• solitary, nontender mass

• round, 1-5 cm

• freely movable, slippery

secondary to lactation

plugged duct

• tender lump

• no systemic infection

• usually resolves in one day

breast abscess - localized infection

• hard pocket of pus, erythema, tenderness

• treat with antibiotics, may require drainage

mastitis

• infection secondary to clogged duct

• erythema, tenderness, warm, hard to touch

• systemic infection → HA, fever, chills, malaise

• treat with rest, localized heat, antibiotics, frequent nursing

male breast abnormalities

adult gynecomastia

• benign enlargement of male breast

• usually under nipple-areola

• causes: Cushing’s, cirrhosis, adrenal disease, hyperthyroid, medications

  • hormonal imbalances

male breast cancer

• dimpling and nipple deviation

• painless palpable mass

• nipple discharge

• early spread to axillary lymph nodes

• progresses quicker due to less breast tissue