Breast Assessment Techniques and Importance

Assessment of the Breast

• Importance of breast assessment:
  • Early detection of breast cancer
  • Identify benign breast conditions
  • Monitor breast health over time
• Assessment techniques:
  • Inspection: Assess breast size, symmetry, contour, color, skin surface, areola size, shape, color, nipple size, shape, position, color, and discharge.
  • Palpation: Examine breast tissue for temperature, consistency, tenderness, and masses.
  • Lymph node palpation: Assess axillary, supraclavicular, and infraclavicular lymph nodes for size, tenderness, and mobility.
• Nursing History:
  • Reason for seeking care: Breast pain, tenderness, nipple discharge, rash, lumps
  • Medical History: Breast disorders, trauma, biopsy, surgery, cancer, medications
  • Risk factors: Family history (mother, sister, aunt with breast cancer), alcohol consumption, high-fat diet, obesity, use of oral contraceptives, menarche before age 12, menopause after age 55, age 30 or more at first pregnancy
• Normal breast changes in older adults:
  • Glandular tissue atrophy replaced by adipose tissue, breasts are softer, elongated, and pendulous.
  • Skin becomes wrinkled, loose, and flabby.
  • Nipples become smaller, flatter, and may invert.
  • Loss of erectile ability.
• Breast self-exam (BSE):
  • Not recommended by the American Cancer Society (2017) but may still be recommended by healthcare providers based on patient condition and history.
  • Perform monthly, 2-3 days after the period ends if menstruating.
  • If menstruation has ceased, perform on the same day monthly.
• Male breasts:
  • Breast cancer in men is rare.
  • Men with a mother or sister with a history of breast cancer are at higher risk.
  • Inspect for size, symmetry, shape, nipple, and areola appearance.
  • Palpate for masses.

Palpatory Techniques

• Vertical strip method: Up and down pattern, recommended by the American Cancer Society.
• Circular method: Circular pattern used for breast palpation.
• Wedged method: Also known as hands-of-the-clock or spokes-on-a-wheel method.

Documentation of abnormal findings:

• Location
• Size and shape
• Consistency
• Mobility
• Skin over the lump
• Nipple appearance
• Tenderness

Tail of Spence

• The upper outer quadrant of the breast extending into the axilla
• Contains a higher concentration of breast tissue
• Often the area where breast cancers are discovered later, due to its position
• Should be carefully palpated

Inspection of Breast

• Normal:
  • Generally symmetrical
  • May be slightly unequal in size, the dominant arm side may be slightly larger
  • Rounded shape with no retractions, puckering, or dimpling
  • Flesh tone, uniform color
  • Smooth and intact skin surface, striae, moles, nevi are considered normal variants
• Abnormal:
  • Edema, discoloration, orange peel appearance, redness

Inspection of Areola

• Normal:
  • Round or oval, bilaterally the same
  • Varies from light pink to dark brown
• Abnormal:
  • Asymmetry, mass, or lesion

Inspection of Nipple

• Normal:
  • Round, everted, and equal in size
  • Similar in color
  • Soft, smooth
  • Point in the same direction
• Abnormal:
  • Asymmetrical size and color
  • Discharge
  • Recent inversion of one or both nipples

Palpation of Breast

• Normal:
  • Uniform temperature
  • Firm, smooth, elastic consistency
    • Postmenopausal breasts tend to be flaccid and pendulous
  • No tenderness
  • No masses
    • The inferior aspect of the breast is firmer due to the transverse inframammary ridge
  • No nipple discharge when compressed
• Abnormal:
  • Any unusual temperature, consistency, tenderness, masses, or nipple discharge

Palpation of Lymph Nodes

• Normal:
  • All lymph nodes are normally non-palpable
• Abnormal:
  • Palpable lymph nodes, indicating infection or malignancy
  • Tenderness, size, and mobility of lymph nodes should be documented.