Comprehensive Assessment of the Breast and Axilla: Techniques, Clinical Findings, and Nursing Implications” “Physical Examination of the Breast and Axilla: A Systematic Approach to Health Assessment and Early Detection of Abnormalities”

The assessment of the breast and axilla is a vital component of health examination, particularly for the early detection of abnormalities such as infections, benign growths, or malignancies. This examination involves both inspection and palpation to evaluate the symmetry, size, contour, skin changes, and the presence of lumps or tenderness in the breast tissue. The axillary region is carefully assessed for lymph node enlargement, tenderness, or swelling, as these findings may indicate underlying systemic or localized disease. Nurses play a critical role in conducting this assessment with sensitivity and professionalism, ensuring patient comfort and privacy. In addition, patient education regarding breast self-examination and awareness of warning signs is an essential aspect of nursing care. Comprehensive assessment not only assists in diagnosis and treatment planning but also supports preventive health strategies and promotes early intervention in breast-related conditions.

1. Assessment Of Breast And Axilla By Miss Abeera Naz RN,BSN

2. Objectives At the end of this presentation ,the learners will be able to: Describe the component of health history that should be elicited during assessment of breast and axilla Describe specific assessment techniques to be used during the physical examination of the breast and axilla Document findings List the changes in breast through life span

3. History Questions Following questions should be asked from the patient (both male & female) Breast lump or mass Breast pain or discomfort Nipple discharge Changes in breast contour ,dimpling or swelling Changes in the skin over the breast Breast self examination(BSE) Any lump or mass in axilla

4. Breast Examination Inspection : Inspect the skin of the breast Check for edema Note breast size and symmetry Inspect the nipples, note their size and shape Inspect the patient’s breasts while she holds her arms over her head and then again while she has her hands on her hips These positions may help to detect skin or nipple dimpling that was not obvious before

5. Contd …. Normal findings : Skin should be smooth , undimpled and the same color as the rest of the skin Edema should not be present because this can accompany lymphatic obstruction and may signal cancer Asymmetry may occur normally in some adult women, with the left breast usually larger than the right Nipple should not be inverted , dimpled or creased

6. Contd … Palpation: Ask the patient to lie in the supine position and place a small pillow under her shoulder on the side you are examining Have the patient put her hand behind her head on the side you are examining ,this spread the breast evenly across the chest and makes finding nodules easier. if her breast are small she can leave her arm at side

7. Contd …. Three methods may be used to palpate the breast during a clinical examination Circular Wedged Vertical strip According to the American cancer society ,the vertical strip method is the most effective method to ensure entire breast palpation

8. Contd …. If you palpate a lump, record these characteristics : Size in centimeters Shape: round, discoid, regular or irregular Consistency: soft, firm or hard Mobility Degree of tenderness Location : using the quadrant or clock method

9. Contd …. Identifying location of breast lesions: Four quadrants Tail of spence Specify location of finding according to clock and by the distance in centimeters from the nipple

10. Contd …. Abnormal findings : Breast cancer mass: Irregular shaped mass with poorly defined edges Mass is fixed, feels firm to hard and is usually non tender Skin retraction may be present

11. Contd …. Ductal carcinoma in situ: Breast cancer in the earliest stage developing in the ducts

12. Contd …. Infiltratting (invasive) ductal carcinoma: Cancer begins within the duct and spreads to the breast’s parenchymal tissue

13. Contd …. Dimpling : Puckering or retraction of the skin on the breast, results from abnormal attachment of the skin to underlying tissues It suggests an inflammatory or malignant mass beneath the skin surface and usually represents a late sign of breast cancer Peau d’orange : Usually late sign of breast cancer This sign can also occur with breast or axillary lymph node infection or grave’s disease Edematous thickening and pitting of breast skin (orange peel skin) This skin appearance stems from lymphatic edema around deepened hair follicles

14. Contd …. Fibrocystic changes(benign cyst): These are round ,elastic ,mobile masses that are commonly tender on palpation especially around menstruation Multiple cyst may be present Typically there is no evidence of skin retraction

15. Contd …. Fibroadenoma : This is a benign , round,lobular and well demarcated mobile mass that feels slipry and firm to soft on palpation It is usually non tender and causes no visible skin retraction

16. Contd …. Nipple retraction: The inward displacement of the nipple below the level of surrounding breast tissues It may indicate an inflammatory breast lesion or cancer It results from scar tissue formation within a lesion or large mammary duct As the scar tissue shortens it pulls adjacent tissue inward causing nipple deviation, flattening and finally retraction

17. Contd …. Paget’s disease: It is a rare form of breast cancer that usually starts as a red ,granular or crusted scaly lesions on the nipple or areola Lesion may ulcerate and cause erosion of the nipple

18. Contd …. Mastitis and breast engorgement: These disorders affect lactating females Pathogens from infant’s nose or pharynx may invade breast tissue through a fissured or cracked nipple and disrupts normal lactation Breast become tender, hard,swollen and warm Breast engorgement results from venous and lymphatic stasis and alveolar milk accumulation and causes painful breast that feel heavy and may feel warm

19. Contd …. Nipple discharge : It may be intermittent or continuous It may be unilateral or bilateral and may be differentiated by color ,consistency or composition It can be a normal finding or can also signal serious underlying disease particularly when accompanied by other breast changes Causes may include endocrine disorder, cancer, certain drugs and blocked lactiferous ducts

20. Contd …. Breast pain: Breast pain commonly results from benign breast disease such as mastitis or fibrocystic changes It may occur during rest or movement and may aggravate by palpation Visible veins : Prominent veins in the breast may indicate cancer in some patients It is considered normal in pregnant women because of engorgement

21. Contd …. Male breast cancer: Thoroughly assess the male breasts and check for the same changes you would in a women Breast cancer in men usually occurs in the areola area Gynecomastia : Abnormal enlargement of the male breast may be barely palpable and is usually bilateral It may be caused by cirrhosis, leukemia,thyrotoxicosis , hormones,Illicit drug use or alcohol consumption

22. Age related causes of gynecomastia : Age group Description Adolescent boys Temporary stimulation of breast tissue is caused by estrogen Adequate testosterone production usually ceases enlargement Elderly men Age related hormonal alteration and certain medication can cause enlargement

23. Axilla Examination Inspection: With the patient sitting or standing inspect the skin of the axilla for rashes, infections or unusual pigmentation Palpation: Ask the patient to relax her arms on the side you are examining Support her elbow with your one hand, cup the fingers of your other hand and reach high into the apex of the axilla . Place your fingers directly behind the pectoral muscles, pointing toward the mid clavicle

24. Contd …. First assess the axillary lymph nodes which should be small,non tender and soft If you feel a hard ,large or tender lesion, try to palpate the other groups of lymph nodes for comparison Then ask the patient to relax her neck muscles by flexing her head slightly forward, stand in front of her and hook your fingers over the clavicle and palpate the clavicular nodes

25. Breast Changes ThroughThe Life Span In females breast starts to change at puberty and continue changing during the reproductive years, pregnancy, and menopause Changes during puberty: Breast development is an early sign of puberty in girls and usually starts with breast and nipple protruding as a single mound of flesh between ages 8 and 13 Development of breast tissues in girls younger than age 8 is abnormal

26. Contd …. Changes during the reproductive years: Having never given birth: Breasts may become full or tender in response to hormonal fluctuations during the menstrual cycle During pregnancy: Changes occur in response to hormones from the corpus luteum and the placenta Areola become deeply pigmented and increase in diameter The nipple becomes darker, more prominent and erect

27. Contd …. Breasts enlarge because of proliferation and hypertrophy of the alveolar cells and lectiferous ducts As veins engorge, a venous pattern become visible Straie may appear as a result of streching and montgomery’s tubercles may become prominent After pregnancy: During breast feeding ,breasts become full and tense and may feel warm After breast feeding ceases ,breast size decreases but usually does not return to the pregnancy state

28. Contd …. After menopause: After menopause ,estrogen level decreases, causing glandular tissue to atrophy and be replaced with fatty deposits Breasts become smaller

29. References Health assessment made incredible visual (2 nd edition )

30. Any question