Identified the structures and function of the breasts and axillae.

Performed an accurate health history of the breasts and axillae.

Described the physical examination techniques performed to
evaluate the breasts and axillae.
Demonstrated how to perform a clinical breast examination.
Documented a complete breast and axilla assessment utilizing
information from the health history and the physical
examination.
accessory reproductive
organs,
produce milk for nourishing
the newborn.
lie anterior to the pectoralis
major and serratus anterior
muscles.
hormonally sensitive tissue,
responsive to the changes of
monthly cycles and aging
• chiefly of a small nipple
and areola.
• undeveloped breast
tissue consisting
primarily of ducts.
• A firm button of breast
tissue, 2 cm or more in
diameter
● Pectoral nodes—anterior,
located along the lower border of
the pectoralis major inside the
anterior axillary fold.
● Subscapular nodes—posterior,
located along the lateral border of
the scapula; palpated deep in the
posterior axillary fold.
● Lateral nodes—located along
the upper humerus.
•Family History
•Medication History
•Lifestyle and Health Practices
The clinical breast examination (CBE) is an important
component of women’s health care: it enhances
detection of breast cancers that mammography may miss
and provides an opportunity to demonstrate techniques
for self-examination to the patient
• Inspection of both Breast, and its skin,
areola, nipples, axillae, position
• Palpation of the breast and axillae, and
nipples.
• Inspection of the Areola
As you begin the examination of the breasts, be
aware that women and girls may feel
apprehensive. Be reassuring and adopt a
courteous and gentle approach. Before you
begin, let the patient know that you are about to
examine her breasts.
1.When possible, instruct the patient to neither use creams, lotion or powder nor shave
her underarms 24-48 hours before the scheduled examination.
2.Encourage patient to express any anxieties and concerns about physical assessment.
3.Inform patient that the examination should not be painful but maybe uncomfortable at
times.
4.Adopt a non judgmental and supportive attitude.
5.Be aware of the impact of culture on breast examination
6.Instruct patient to remove anu jewelries that might interfere
7.Ensure room is warm enough to prevent chilling and provide additional draping
8.Warm your hands with warm water or by rubbing them together
9.Ensure privacy.
Start by inspecting the breasts
with the patient sitting with her
arms at her sides.
Gently lift each breast with
your fingers and inspect the
lower and outer aspects for
dimpling, retraction, or
bulging.
• appear smooth, with
an even color.
• venous patterns
should be bilaterally
similar.
The color of the areola may vary,
depending on the patient’s skin
color.
The areola should be round or oval
and appear bilaterally similar.
Montgomery’s tubercles may
appear as slightly raised bumps on
the areola tissue.
Hairs on the nipple may also be
seen.
Nipples are normally
smooth and intact without
evidence of crusting,
lesions, bleeding, or
discharge.
Supernumerary nipples are
considered a normal variation,
although they are uncommon.
These nipples look similar to
pink or brown moles and
generally appear along the
embryonic “milk line”
Step One. Ask the patient to
remain seated and raise her arms
over her head This position adds
tension to the suspensory ligaments
and accentuates dimpling or
retractions.
Observe and compare the breasts,
areolae, and nipples. The breasts
should appear equal on both sides
(bilaterally symmetric).
Step two. Patient with arms
raised and leaning forward.
The breasts should hang equally
with a smooth contour, and pull
should be symmetric.
Having the patient lean forward is
an especially useful technique if
she has large and pendulous
breasts because the breasts fall
away from the chest wall and hang
freely.
Step three. Inspect
the breasts while the
seated patient pushes
her hands onto her hips
or pushes her palms
together, thus
contracting the pectoral
muscles
Instruct the patient to relax
both arms at her sides. Using
your left hand (if you are right-
handed), lift one of the
patient’s arms and support it
so her muscles are loose and
relaxed. While in this position,
use your right hand to palpate
that axilla.
1. Reach your fingers deep into the
axilla and slowly and firmly slide
your fingers along the patient’s
chest wall, first down the middle
of the axilla, then along the
anterior border of the axilla, and
finally along the posterior border.
2. Then turn your hand over and
examine the inner aspect of the
patient’s upper arm.
3. Repeat the same palpation in the
opposite axilla.
Position: The preferred position for breast palpation is
supine with a small pillow or towel placed under the
shoulder of the breast to be examined. Instruct the patient
to place her arm over her head.
Note: A sitting position may be used if the patient has
difficulty lying down, if she is young and has very small
breasts, or if she has very large breasts, making palpation
difficult in a supine position.
• Use the fingerpads of the 2nd, 3rd, and 4th fingers,
keeping the fingers slightly flexed.
• Press firmly enough to feel the underlying tissue but
not so firmly that the tissue is compressed against the
rib cage. Do not lift your fingers from the chest wall
during the palpation because this breaks the continuity
of the palpation. Instead gently slide your fingers over
the breast tissue, moving along the designated pattern
of palpation
This is the most common
palpation technique. Place
the finger pads of your
middle three fingers
against the outer edge of
the breast. Press gently in
small 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.
Place the finger pads of your
middle three fingers on the
areola and palpate from the
center of the breast outward.
Return your fingers to the
areola and again palpate from
the center outward, covering
another section of the breast
(in a spokelike fashion).
Repeat this until the entire
breast has been covered.
Place the finger pads of
your middle three
fingers against the top
outer edge of the breast.
Palpate downward and
then upward, working
your way across the
entire breast.
If the sitting position is
used for a woman with
very large breasts, ask the
patient to lean forward
slightly and position your
hands between the breasts
Divide the breast into four
quadrants with a horizontal
line and a vertical line
crossing at the nipple, the
center point.
The breast is the face of a
clock with 12 o’clock at the
top, 6 o’clock at the bottom.
1. Location—Using the breast as a clock face, describe the
distance in centimeters from the nipple (e.g., “7:00, 2 cm from
the nipple”). Or diagram the breast in the woman’s record and
mark in the location of the lump.
2. Size—Judge in centimeters in 3 dimensions: width × length ×
thickness.
3. Shape—State whether the lump is oval, round, lobulated, or
indistinct.
4. Consistency—State whether the lump is soft, firm, or hard.
5. Movable—Is the lump freely movable, or is it fixed when you try
to slide it over the chest wall?
6. Distinctness—Is the lump solitary or multiple?
7. Nipple—Is it displaced or retracted?
8. Note the skin over the lump—Is it
erythematous, dimpled, or retracted?
9. Tenderness—Is the lump tender to palpation?
10. Lymphadenopathy—Are any regional lymph
nodes palpable?
With your thumb and forefinger
gently depress the nipple tissue
into the well behind the areola.
The tissue should move inward
easily. If the woman reports
spontaneous nipple discharge,
press the areola inward with your
index finger; repeat from a few
different directions. If any
discharge appears, note its color
and consistency
“Breasts symmetric, color tan without
pigment changes and smooth bilaterally; no
masses, dimpling, lumps, edema, or
thickening; nipples everted, equal in size,
point outward; no discharge, rashes, or
ulcerations.”
Asymmetry, distortion, or
decreased mobility with
the elevated arm
maneuver.
Here note that the right
breast is held against the
chest wall.
Inflammation (e.g.,
cellulitis or breast
abscess) in the
breast tissue may
cause surface
erythema and heat
The skin becomes
thick and pitted,
with a texture and
appearance
similar to that of
orange peel.
The shallow dimple
shown here is a sign
of skin retraction.
The dimple may be
apparent at rest, with
compression, or with
lifting of the arms.
depressed below the
areolar surface.

It may be enveloped by
folds of areolar skin, as
illustrated.
The retracted nipple
looks flatter and
broader, like an
underlying crater.
A recent retraction
suggests cancer,
which causes fibrosis
of the whole duct
system and pulls in
the nipple.
An underlying cancer
causes fibrosis in the
mammary ducts,
which pulls the nipple
angle toward it. Here
note the swelling
behind the right nipple
and that the nipple
tilts laterally.
an inflammatory mass
before abscess formation.
Usually occurs in single
quadrant.
Area is red, swollen,
tender, very hot, and hard,
here forming outward from
areola upper edge in right
breast.
Benign enlargement
of male breast
It is a mobile disk of
tissue located
centrally under the
nipple-areola. At
puberty it is usually
mild and transient.
Weber, J. and Kelley, J. (2018). Health Assessment in Nursing 6th edition. Lippincott
Williams and Wilkins.

Innes, J., Dover, A, & Fairhurst, K. (2018). Macleod’s Clinical Examination 14th
edition. Elsevier, Inc.
Hogan-Quigley, B., Palm, M., & Bickley, L., (2012). NURSING GUIDE TO
Physical Examination and History Taking

Wilson, S. & Giddens, J. (2013).Health Assessment for Nursing Process 5th edition.
Elsevier Inc
Jarvis, C (2016). Physical Examination & Health Assessment 7th edition. Elsevier,
Inc
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