The Breasts and Axillae

Chapter 30
(pp. 627 630)
Dyana M. M. Saplan, RN, MAN

The Breasts and Axillae

Breasts of men and women need to be inspected and palpated Men
Have some glandular tissue beneath each nipple A potential site for malignancy

Women
Mature glandular tissue throughout breasts
Dyana M. M. Saplan, RN, MAN

Female Breasts
largest portion of glandular tissue @ upper outer quadrant
Axillary Tail of Spence breast tissue extending into the axilla majority of breast tumors are located including Tail of Spence

nurse can localize specific findings by using this division of breast quadrants and tail of spence
Dyana M. M. Saplan, RN, MAN

Assessing the Breasts and Axillae

Methods
Inspection and Palpation

Equipment:
Centimeter ruler

Assessment of the Breast and Axillae is not delegated to unlicensed assistive personnel (UAP)
However, persons other than the nurse may record aspects observed during usual care. Abnormal findings must be validated and interpreted by the nurse
Dyana M. M. Saplan, RN, MAN

Implementation
Introduce self; verify clients identity; explain procedure (why its necessary, and how he/she can cooperate); hand hygiene; provide privacy Inquire:
Whether client has ever had a clinical breast exam previously; discuss how results will be used in planning and further tx

Dyana M. M. Saplan, RN, MAN

Inquire about:
Hx of breast masses (and what was done about them) pain or tenderness and relation to menstrual cycle discharges from nipples medication hx
oral contraceptives, steroids, digitalis, diuretics nipple discharge estrogen replacement therapy assoc. w/ cysts or CA Risk factors assoc. w/ development of breast CA
Mother, sister, aunt w/ breast CA Alchohol consumption High-fat diet, obesity, oral contraceptives, menarhe before 12 y.o. Menopause after 55 y.o. 30 or more @ 1st pregnancy

Performs breast self-examination, technique used when performed, and when performed in relation to the menstrual cycle Dyana M. M. Saplan, RN, MAN

Assessment

Palpate axillary, subclavicular, and supraclavicular lymph nodes Use flat surfaces of all fingertips to palpate the 4 areas of the axilla:
Edge of the greater pectoral muscle along axillary line Thoracic wall in midaxillary area Upper part of humerus Ant. Edge of the lassitimus dorsi muscle along posterior axillary line

Dyana M. M. Saplan, RN, MAN

Assessment
Palpate the axillary, subclavicular, and supraclavicular lymph nodes while client sits w/ the arms supported on the nurses forearm

Dyana M. M. Saplan, RN, MAN

Palpation of breast
For masses, tenderness, and any discharge from nipples. Generally performed while client is supine Use palmar surface of the middle 3 fingertips (held together) and make a gentle rotary motion on the breast 3 patterns for palpation:
Hands-of-the-clock or spokeson-a-wheel Concentric circles Vertical strips pattern

Dyana M. M. Saplan, RN, MAN

Lifespan Considerations

Dyana M. M. Saplan, RN, MAN

Infants
Newborns (boys and girls) up to 2 weeks of age may have breast enlargement and white discharge from the nipples =
Witchs milk

Supernumerary (extra) nipples infrequently are present as small dimples along the mammary chain
may be associated with renal anomalies

Dyana M. M. Saplan, RN, MAN

Children
Female breast development begins between 9 and 13 years of age and occurs in five stages (Tanner Stages)
Stage 1 Prepubertal w/ no noticeable change Stage 2 Breast bud with elevation of nipple and enlargement of areola Stage 3 Enlargement of the breast and areola with no separation of contour Stage 4 Projection of the areola and nipple Stage 5 - Recession of the areola by about age 14 or 15, leaving only the nipple projecting

One breast may develop more rapidly than the other, @ the end of development more or less the same size
Dyana M. M. Saplan, RN, MAN

Children
Boys may develop breast buds and have slight enlargement of the areola early adolescence
Further enlargement of breast tissue may occur = gynecomastia
Transient, usually lasting about 2 yrs., resolving completely by late puberty

Axillary hair usually appears in Tanner stages 3 or 4 rel. to adrenal rather than gonadal changes
Dyana M. M. Saplan, RN, MAN

Pregnant Females
Breast, areola, and nipple size Areolae and nipples darken; nipples more erect; elevated Montgomerys glands Superficial veins more prominent, nd jagged linear stretch marks may develop Thick, yellow fluid (colostrum) may be expressed from nipple after 1st trimester

Dyana M. M. Saplan, RN, MAN

Elders
Postmenopausal female
Breast change in shape, often appear pendulous or flaccid Lack firmness

Breast lesions may be detected more readily in connective tissue General breast size remains the same
Altho glandular tissue atrophies, amount of fat in breasts (predominantly in the lower quadrants) es in most women
Dyana M. M. Saplan, RN, MAN

Video Presentation

Dyana M. M. Saplan, RN, MAN