Assessment of the Breast and Lymphatic System

This chapter examines the breasts of non-pregnant women. Remember, if the client discloses any symptoms, you should investigate further by doing a symptom analysis using the guide below. Current health concern history Have you seen any breast lumps or swelling? If so, where is it? When did you first become aware? Is the lump becoming bigger or is the edema getting worse? Is the bulge or swelling connected to any other issues? Is the lump or swelling changing throughout your menstrual cycle? Have you seen any lumps or swelling under your arms? Have your breasts developed any redness, warmth, or dimpling? Is there a rash on your breast, nipple, or axilla? Have you seen any changes in your breast size or firmness? Do you have any soreness in your breasts? If so, where is it? Does it happen at any particular period during your menstrual cycle? Is there a certain activity that tends to set off the pain? Is there any discharge from your nipples? If so, explain its color, consistency, and, if present, odor. When did it all begin? Which nipple is discharged? Previous medical history Have you ever had breast cancer? Have you ever undergone breast surgery, a biopsy, breast implants, or experienced breast trauma? If so, when did this happen? What was the outcome? How old were you when you first started menstruating? Have you gone through menopause? Have you ever given birth to a child? When did you have your first child? When was your menstrual cycle's first and last day? Ancestral history Is there a family history of breast cancer? Who? Health and wellness practices Do you use any hormones, contraception, or antipsychotic medications? Do you live or work in a region where you are exposed to high levels of radiation, benzene, or asbestos? What do you eat on a daily basis? How much alcohol do you consume on a daily basis? How much coffee, tea, and cola do you drink on a daily basis? Do you workout on a regular basis? If so, what kind of bra do you use when working out? How important are your breasts to you in terms of feeling good about yourself and your physical appearance? Do you have any concerns about breast cancer? Do you check your own breasts? Explain when you do this. Have you seen any changes in your breasts, such as a lump, swelling, skin irritation or dimpling, nipple soreness or retraction, redness or scaliness of the breast skin, or discharge? If so, have you informed your healthcare provider? Have you ever had your breasts checked by a doctor? When was your most recent exam? Have you had a mammogram before? If yes, when was your most recent one? Breasts of females Inspection   Examine the size and symmetry. Allow the client to disrobe and sit with his or her arms hanging freely. To alleviate customer worry, explain what you're seeing. Examine the color and texture. When checking the breast skin, take note of the client's overall skin tone. Make a note of any lesions. Examine the superficial venous pattern. Take note of the visibility and pattern of the breast veins. Examine the areolas. Take note of the color, size, shape, and texture of both breast areolas. Examine the nipples. Take note of the size and orientation of the nipples on both breasts. Keep track of any dryness, lesions, bleeding, or discharge. Examine the retraction and dimpling. To accurately evaluate the breasts for retraction and dimpling, advise the client to remain seated while executing multiple exercises. Request that the client extend her arms upward and put her hands against her hips. Next, request that she press her hands together. Palpation   Texture and elasticity should be felt. Smooth, firm, elastic tissue is typical. Tenderness and temperature should be palpated. A generalized increase in nodularity and tenderness may be a normal finding associated with the menstrual cycle or hormonal medications. Palpate for masses. Note location, size in centimeters, shape, mobility, consistency, and tenderness. Also, note the condition of the skin over the mass. Palpate the nipples. Wear gloves to compress the nipple gently with your thumb and index finger. Note any discharge. Palpate mastectomy or lumpectomy site. If the client has had a mastectomy or lumpectomy, it is still important to perform a thorough examination. Palpate the scar and any remaining breast and axillary tissue for redness, lesions, lumps, swelling, or tenderness. Axillae Inspection and Palpation   Inspect and palpate the axillae. Ask the client to sit up. Inspect the axillary skin for rashes or infections. Hold the client’s elbow with one hand, and use the three fingerpads of your other hand to palpate firmly the axillary lymph nodes. First, palpate high into the axillae, moving downward against the ribs to feel for the central nodes. Continue to move down the posterior axillae to feel for the posterior nodes. Male breasts Inspection and Palpation   Inspect and palpate the breasts, areolas, nipples, and axillae. Note any swelling, nodules, or ulceration. Palpate the flat disc of underdeveloped breast tissue under the nipple.

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