BREAST AND

LYMPHATICS SYSTEM
STRUCTURE AND FUNCTION

 BREASTS- are paired mammary glands that  The female breast is an accessory reproductive
lies over the muscles of the anterior chest organ with two functions: to produce and store
wall, anterior to the pectoralis major and milk that provides nourishment for newborns
serratus anterior muscles. and to aid in sexual stimulation.
 The male and female breasts are similar until  The male breast have no functional capability.
puberty when female breast tissue enlarges in
response to the hormone estrogen and
progesterone, which are release from the
ovaries.
 For the purposes of describing the location of  LYMPH NODES
assessment findings, breasts are divided into  Major axillary Lymph Node consists the ff:
four quadrants by drawing horizontal and
vertical imaginary lines that intersect at the  Anterior (pectoral) nodes
nipple.  Posterior (subscapular)nodes
 The upper quadrant which extends into the  Lateral (brachial)nodes
axillary area, is referred to as TAIL OF
SPENCE.  Central ( mid axillary ) nodes
COLLECTING SUBJECTIVE DATA

 HISTORY OF PRESENT ILLNESS  PRESENT HEALTH HISTORY

 Had any lumps or swelling in the breasts or in  Have you had any prior breast disease? Breast
the underarm area? surgery, implnts, or trauma? When did it
occur, result?
 Have you noticed any redness, warmth,
dimpling, rashes, changes in size and firmness  Start of menstruation? Menopause? What age?
in the breasts?  Have you given birth to any children? Age did
 Do you experience any pain in your breasts? you have your first child?
Use COLDSPA to further explore symptoms
 PERSONAL HEALTH HISTORY  LIFESTYLE AND HEALTH PRACTICES
 First and last day of menstrual cycle?  Taking any hormones, antisychotic agents?
 Live/work in area with excessive exposure to
radiation, benzene, or asbestos?
 FAMILY HISTORY
 Typical daily diet?
 History of breast cancer in the family?
 How much coffee, tea, cola consume in a day?
 Engage in any type of regular exercise?
 Do you have any fear regarding breast disease?
 Do you examine your own breasts?
 Older clients no longer menstruate may find it helpful to pick a set day of the month for
BSE, a date they will remember each month such as the day they were born.
 Had breasts examined with an examiner? When last examination?
COLLECTING OBJECTIVE
DATA:PHYSICAL EXAMINATION

 KEY POINTS FOR PHYSICAL  Perform examination of breast to female

ASSESSMENT: clients as well as male clients.
 Explain in detail of what is happening in the  Breasts are first inspected in sitting position-
assessment client hold arms in different position.
 May create anxiety, client may feel  Breasts are then palpated while the client
embarrassed exposing breast, provide privacy. assumes a supine position
 Warm hands.
FAMLE BREASTS: INSPECTION

 INSPECT SIZE AND SYMMETRY  NORMAL:

 Have the client disrobe and sit with arms  Older clients have more pendulous, less firm,
hanging freely.Explain to client what you are and saggy breasts.
observing to ease anxiety

 ABNORMAL:
 Recent increase in the size of one breast-
indicates inflammation or an abnormal growth
 INSPECT COLOR AND TEXTURE  NORMAL:
 Color varies with client’s skin tone
 Texture- smooth, with no edema
 Veins radiate horizontally and towards the axilla or
longitudinal
 ABNORMAL
 INSPECT SUPERFICIAL VENOUS  Redness- inflammation
PATTERN  Pigskin like or orange peel- mestatatic breast CA
 Prominent venous pattern – increased circulation
due to malignancy
 INSPCECT THE AREOLAS  NORMAL
 Note color, size, shape, and texture  Areolas- dark pink to brown, round, may vary
in size, small Montgomery tubercles present
 NIPPLES- bilateral in size, everted, but may
 INSPECT THE NIPPLES
be inverted or flat
 Size, direction of the nipples, dryness, lesions,  Older clients – have smaller, flatter nipples
bleeding, discharges
that are less erectile on stimulation
INSPECTION

 INSPECT FOR RETRACTION AND

DIMPLING
 Ask client to remain seated, raise arms
overhead, then press hands against her hips.
Ask her to press her hands together. These
actions contract pectoral muscles.
 Ask client to lean forward from the waist
 Nurse should support the client by the hands
or forearms. A good position for women who
have large, pendulous breasts.
FEMALE BREASTS: PALPATION

 PALPATE FOR TEXTURE AND  NORMAL

ELASTICITY  Older client’s breasts- more grandular, and the inframmamary
ridge may be more easily palpated as it thickens
 No masses present
 PALPATE FOR TENDERNESS AND  ABNORMAL
TEMPERATURE  Thickening of the tissues
 Painful, tender breasts- fibrosystic breasts
 Malignant tumors
 PALPATE FOR MASSES  Fibroedemas – 1-5cm, round, oval,mobile,firm,solid
 Note for location, size in cms, shape, motility, elastic,nontender, single/multiple benign masses in 1 or both
breasts
consistency and tenderness.
 LIMPOMAS – fatty tissues that may appear as lump
 PALPATE THE NIPPLE  NORMAL
 Wear gloves to compress the nipples gently  Nipples are less erectile upon stimulation
with your thumb and index finger. Note any  No discharges noted
discharges, swelling, and redness
 ABNORMAL
 Discharges noted- endocrine disorders, with
meds ( antihypertensive, antidepressant,
estrogens)
 Watery, pink discharges- fibrocystic disease,
breast CA
THE AXILLA: INSPECTION AND
PALPATION

 INSPECT THE AXILLAE

 Client sit up.
 Inspect axilla skin- rashes or infection
 PALPATION
 Hold client’s elbow with one hand, use three fingerpads
or other hand to palpate firmly the axillary nodes
 Palpate high into the axilla, moving downward against
the ribs to feel for the central nodes
 Continue to move down the posterior axilla. Use
bimanual palpation to feel for the anterior axillary nodes.
 Finally, palpate down the inner aspect of the upper arm.
BREAST SELF EXAMINATION

 Lie down with right arm behind your head.

Lying down spreads the breast tissue evenly
over the chest wall, making it easier to feel.
 Use the three middle finger pads of your left
hand to feel for any right breast lumps, using
overlapping small (dime-sized) circular
motions to feel breast tissue.
 Use light pressure to feel the tissue closest to
the skin, medium pressure to feel deeper; and
firm pressure to feel the tissue close to the
chest and ribs. Use each pressure level to feel
breast tissue before moving on to the next
area. Move on in and up down pattern, starting
at an imaginary line drawn straight down your
side from the underarm. Move across the
breast to the middle of the chest bone
(sternum). Check the entire breast area, going
to your ribs and up to your neck or collar
Bbone (clavicle).
 The up and down vertical pattern is most  Look at your breast for changes in size, shape,
effective for covering the entire breast. or contour. Note any dimpling, redness,
scaliness of the nipple or breast skin.
 Examine left breast by putting your left arm
behind your head and using your right hand  Examine both underarms while sitting up or
finger pads to do the exam. standing, with your arms slightly raised. Do
not raise arms straight up, because it will
 Next, stand in front of the mirror and press
tighten the breast tissue, making it difficult to
your hands firmly down on your hips (this
examine.
contracts chest wall muscles and emphasizes
any breast changes.
THE MALE BREASTS: INSPECTION AND
PALPATION

 INSPECT AND PALPATE THE BREASTS,  NORMAL

AREOLAS, NIPPLES, AND AXILLAE.  No swelling, nodules or ulceration
 Note for swelling, nodules, or ulceration
 Palpate the flat disc or underdeveloped breast  ABNORMAL
tissue under the nipple
 Soft, fatty, enlargement breast tissue- obesity
 Gynecomastia- in hormonal imbalance, drug
abuse, cirrhosis, leukemia, thyrotoxicosis
 Irregular in shape, hard nodules in breast CA