Physical Exam: Breasts

I. Inspection (Performed with client in lying, sitting or standing position)

• Size: Vary from convex to pendulous
• Symmetry: (The breast in the same side as your dominant hand is commonly larger than the other)
• Skin: Color, venous pattern, possibly a few hairs around areola
• Alterations:

1. retractions
2. dimpling
3. lesions
4. edema
5. inflammation

• Alterations with Pregnancy and Lactation:

1. enlargement of breasts
2. soreness of nipples during lactation
3. possible striae

• Nipple and areola:

1. size
2. color - ranges from pink to brown
3. shape - areola round or oval; nipples everted
4. symmetry - normally symmetrical
5. direction - normally nipples point in same direction
6. alterations - discharge; inverted nipples; bleeding

II.Palpation - Breast

• Lymph nodes: Normal findings - not palpable
• Breast tissue

Client should be in supine position with hand placed behind the neck.

• Methods of Examining Breast:

1. Clockwise or counterclockwise circling breast from nipple outward
2. Back and forth with fingers moving up and down each breast

• Consistency:

1. varies widely from person to person
2. Normal findings - dense, firm, and elastic

• Alterations: fibrocystic disease of the breast
• Geriatric alterations:

1. relaxed breasts 
2. may appear elongated or pendulous
3. decrease in glandular tissue

POINTS TO REMEMBER:

• Breast tissue shrinks with menopause
• Teach client breast self examination: