Physical assessment - Breast exam: Nursing

Assessment of the breasts should be completed as part of a comprehensive client assessment or as part of a focused exam, if the client is experiencing issues, such as discovery of a breast lump or nipple discharge. This assessment provides the nurse with information about the breast tissue, lymphatic system, and general sexual and reproductive health. Let’s review the process of completing a breast exam.

Okay, the supplies needed for the breast exam include drapes, gloves, and a good source of light. Then, prepare for the exam by ensuring your client is in a comfortable position, that your hands are warm, and that the temperature in the room is comfortable.

Provide privacy by closing the door and curtains, properly draping your client, and only exposing areas of their body as needed to perform your examination.

Now, as the nurse, you may assist the healthcare provider or act as a chaperone, which is often required by facilities to protect clients and clinicians during breast exams. During the examination, keep in mind that the breast assessment can be emotionally uncomfortable and anxiety-producing for some clients, particularly those who have experienced sexual trauma or who are transgender. Be sure to use preferred pronouns and be aware of variations in the breast for those who have had breast augmentation or gender affirming surgeries.

It’s also crucial to explain exactly what will happen at each step of the exam. Remember to avoid rushing your assessment, use a gentle touch, and to let your client know that at any time the exam can be stopped or paused if they request.

Before getting started, explain the procedure to your client and be sure to answer any questions they might have before obtaining verbal consent. Then, perform hand hygiene and collect your supplies.

Alright, locating the anatomical landmarks of the breasts will help guide your assessment. The breasts are located on the anterior chest wall in front of the pectoralis major and serratus anterior muscles. You should examine vertically in the area just above the clavicles and down to rib six or seven, and then horizontally from the sternum to the midaxillary line. Each breast is divided into 4 quadrants and the tail of Spence, which extends into the axillae.

Methods of assessment for the breast exam include inspection and palpation.

First, remember to inspect the breasts bilaterally and in various positions. For example, inspect the breasts while asking your client to raise their hands above their head, lean forward, and while pushing their hands together. Inspect the breasts for size, symmetry, shape, and venous patterns. Sometimes breasts appear slightly asymmetrical and this is considered normal; however, marked asymmetry is an unexpected finding.

The skin should look smooth, and the color should be similar to the rest of the body’s pigmentation. If you note localized redness or warmth, this could be a sign of cellulitis or mastitis, which can develop into a breast abscess. Also, be sure to look under the breast, especially for clients who are obese and have very large breasts, to check for a rash which could indicate candidiasis due to accumulation of moisture on the tissue.

Then, you should inspect the areolae, which will vary in color depending on the client’s skin tone. The areolae can appear round or oval, but should be symmetrical on both breasts. It’s normal to see fine hairs as well as Montgomery glands, which are small structures that release milk and sebaceous fluid. Next, inspect the nipples, which should be bilaterally symmetrical, but might appear either flat, protruding, or inverted. You should also note if your client has supernumerary nipples which are considered a normal variation. These may appear as pink or brown moles, and typically grow along the embryonic “milk line.”